Farewell to the Bleeding Mountain People: Government and Industry Negligence in Appalachia Those who are born of Appalachian blood are deemed meritless beyond their labor by industry and the United States government. Appalachia’s history and current state comes as a result of being mistreated by governmental, industrial, and otherwise institutional powers. Appalachia is a region in the United States that spans thirteen states from southern New York to northern Mississippi. It contains four-hundred and twenty counties and roughly twenty-six million people. West Virginia is the only state consisting entirely of Appalachian counties (fifty-five total). The region has the Appalachian mountain range running through the middle of it and is isolated both geographically and socially. Negative images of the Appalachian people like the “hillbilly” or inbred mountain-person (found in media such as the Wrong Turn franchise) are common in representing the region by those outside of the region. Despite their popularity, these and many other stereotypes of the region are inaccurate and harmful representations. Appalachia has a rich folk tradition, specific dialectal features similar to other regional dialectics in the U.S., and abundant natural resources. The abundance of natural resources in the region made it a prime location for extractive industries, mainly coal mining, in the mid-nineteenth century. Coal mining companies quickly gained monopolistic dominance in the region and instituted company towns to maximize the productivity of their operations regardless of the well-being of the population there, which was made up of mostly southern and eastern European immigrants at the time. A company town is a town in which things that would usually be owned separately by private entities are instead owned entirely by a coal company (in this context) with a mining operation typically close by. Housing, stores, and schools were owned by the company, wages and work benefits (if any) for the coal-miners were dictated entirely by the company, and all things purchased or paid for were paid to the company. This model encouraged a boom or bust mono-economy throughout Appalachia which made it extremely difficult to advocate for better working conditions and pay. Unions in particular were difficult to organize under penalty of losing work or being jailed.
When the Appalachian coal mining boom started to decline in the 1930s and 1940s due to mechanization and further westward movement of the coal-industry as a whole, coal companies largely pulled out from Appalachian communities without leaving any sort of “safety net” for the towns they had been a backbone for. This brought about wide-spread poverty and other issues stemming from such poverty. Besides the severe poverty the region still experiences, the prominence of the coal mining industry in Appalachia has left other scars still seen today. Government negligence further perpetuates and worsens lasting psychological and physical effects in Appalachian communities in a post-coal mining boom and post-company town era.
Appalachian suffering is important to discuss not to glorify the region’s suffering but to further legitimize it and bring awareness to the fact that what it has experienced is not the only time and will not be the last time such a thing happens in the United States. One should be educated on exactly how the government and industry have been able to abuse a region and continue to neglect it so that one can understand the signs of it happening in their own locale and take preventative measures on both small and broad scales. Compared to the rest of the United States, Appalachia has severe health and socioeconomic disparities that stem from active neglect and mistreatment under government and industry powers through historically mono-economic practices, intentional perpetuation of poverty, and the lack of access to resources. While there is federal action currently in-place to remedy some of Appalachia’s problems, it lacks appropriate execution to achieve many of its intended purposes.
For the sake of properly understanding the topic being discussed, the terms mistreatment, negligence, government, and industry will be clearly defined. “Negligence” is the failure to use reasonable care, resulting in damage or injury to an individual or group. “Mistreatment” is the act of treating an individual or group badly, cruelly, or unfairly. “Government” refers to the United States federal government as well as all state-level and local governments that have some sort of jurisdiction over Appalachia. “Industry” refers to all major companies and corporate entities that have or have had any level of operations or direct effect in Appalachia.
Understanding the basic facets of Appalachian culture and history is essential to better understanding government and industry negligence in the region. Appalachian culture is not uniform but the United States and the internet tend to identify being Appalachian as being a part of a single static culture (Maloney and Obermiller 105; Robinson 85). Poverty is a part of this culture in the eyes of the United States and the internet as well as in Appalachian reality.
The distribution of poverty in Appalachia is concentrated in rural areas, however, urban areas and rural areas both deal with poverty as Appalachia as a whole is poorer than the rest of the United States (Thorne et al. 343). Poverty has long been a constant for Appalachian people, regardless of smaller parts of Appalachia faring better than others in the face of it.
