A view of Grundy, Virginia, nestled in the mountains of southwest Virginia.
Photo by t.emilynere

For more than 100 years the coalfield communities of Central Appalachia — which includes dozens of counties in Southwest Virginia, Eastern Tennessee, Eastern Kentucky and Southern West Virginia — have been characterized as economically depressed, politically oppressed, chronically impoverished, and brutally raped of their natural resources. The term “Third World” comes up often when the coalfield region’s health care system, economic see-saw and environmental degradations come into focus.

While many observers, activists and scholars can find plenty of historical and current data to support these negative images, we have all figured out that help is needed and further studies and debates are not necessary to develop and pursue a more comprehensive plan of action. Improved roads and public schools, high-speed Internet, public water and sewer access, enhanced mine safety and reclamation and pro-active economic development are all very important and have been belatedly pursued with diligence and a new sense of urgency.

Despite these gains, our region’s health care statistics are still shameful, and the images of the huge crowds at annual Remote Area Medical (RAM) health care events in the Virginia communities of Wise and Grundy are not acceptable in one of the richest states of the world’s richest nation. When under-served citizens will stand in line for hours and sleep in cars overnight just to have a throbbing tooth pulled or to obtain life-saving medicines, something very bad has gone wrong.

Although medical schools, health care groups and medical societies have yet to muster enough forces to address adequately the region’s critical lack of family practitioners, the region’s citizens cannot entirely blame the government or health care facilities. Rather, the state of the region’s poor health statistics has many causes, most of them preventable. Coalfield residents, more than almost any other national sub-group, eat too much of the wrong foods, fail to exercise and go about abusing drugs, alcohol and tobacco at alarming rates.

For example, adults in Central Appalachia use tobacco at three times the national average, many times purchasing that high-priced deadly commodity instead of buying fruits and vegetables or dental care for their kids. Pregnant Appalachian women smoke at the nation’s highest rate and too often consume alcohol and drugs to the detriment of their unborn children. It will take a mixture of increased help from the outside and self-discipline, education and action from within to resolve these issues.

A pupil at Stateline Christian Academy, a private school in southwest Virginia.
Photo by Layne Greene/Rural Archive

Education in the coalfields is the answer to many of these woes. Preventive health care is a must and those efforts have to start early in our public schools. This will take a combined effort of motivated and role-model physicians, nurses, nutritionists, naturopaths and self-taught health-care advocates to achieve. Reducing fat and calories in school meals, allowing time for recess and exercise and getting tobacco, drugs and alcohol entirely off of school properties are in order.

Holding parents and caretakers more accountable for harming children with second-hand smoke, drug use and alcohol abuse would be a good start as well. The throngs of adults who attend coalfield higher education institutions should follow the examples of the Appalachian School of Law and the University of Appalachia College of Pharmacy. These graduate schools located in Buchanan County, Virginia, are national leaders in requiring community services of their students to promote healthier living, leadership and guidance to the young generations who will soon face the option of staying in their coalfield communities to seek higher education and making a difference, or leaving the region and continuing the “brain drain” that ultimately disables progress.

It is clear that many parents and guardians will not or cannot guide their children properly regarding these life-and-death issues of good health and appropriate lifestyles. Once again, it is the public and private education system and enlightened churches that will need to step up these efforts. We cannot allow another generation of coalfield youth to become national poster children for bad choices. The state governments of Virginia, Tennessee, Kentucky and West Virginia and federal agencies must make health education and preventive health care priorities in the coalfields and other under-served areas. Thousands of lives and billions of taxpayer dollars in treatment expenses hang in the balance.

Frank Kilgore is an attorney in St. Paul, Virginia, and a lifelong advocate for improved natural resource conservation, health care and education in the Appalachian coalfields. This article first appeared in The Southern Ledger.

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