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But the disparities between Central Appalachia and the rest of the country persist still today. The area roughly comprising West Virginia, eastern Kentucky, southwest Virginia, east Tennessee and southeast Ohio remains one of the poorest places in the United States; 36 of the 100 poorest counties in the country measured by median household income are in this region. The poverty rate ranges as high as 45 percent in these counties, with the greatest poverty found in the region’s more rural communities and in counties with higher coal production. Inequality in wealth, income, political power and other measures continue to characterize life in our region.
The efforts to build a modern industrial economy in Appalachia resulted in far fewer benefits in Central Appalachia compared to the rest of the region. The industrial sites and tax incentive programs have attracted few branch plants; many of those that were attracted have paid low wages and closed their doors after only a few years. A growing share of the region’s employment is in services or retail, but those jobs are often low paying as well. Only about 2 percent of the flat land created by surface mining has been reclaimed for industrial or commercial uses.
People in the region have been left with few options. Some are commuting long distances each day for jobs in cities or factories. Others are just getting by on disability assistance, Social Security, odd jobs and the support of family. And many, particularly the region’s young people, continue to take the “hillbilly highway” out of the region to education and job opportunities in faraway places.
While educational attainment in the region has increased, progress in education has been much slower in the more rural parts of Central Appalachia. New consolidated schools, while presenting opportunities for some, have meant challenges for many rural kids who face long bus rides and cultural and class differences at the larger schools. While the expansion of community college systems in the region have meant greater access to higher education for many students, the region still lacks adequate postsecondary institutions and students attending college in the region face rapidly rising tuition.
Central Appalachia has greater-than-average levels of a variety of health problems. The region has high rates of diabetes; lung, cervical and breast cancer; cardiovascular disease; and mental health conditions. Eastern Kentucky’s 5th congressional district recently ranked last among all 436 congressional districts in the health index of the American Human Development Project. Workplace-related risks and health problems persist; the Center for Disease Control and Prevention reports that black lung disease—despite being preventable—is actually on the rise among coal miners, and has caused 10,000 deaths over the last decade. Prescription drug abuse is a pervasive problem. And access to health care remains inadequate: the region persists as a health professional shortage area, and many communities’ health care dollars are spent outside the region in more urbanized areas.
Some of the starkest persistent challenges concern treatment of the land itself. Mountaintop removal mining has meant the elimination of nearly 500 mountains and the burying of over 1,200 miles of streams. Additional impacts on the land and water relate to mining, including flooding; sludge pond breaks; acid mine drainage; dust from coal trucks; and damage to homes and wells from blasting and subsidence. Other environmental problems, like continuing poor logging practices, are also significant. Treatment of the land relates significantly to its ownership. The ARC-funded Appalachian Land Ownership Study documented a pattern of absentee and corporate ownership of the land and resources of the region that continues today.
The politics in local communities remains a fundamental challenge for the region. Many counties are still run by small groups of powerful people and families. Elected positions are too often used for personal gain rather than public interest. Patronage and nepotism continue, and election fraud is too common. Challenging politics are also found at other levels of government. State and federal regulation in the areas of mine safety and environmental protection, in particular, has been inadequate. Regulators have not properly enforced laws put in place to protect workers and the land.