As previously mentioned, the region has a long history of mistreatment under industrial and governmental hands throughout the last century and a half. Appalachians resisted violently and non-violently to this mistreatment through uprisings, strikes, and protests despite the severe punishments for doing so. The fight that Appalachian people put up for the integrity of the land around them and themselves created an extremely strong tie to said land. The Appalachian mountains became an integral part of being Appalachian through the region’s history of resistance. This is especially true because of part of the reason for that resistance as Beth Nardella, an Associate Professor in the Health Sciences Center at West Virginia University, explains: “Spatial identities are salient because of their ties to memory and shared history…In situations where the landscape itself is affected, it becomes the center from which the community is based” (186). The people and environment of Appalachia were damaged and tied closer together through such damage. Place is a deeply ingrained part of Appalachian culture strengthened by the region’s long struggle against industry and government.
Because of the absolute control industry had over Appalachian life and the nature of the resistance against that control, Appalachia is sometimes classified as an internal colony of the United States. An internal colony is defined by Cara Robinson, an Associate Professor of Urban Studies at Tennessee State University, as “the exploitation of a minority by a majority within a country’s boundaries” (76). Being defined as an internal colony in the context of Appalachia is debated due to a larger debate of what factors truly dictate a group or area being colonized. Nevertheless, the concept illustrates the dynamic between Appalachia and the greater United States well.
In discussing Appalachia’s struggles under the coal industry, it is important to differentiate between the different types of coal mining and the types of damage they cause. No type is less harmful than another and there is no entirely safe type of coal mining. The three that will be referred to moving forward are mountaintop removal mining and its companion valley filling, surface mining, and underground mining. Mountaintop removal mining involves explosives detonated on the tops of mountains to access coal deposits below. Valley fills are valleys where excess material from mountaintop removal is dumped, often cutting off waterways and polluting the surrounding area (Palmer et al. 148). Surface mining is the more general practice of simply mining near the surface of the ground to access coal deposits. Underground mining consists of creating underground tunnel networks (usually using explosives) to access coal deposits. All types of mining cause air, water, and ground pollution that directly affect most Appalachian communities.
It should be noted that the coal industry is on the decline in terms of the amount of people it employs and societal control it has in Appalachia as of the 2010s (Schwartzman 351). Despite this, the coal industry still carries a lot of weight as a legacy of Appalachia and a factor found throughout a majority of the region’s problems. To name two realities of a post-coal boom Appalachia; careless industrial pollution are major hazards for Appalachian communities and the loss of jobs due to the decline of the coal industry leaves people little opportunity and worsens poverty. Both of these compromise the physical and mental wellbeing of Appalachian people and both are treatable if adequate government and industry actions are taken. Unfortunately, adequate institutional action is often a luxury offered to few in Appalachia.
There are several specific instances and broad long-standing practices of the government and industry that are negligent and sustain mistreatment in Appalachia. Appalachian people have historically been treated as if they are less than the average American by industry and government. The notion that Appalachia is an alien entity isolated from the rest of the United States makes it easier for the greater national population to ignore or even encourage such treatment. This notion also allows government and industry to continue without serious repercussions or any large national outcry. As mentioned earlier, this goes back all the way to the coal mining boom when companies had control over Appalachian communities’ lives and abused that power to prevent any sort of lobbying for better conditions. While that was extremely intentional mistreatment, negligence and subsequent mistreatment of Appalachian communities holds more nuance today.
Broad long-standing practices perpetuate lasting psychological and physical effects in Appalachian communities on a wide scale. For example, higher rates of chronic-pain related disorders due to the prominence of labor based employment (mainly coal mining) allowed an opening in Appalachia for pharmaceutical companies to heavily advertise opioids to physicians, leading to the overprescribing of opioids (Moody et al. 2-3). Health systems overprescribing opioids to Applachians provided the government a way to placate through the claim that it was providing a solution to chronic-pain disorders in the region. It was also an avenue to increase profits for the pharmaceutical companies at the expense of Appalachian people. Because of that overprescription, it became easier for Appalachian individuals to become addicted to opioids and start using drugs like heroin (Moody et al. 2-3). As a direct result, Appalachia experiences high rates of HIV and other bloodborne diseases from needle use, all stemming from pharmaceutical companies capitalizing on the coal industry’s dominance over employment opportunities for decades under complete governmental approval. If money can be made easily, industry will do it regardless of the expense to Appalachian communities.
