top of page

Public Health in Appalachia

Appalachia's Public Health

Report Card

While the Appalachian Mountain region is one of the most beautiful landscapes in the United States, people living in the region have some of the highest rates of infectious disease diagnoses, chronic illnesses, and preventable deaths in the United States.

Alabama 24.jpeg

Across Appalachia's 13 states, 423 counties, and 8 independent Virginia cities, a "perfect storm" of factors, including labor-intensive jobs, a lack of both general practitioners and specialist physicians, chronic underfunding of public health systems, a near-total lack of underlying public health infrastructures, low levels of education, and environmental circumstances have resulted in a population that leads the nation in many adverse health outcomes.

Health Issues in Appalachia

Barriers to Care and Treatment in Appalachia

Appalachians face significant barriers to accessing care and treatment, including geographic, transportation-related, communication, income, and age/disability-related barriers.

In many cases, the very mountains we call home can present a barrier to care, particularly during the winter when roads may become impassable.

Additionally, the mountainous terrain has made modernizing parts of Appalachia incredibly difficult. This means that many areas lack access to reliable mobile phone coverage and sufficient Internet infrastructure. In those areas, even were those services readily available, many residents would be unable to afford to access them.

An example of this occurred during the COVID-19 pandemic. When schools made the transition to virtual schooling, thousands of students were unable to access Internet services at home in order to attend. This required a unique solution: turning unused school buses into mobile WiFi hotspots. Students would park in vehicles around these buses and attend school using school-provided laptops.

Barriers to Healthcare Access in Appalachia. Geographic: Rural locations, Mountainous terrain, Physician shortages, Lack of specialists, Rural hospital closures, Technology gaps. Income: Cost of care, Ability to afford care, Poor insurance coverage, No insurance coverage, Not enrolled in Medicaid, No Medicaid expansion. Transportation: Long distance travel, Lack of vehicle, Transportation costs, No public transportation, Poor road quality, Weather-related issues. Communication: Reading deficiencies, Poor health literacy, Lack of trust in providers, Cultural barriers, Perceived or actual stigma, Language barriers. Age & Disability: Mobility issues, Lack of transportation, Social isolation, Lack of assistance, Inability to communicate, Technology barriers. Follow us @APPLIOrg on Facebook, Instagram, LinkedIn, Pinterest, Twitter, and YouTube. Visit our website at

The Social Determinants of Health

While people living in the Appalachian Mountains face significant barriers to actually accessing healthcare services, there are also underlying circumstances that increase the likelihood of adverse health conditions:

These are called the Social Determinants of Health (SDOH)

Kentucky 11.jpeg

The basic concept behind the SDOH is that underlying factors, such as education, where we live, where we work, the language that we speak, and how much we earn, all contribute to our health outcomes.

For example, children born to parents who have not completed high school are more like to live in an environment that poses barriers to health, such as a lack of physical safety, high levels of stress,  and substandard housing.


These circumstances can then lead to long-term and even generational adverse health outcomes.

Another example of the SDOH impacting health outcomes is how Appalachia's reliance upon the coal industry has had long-standing impacts on the health of those not only working in the industry but those living in areas where coal is the driver of the local economy.

Nearly every study conducted has found that people working in and living near the coal mining industry have an increased risk of developing and dying from numerous conditions, including:

  • Neoplasms (abnormal growths)

  • Circulatory and respiratory disease

  • Metabolic Diseases

  • Diseases of the eyes and skin

  • Perinatal conditions

  • Congenital and chromosomal abnormalities

Cortez-Ramirez, J., Naish, S., Sly, P.D., & Jagals, P. (2018, June 11). Mortality and morbidity in populations in the vicinity of coal mining: a systematic review. BMC Public Health 18, 721.

Developing Practical Solutions

bottom of page