In 1982, the small, low-income rural health clinic operated by Eula Hall from her home in Mud Creek, Kentucky, burned to the ground. After taking the morning off to assess the damage, likely caused by a frustrated intruder attempting to loot the pharmacy, she re-opened the clinic, such that it was, from a picnic table pulled under the shade of a tree where she coordinated appointments from a telephone line hastily installed on its trunk.
This memory of Eula served me well during 2017 and I thought about her often—a determined woman who, like me, became stuck and then worked to free herself and others from the wreckage of a clumsy thief who would rather burn things down than admit his plans a failure.
The national perception of Appalachia in 2017 made little room for people like Eula Hall, who today is 90 years old and is still the patron of her low-income clinic. Rather, many came to know Appalachia through a glut of character studies obsessed with the inner lives of white, disaffected Trump voters in which progressive, justice-seeking voices became as rare as employed coal miners. Entire population groups that complicated the idea of Appalachia as the natural dominion of resentful, white, working-class men and their families ceased to exist.
This monolithic place is not the Appalachia I know. As I wrote in my forthcoming book, the Appalachia I live in is one where the region’s problems are set against a long history of organizers who “have struggled against them, often sacrificing their health, comfort, and even their lives.” With a similar intent, let me give you a snapshot of the Appalachia you didn’t often see in the press this year—the Appalachia filled with activists and organizers seeking many forms of justice, from reproductive rights to environmental protections, often using principles of community organizing passed down through generations to mitigate the harm promised to the region’s most vulnerable residents.
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The potential for harm is great. According to many metrics, Appalachia is ground zero for rising health-care costs and access disparities, which have profound consequences on reproductive and sexual health in the region and, when combined with reactive politics, literally hold bodies hostage in a war over values. Political leaders in Kentucky and West Virginia, on both sides of the aisle, are particularly hostile to reproductive freedom, orchestrating the closure of all but one abortion-providing clinic in both states this year.
Caring for the reproductive and sexual health needs of rural and low-income people and all people of color in Appalachia often falls to clinics like the Women’s Health Center, in Charleston, West Virginia, and the EMW Women’s Surgical Center, in Louisville, Kentucky, both facing ongoing and pivotal legal battles this year as pressure to effectively ban abortion in these states intensifies. The new year in Kentucky started, for example, with a ceremonial signing of historic anti-abortion legislation by Republican Gov. Matt Bevin, who told the press, “We must continue to fight this scourge that is the taking of innocent life.”
In Appalachia, the movement for reproductive justice that has risen to the challenge of combating abortion restrictions is multi-racial, multi-generational, and multi-faith. Its leaders are people like the the Rev. Millie Peters, who formed the Kentucky chapter of Concerned Clergy for Choice in 2014 and Caitlin Hays Gaffin, the director of operations at WV Free, a reproductive rights organization based in Charleston, West Virginia. Other grassroots organizations that fill gaps in reproductive care and education have formed or expanded. The Kentucky Health Justice Network recently launched the All Access EKY program, directed by Whitesburg, Kentucky, native Stacie Sexton, to promote birth control access in underserved counties. In a recent interview with CNN, Sexton said, “Our goal is helping people control their futures.”
The opioid epidemic in Appalachia also occupies an urgent place in regional public health concerns. Although the Trump administration has recently announced plans to focus policy on combating the crisis, including expanding the enforcement powers of the Drug Enforcement Agency in Appalachia, much of the day-to-day care and management of those experiencing addiction falls to organizations in the hardest-hit communities. In southeastern Ohio, Bassett House is one of the only treatment centers for children and teens and now operates on a shoestring budget due to funding cuts enacted under the Ohio’s Behavioral Health Redesign program that caps Medicaid payments at a lower rate.
Because of the dearth in drug-treatment funding in Appalachia, grassroots organizations often focus on prevention, harm reduction, and compassionate programs that offer emotional support and outlets
to those impacted. In April, the Pittsburgh-based Saltworks Theatre Company premiered “Off Script,” a play performed by teens based on the experiences of individuals who had battled addiction. The Higher Ground Theater, in Harlan County, Kentucky, offers similar programming through participatory action theater, starting with their 2005 namesake production that focused on prescription drug abuse.
In November of this year, officials in North Carolina launched the state’s first needle exchange program run by a county fire department, using kits donated by the North Carolina Harm Reduction Coalition. According to the organization, “harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with drug abuse, sex work, and other high-risk activities.” Support for harm reduction strategies has risen in Appalachia as the opioid crisis has worsened.
Environmental activism in Appalachia is a public health matter as well, but also a reminder that environmental justice is always racial justice. In West Virginia, Virginia, and North Carolina, affected residents and their allies have waged a determined fight this year against two proposed natural gas pipelines planned for immediate construction. The developers of the Atlantic Coast Pipeline plan to use experimental compressor stations in two communities in Virginia and North Carolina that are home to a significant population of low-income African-Americans and Native individuals respectively. In response to this threat, a coalition of groups across three states organized a people’s tribunal in Virginia in October, placing modern resource extraction and its consequences within the long history of settler colonialist plunder.
In December, grassroots environmental organization Appalachian Voices joined the North Carolina NAACP to sue Duke Energy to obtain an order requiring the energy company to remove coal ash from the groundwater in Stokes County, North Carolina. NAACP North Carolina President the Rev. T. Anthony Spearman told the Greensboro News & Record, “This is a quintessential example of environmental justice. In a county that’s predominately white, Duke Energy’s polluting coal ash sits in the middle of a Black community with limited means.”
In West Virginia, opposing a proposed Appalachian gas storage hub—a vast network of underground storage and pipelines for natural gas—is a focus of the Ohio Valley Environmental Coalition. Trump’s November $83.7 billion memorandum of understanding with China Energy Investment Corp. to create chemical and gas projects in West Virginia brought the hub one step closer to reality. Set against this enormous sum are people like the late Dianne Bady, the founder of the Ohio Valley Environmental Coalition, who passed away this year, who believe “The only way you can win on environmental issues is if the power of organized people is greater than the power of organized money.”
This brief slice of Appalachian activism has been about the year that was—but it is also about the year ahead and the battles to come. Instead of telling people in red states or Trump Country to “just move to a blue state,” a more productive strategy in 2018 might be to support, acknowledge, and learn from the work of Appalachian organizers engaged in local fights that the Trump administration promises will soon be national.