This is indicative of a cycle in which industry harms Appalachia and the government hands out light or no punishment for doing so, essentially giving a go ahead for further harm. The Elk River chemical spill is a specific event that illustrates the aforementioned cycle. The Elk River chemical spill occurred on January 9, 2014 and affected the safe water access of nine total counties and over 300,000 people in southwestern West Virginia (Young 96-98). The spill was perpetrated by Freedom Industries, a company that produced a variety of coal-cleaning products. Freedom industries allowed the toxic chemical 4-Methylcyclohexanemethanol (MCHM), to leak from a container for hours into topsoil and eventually into the Elk River. The chemical leaked upstream from the West Virginia American Water plant on the Elk River, which served as the main source of water for the surrounding area. When residents noticed an odd smell in their water, the West Virginia Department of Environmental Protection was brought in to assess the cause. When investigating the spill site, there were no apparent clean up efforts taking place by the company even hours after the spill and Freedom Industries denied any knowledge of the spill until after the WVDEP had observed negligence at the site. The water company decided to cut tap water to residents and flush the pipes to minimize harm. Even with such action, a large number of the people affected sought medical attention for adverse health effects from consuming the contaminated water. Many people also couldn’t go about their daily lives due to not having access to water for a period of time. In a rare instance of a company being held accountable, Freedom Industries received little more than minor fines and short prison sentences for low-ranking employees at the site. The company escaped anything more major through claiming bankruptcy (Young 97-99). People and land were made sick by a company’s lax regulatory practices that it felt extremely comfortable to disregard.
Another specific instance that highlights government negligence rather than industry negligence involves the town of Centralia in Columbia County, PA. Centralia was an Appalachian mining town that currently sits abandoned because of a coal fire burning in mine tunnels under the town. The fire was unintentionally started in 1962 by firefighters who were tasked with burning trash at Centralia’s landfill. The ground below had not been properly sealed and flames managed to get underground and reach a coal seam. Naturally, the coal seam was attached to other seams as well as mining tunnels, which provided large amounts of fuel for the fire.
The mining tunnels were closed shortly after the beginning of the fire for concerns of miners succumbing to carbon monoxide poisoning. After the fire became known, local industry and government powers made efforts to stop the fire. They tried flushing it out with water-rock slurry, creating fly ash barriers, and trenching for the first few years after the fire was started. Despite the pragmatic intention behind these efforts, the methods were mostly unsuccessful due to lack of full commitment. Flushing the fire with water-rock slurry had the potential to be successful but wasn’t because there were insufficient amounts of water-slurry provided by the government for extinguishment to be possible (Nolter and Vice 104). The other methods were also unsuccessful due to the magnitude of the fire at that point and the resources, personnel, and initiatives provided being inadequate.
Following these moderately proactive efforts, the Pennsylvanian government took to evacuating the population of Centralia instead. Using federal funds allocated to areas with abandoned mines, the state compensated people to leave rather than pursuing any further efforts of stopping the fire (Nolter and Vice 99-102). Evacuation efforts were pursued instead of efforts towards stopping the fire because of the federal funding available to incentivize people to leave and the ease of such a solution for the government. Centralia was abandoned because of the cost associated with stopping the fire. Roughly a thousand people were forced to leave the town, leaving employment, homes, and communities because the government did not see Centralia as a worthwhile problem to fix. Put simply, the government took the “easy” way out.
Centralia is a prime example of an Appalachian environmental disaster in which the government does not see it as a problem worth a full investment of time and resources. The government often seeks cosmetic solutions rather than solutions that benefit Appalachian communities in the long term as evident through Centralia’s outcomes.
