Cheap smokes in Letcher County, Kentucky, 2008.
Photo: Andrew Stern

Several national publications, including Time Magazine, The Washington Post and the New York Times Magazine, have highlighted the abysmal health of the people of Central Appalachia, and of the Virginia coalfields in particular. Federal and state authorities have spent significant funds verifying the same statistics over and over, but little has been accomplished to ameliorate the problems so thoroughly documented.

(Look here for the rural counties that have had a significant decrease in longevity over the last 20 years.)

Some small portion of the heart and respiratory problems ravaging the mountain population might be due to congenital factors or, in specific locations, to air and water quality. But the overwhelming majority of the chronic health problems are self-inflicted, the consequence of tobacco, drug abuse, fatty and sugar-laden foods, lack of exercise and a fatalistic outlook on life that relieves individuals of responsibility for their own health.

While historical abuses of the environment and workforce may have shaped a culture of low self esteem and malaise about the future, there is no excuse for allowing such self-defeating attitudes to go unchallenged. Coalfield communities must instill healthier lifestyles through intense health education beginning in early childhood and continuing through high school. As President Bush famously said: “Childrens do learn.”

Children respond to community and adult encouragement, expectations and rewards. Just as coalfield kids prove they are capable of stellar achievements in sports, like high school football, they could improve their longer-term health and fitness if their communities made it a priority.

Students and health care professionals in preventive health care public health, exercise, nutrition and naturopathic medicine (as taught in science-based accredited schools, not the self-taught quacks) are the key to turning around the health of thousands in the coalfields. But they must do more than talk the talk. Children respond to role models, not preaching or threats.

One thing is for certain, the existing hodgepodge of programs is not working well. Given limited resources, we may need to perform a coldly calculated triage: If a high percentage of the region’s adult population is set on an irreversible course of lifestyle-driven premature disease and death, perhaps we should focus our limited resources on the young. If we concentrate our programs on mobilizing dedicated educators and focusing programs where they do the most good, perhaps we can move the statistics in the right direction within a generation.

How else, but through early intervention, can we alter the fact that Appalachian adult males use tobacco at a rate three times the national average? Nicotine is a known threshold drug to other health wrecking substances, particularly cocaine, meth and prescription drugs. How else can we persuade kids, otherwise destined to early mortality due to obesity and diabetes, to adopt alternate lifestyles unless we marshal our forces to teach them better today?

Sociologists often blame the government and coal industry for the current lack of health care and sustainable jobs in the coalfields. Certainly an argument can be made that a culture of throwaway lives emanated from decades of coal miners being expendable. In the early and mid part of last century thousands of miners were killed and maimed each year. For every three soldiers killed in combat during WWI, one miner died back home getting out the coal for the industrial war effort.

The deep-seated cultural preference for living for today, based on the conviction that God has a certain date planned for a person to die, persists to a troubling degree in our mountain society. Whatever historical justification there may have been for such hopelessness, however, today is today. Future generations must embrace self-discipline and control what they put into their bodies.

Indian reservations, inner cities and coalfield communities share the same issues of poverty, despair and self-inflicted wounds. We accomplish nothing by affirming well known facts over and over. Let’s get busy addressing the problems with prevention and education. We can no longer tolerate the idea that Appalachia is a place of throwaway lives.

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