In policy decisions and practices nearly traditional at this point, government and industry do not see Appalachia as a region that they must be properly accountable for. The treatment of the Elk River chemical spill is negligent at best and a human rights abuse at worst. It got little attention in the media and was hushed quickly through policies meant to placate and an inadequate clean up similar to Centralia. Centralia continually receives a fair amount of media attention but rather than advocate for Centralia, it sensationalizes the fact of the fire and drums up conspiracy theories around it. The people and communities affected by the Centralia fire and the Elk River chemical spill are seen as little more than collateral damage. There is no one jumping to stand up for the region besides Appalachia itself, the very victim needing defense.
The effects of the aforementioned negligent events and practices are far-reaching across Appalachian communities and the region as a whole. Improper clean ups of environmental hazards affect large amounts of the Appalachian population to this day through water supply, air supply, and more (Palmer et al. 148). These improper clean ups turn the natural environment toxic and Appalachians can no longer safely enjoy the land tied so closely to them. Any possible alternative economies for tourism of the natural environment is compromised by the fact that these environments are no longer safe to recreate in. In the current relationship between government and industry, poverty has become a generational problem in Appalachia. Given this poverty, many choose to leave to try and seek opportunities elsewhere which causes depopulation, further leading to the decline and general abandonment of the region. Those who can’t afford to leave or want to stay as a form of resistance (Nardella 188-190) in the region continue to experience mistreatment.
One of the most concerning indicators of mistreatment and the negligence that perpetuates it is health and healthcare in Appalachia. Healthcare and health (both physical and psychological) serve as a microcosm that can be used to examine specific disparities as indicators of larger issues in Appalachian communities and tie them to government and industry negligence. Years of potential life lost (YPLL), used as a measure of premature death, shows this reality of Appalachia. In the region, YPLL is 25% higher than the United States as a whole (Marshall et al. 6), meaning that a significant amount of people in Appalachia have lost decades of life to premature deaths. Premature death was very common during the coal mining boom due to lack of regulation in every regard, however, the rate of YPLL in Appalachia still sits higher than the rest of the country today due to that same lack of regulation, particularly regarding the proper treatment of toxic material, and systemic poverty perpetuated by government policy. The poor state of Appalachian healthcare and health is a direct repercussion of mistreatment stemming from negligence. This can best be explained when “health and healthcare” are broken down into components of physical outcomes, psychological outcomes, and access to healthcare.
In the realm of physical outcomes, respiratory conditions are prevalent and deeply tied to the region’s history with coal mining and the toxic leftovers of the industry. In Appalachia, the mortality rate of chronic obstructive pulmonary disease (COPD) is 27% higher than in the United States overall (Marshal et al. 6). COPD is a long-term disease affecting the lungs that makes it harder to breathe that can be treated but not cured and can significantly reduce a person’s lifespan. In the context of Appalachia, it is a disease associated with exposure to coal dust and other toxic materials that damages the lungs.
Obesity is also a major indicator of larger issues in the region with rates of adult obesity sitting at 31% while the rest of the United States sits at only 27.4% (Marshall et al. 7). While also an issue in other regions of the United States, obesity in Appalachia is unique in that it is directly affected by the region’s isolation. Access to grocery stores is limited in the region due to geographic isolation making it difficult to maintain them, with many getting food from alternative sources such as dollar stores. Grocery stores tend to provide access to healthier food than what is at alternative sources and lack of such food worsens health outcomes (Marshall et al. 179). Conditions that are simple facts of life for many Appalachians create an often inescapable environment that perpetuates poor physical health outcomes.
In the realm of psychological outcomes, the suicide rate in Appalachia is 17% higher than the national average (Marshall et al. 123). This increased rate of suicide can be linked to poor mental health in the region which is exacerbated by the lack of mental health services. Stigma of mental health, poverty, substance abuse, and lack of opportunity all feed into the decline of mental health in Appalachian communities (Cole and Shelly 1003-1006). The poor conditions many Appalachians are born into creates a mental health crisis predicated on hopelessness especially for the majority of people in the region who don’t have the resources to access already limited mental health services or to seek better opportunities elsewhere. Stigma surrounding mental health and a general attitude towards healthcare as a last resort reserved only for physical ailments in Appalachia worsens the mental health crisis further (Cole and Shelly 1005). For many Appalachians, mental health is not considered something significant enough to warrant professional treatment. There are also generational factors to consider, such as cycles of abuse that continue through the constant struggle to survive in the face of poverty, depopulation, and poor opportunities across all fronts.
Regardless of the type of condition, all disparities in Appalachia can be tied back to industry and government factors that influence access to healthcare. Healthcare access means two things: actual access and use of healthcare services, and the willingness of Appalachians to seek out such services. Geographic isolation and improper federal and state funding make it difficult for infrastructure like hospitals to be established and even more difficult for such infrastructure to last. A lack of general and specialized physicians in the region make it even harder to access proper healthcare. Many of the hospitals in Appalachia are a result of the Hill-Burton Act of 1946, which provided federal assistance (mainly through funding) that supported viable healthcare infrastructure in the region. The act was discontinued in 1997 and all beneficiaries of it lost funding yet were still expected to operate at the same capacity as before (Cole and Shelly 1003). In Appalachia, healthcare cannot function without federal assistance and without that assistance the quality and accessibility of healthcare is diminished greatly. As touched on earlier, the willingness of Appalachians to seek out such services is also dependent on Appalachian identity and feelings of resistance towards institutions after being mistreated by such powers for so long.
The concept of Appalachian identity is a complicated one that affects everything from health and socioeconomic factors to how communities of the region interact with consistent government and industry negligence. Appalachian people are often mischaracterized in two ways; by an exclusively positive culture model or an overly negative model that does not acknowledge any existing culture in Appalachia to begin with. The first model only acknowledges positive traits of Appalachians which can be digested as “good” by the greater United States. This includes traits such as being devoted christians (protestant-christianity), being hard-working, family and community oriented, and resilient (Maloney and Obermiller 104). The exclusively positive model is problematic because it only serves to put a coat of gloss over Appalachia to make it palatable. While some of the traits listed above apply to most Appalachian people, people are not entirely composed of only “good” traits. This model is a hollow attempt to improve the image of Appalachia for an outside audience in order to earn assistance through proving that Appalachians are an acceptable group. It serves to say: “look how good we are, don’t we deserve your sympathy and help?” While it acknowledges the existence of an Appalachian culture, it does not provide a meaningful perspective of it. The second model doesn’t acknowledge the existence or potential use of Appalachian culture. It focuses mainly on things deemed negative or as a marker of lesser-than status by the rest of the United States such as low intelligence, generational poverty, bad hygiene, highly fatalistic, and hostility. This model is a way for the United States to rationalize its dislike of Appalachia purely on a basis of traits that it does not approve of and views as a hallmark of low value.
Both models feed into stereotypes about the region. Dissolving Appalachia into an itemized list of positive and negative is a shallow way of perceiving the region. Rather than an organized culture, Appalachia is a collection of identities that span in size from an individual to communities to the entire region itself (Maloney and Obermiller 111). It is a complex region that contains living people who change everyday, as well as traditions and folkways that are integral to such individual’s identities and should not be ignored.
With that being said, in relation to government and industry, resistance and forced powerlessness are crucial to Appalachian identity and vice versa. Appalachians have often been the only ones willing to stand up for themselves through direct action such as the Battle of Blair mountain, an uprising of miners against the United States government in which the government ended up dropping bombs on Appalachia to stop the conflict (Nardella 184-185). From such attitudes, Appalachians have developed a transgenerational sense of hostility towards institutional action. As provided in “Substance Use in Rural Central Appalachia: Current Status and Treatment Considerations,” published in Rural Mental Health, this “long history of anti-regulatory sentiments in the region..create[s] resistance to legal efforts” (Moody et al. 2) that attempt to curb issues ranging from substance abuse to education.
On the other side of things, Appalachian identity also serves to strengthen ties of communities in the region and aids in group power through tight-knit interpersonal bonds with fellow Appalachians. It creates a sense of self for many and a rich oral tradition helps to pass on the ideas of power through resistance, even in current times when more nuanced negligence and mistreatment is experienced. Appalachian identity is a crucial part of the region but a part that is often at odds with the little effort government and industry actually do take to assist the region.
There is a case to be made for measures the government (and less so but still significantly, industry) has taken to aid Appalachia through various programs, initiatives, legislature, and dispensing of federal funding. An instance that highlights government action to regulate industry and assist Appalachian poverty well is the implementation of the Federal Coal Mine Health and Safety Act.
The Federal Coal Mine Health and Safety Act was put into place in 1969 under the Nixon administration after rates of coal dust related health issues (specifically pneumoconiosis, a lung disease caused by exposure to certain dust) kept increasing and several mining disasters occurred. The act set a federal exposure limit to coal dust and created the Coal Workers Health Surveillance Program (CWHSP). The CWHSP was a national program that monitored underground conditions for miners and allowed miners to get free periodic chest x-rays. If certain adverse signs were revealed in an x-ray, that miner would be allowed to work in an environment with less coal dust. Due to this act, rates of pneumoconiosis did decline consistently until the early 1990’s (Suarthana et al. 908). Effective federal action and industry compliance created a rare atmosphere in which Appalachian miners were recognized as more than just labor and were given resources to overcome some of the negative effects of working in the industry. Despite these measures, Appalachia still suffers from the amount of weak points in such action and the lack of action that they accomplish in the first place. A study published in Occupational and Environmental Medicine highlights some areas of failing of the Federal Coal Mine Health and Safety Act by the early 2000s and to this day through rates of pneumoconiosis in coal miners. The study was conducted by surveying around twelve-thousand underground Appalachian coal miners and the prevalence of pneumoconiosis in that group from 2005-2009. It found that rates of pneumoconiosis had increased instead of continuing to decrease as it had before under the Federal Coal Mine Health and Safety Act (Suarthana et al. 908). The act did create an excellent safety net for Appalachian coal miners but is not entirely effective in its goals. It brings to light the problem of most federal action that attempts to assist Appalachia; it is not a fully committed effort. There is some factor lacking from the action, whether it be lack of proper legislation, resources, or corruption in the action itself. All of these pitfalls can be seen in both the Elk River chemical spill and Centralia coal fire discussed earlier.
Though Appalachia is inundated with disparities across socioeconomic and health fronts, there are potential solutions to some of the problems it faces. As a first step, industry should be held comprehensively accountable for the long-term effects it has had on Appalachia. Defining what exactly “comprehensively accountable” entails is complicated but should involve legal prosecution as well as more regulations and strict enforcement of those regulations moving forward. This means more than just arbitrary fines; it means sanctions, even if profit margins suffer from it. Appalachian economies should be diverse and for the good of the people living in them rather than for the use of industry. History cannot be changed but what can be improved for Appalachians now should be.
On the health and healthcare front, better education and access are key. Education refers to better dissemination of information to Appalachians through a variety of means that help to demystify and de-demonize healthcare as it is so deeply ingrained as such in Appalachian identity. The means in which this is accomplished should be wide-spread and community-based. As aptly put by William Schumann, the director of the Center for Appalachian Studies at Appalachian State University, “[we] cannot only focus on resistance and expect systemic results…history informs us of the importance of (at some point) integrating grassroots pressure and legislative action” (27-28). In regards to access, broadband internet should continue to be expanded in the region in order to make telehealth a more viable option for Appalachian people. Hospitals and physicians alike (especially mental-health related personnel and infrastructure) should receive more stable federal funding to help cross the bridges of geographic isolation and to operate at better capacities.
Appalachia experiences negative health and socioeconomic outcomes from government and industry neglect. Even though some minor government action has been taken, it tends to lack proper resources to actually help the region. Both specific and broad instances of government and industry negligence have severe effects on Appalachia’s wellbeing across all fronts. This is easily illustrated through the disparities in health and healthcare in Appalachia. Appalachia’s unique identity serves an active role in how Appalachians interact with such negligence, mistreatment and disparities. Appalachia is not something to look at and pity, it is a region that only asks for an apology in the form of legal and social justice. It is full of individuals who are deeply tied to the mountains surrounding them, with both entities surviving different forms of mistreatment. Action can and should be taken towards better treatment of Appalachian communities that centers around quality of life and reparative action for the consistent negligence committed. Appalachian blood is as formidable as the mountains themselves.
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