appalachia – UAB Institute for Human Rights Blog

Human Rights in Appalachia: Socioeconomic and health disparities in Appalachia

The previous blog posts in this series are located here:
Human Rights in the Appalachian Region of the United States of America: an introduction
Human Rights in Appalachia: The Battle of Blair Mountain and Workers’ Rights as Human Rights

In the Appalachian region of the United States, there have long been overarching socioeconomic problems that have prevented the region from seeing the same levels of growth as other parts of the country, and even been part of its decline in other domains. Much of Appalachia’s population of twenty-five million people remains remote, isolated from urban growth centers and beneficial resources that exist in cities. The rural towns and counties in which many Appalachian people live have not had the ability to maintain the public infrastructure, furnish the business opportunities, or provide the medical services that are necessary to sustain populations.

There are three regions of Appalachia: the southern region, which covers parts of Georgia, Alabama, Mississippi, the Carolinas, and Tennessee; the central region, which covers parts of Kentucky, southern West Virginia, southern and southeastern Ohio, Virginia, and Tennessee; and the northern region, which includes parts of New York, Pennsylvania, northern West Virginia, Maryland, and northern and northeastern Ohio. While the entire Appalachian region struggles with higher levels of poverty, unemployment, and lack of services and infrastructure, some sub-regions suffer worse than others, and in different ways (Tickamyer & Duncan).

graph of people in poverty by age group — Percent of persons in poverty in rural Appalachia by age group: 2014-2018

Even when compared to other rural areas, Appalachia struggles on measures of educational attainment, household income, population growth, and labor force participation. Rates of disability and poverty are significantly higher in rural Appalachia than they are in other rural areas of America. In 2018, the number of Appalachian residents living below the poverty line was higher than the national average in every age group except those 65 and older. The largest disparity was among young adults (18-24), where the Appalachian population was more than 3% higher than elsewhere. From 2009 to 2018, median household income in Appalachia went up by 5%, not far behind the national average of 5.3%. However, the median household income in Appalachia remains more than $10,000 lower than the national median.

map of population age in appalachia — Map of population age in Appalachia

One area where disparities between Appalachia and elsewhere in the country are particularly noticeable is in healthcare. The Appalachian Regional Commission released in 2017 “Health Disparities in Appalachia”, which reviews forty-one population and public health indicators in a comprehensive overview of the health of the twenty-five million people living in Appalachia. The study found that Appalachia has higher mortality rates than the rest of the nation in seven of the nation’s leading causes of death: heart disease, cancer, COPD, injury, stroke, diabetes, and suicide. In addition, diseases of despair are much more prevalent in Appalachia than the rest of the country. Rates of drug overdose deaths are dramatically higher in the Appalachian region than the rest of the country, especially in the region’s more rural and economically distressed areas. Research indicates that diseases of despair will increase under COVID-19, as well. This will be especially true for women, who experience death from diseases of despair at a rate 45% higher than the national average in Appalachia. The ARC found that, while deaths as a result of diseases of despair were more numerous in metropolitan counties of Appalachia, rates of suicide and liver disease were higher in rural counties.

These issues are exacerbated by the fact that there is a much lower supply of health care professionals per capita, including primary care physicians, mental health providers, specialists, and dentists in Appalachia. The supply of speciality physicians is sixty-five percent lower in the central sub-region of Appalachia than the rest of the nation as a whole. Other factors negatively impact health in Appalachia, as well. Nearly twenty-five percent of adults in Appalachia are smokers, compared to just over sixteen percent of all American adults, and obesity and physical inactivity are extremely prevalent. However, it is worth noting that in some areas of public health interest, such as the occurrence of STIs/STDs and HIV, Appalachia does better than the rest of the country.   Healthcare disparities are an increasingly dramatic phenomenon. From 1989-1995, the cancer mortality rate in Appalachia was only 1% higher than the rest of the US, but by 2008-2014, it had risen to be 10% higher. In the same time frames, the infant mortality rate was 4% higher versus 16% higher, respectively. And, in 1995, the household poverty rate in Appalachia was 0.6% higher than the national average, but by 2014 was 1.6% higher. We like to think of these problems as things of the past, but the gaps are still very much relevant. Fortunately, people living in Appalachian communities are more likely to have health insurance coverage than other Americans. 8.8% of the population in Appalachia do not have health insurance versus the national average of 9.4%.

This year, in the midst of the coronavirus pandemic, some factors of the Appalachian population have put people living there at greater risk of COVID-19. 18.4% of people living in Appalachia are over age sixty-five, which is more than two percent higher than the national average. In more than half of Appalachian counties, over 20% of people are older than 65. This, combined with high rates of obesity and smoking, put many people in the “high-risk” category. COVID-19 has affected Appalachian communities in ways that don’t result in death but make surviving even more difficult. Food insecurity, for instance, is an increasingly severe problem. At one soup kitchen, “…we were serving about 200 people a day, and our numbers have nearly tripled since COVID started,” social worker Brooke Parker, from Charleston, West Virginia, said.
However, perhaps due to the isolated nature of many Appalachian communities, mortality rates from COVID-19 have not been markedly higher than the national averages.

With schools moving to online learning, problems with access to internet in Appalachia become more relevant and pressing. Around 84% of Appalachian households have a computer, which is five percentage points below the national average. 75% have access to reliable internet, which is also five percent lower than average. There is no easy solution to this lack of access to education. Even in non-Appalachian counties, students are being severely impacted by the disruption to their normal education activities.

Human rights organizations ought to keep a close eye on Appalachia as we see the results of COVID-19 on an already vulnerable and at-risk population. The ultimate consequences of the pandemic will likely be more severe here than elsewhere in the country. People living in Appalachia deserve the same assistance being offered to and resources being put towards urban centers in other parts of America. Too often have they seemingly been forgotten.

Additional References:
1. “Health Disparities in Appalachia”. Marshall, J.,Thomas, L., Lane, N., Holmes, G., Arcury, T., Randolph, R., Silberman, P., Holding, W., Villamil, L., Thomas, S., Lane, M., Latus, J., Rodgers, J., and Ivey, K. August 23, 2017. https://www.arc.gov/wp-content/uploads/2020/06/Health_Disparities_in_Appalachia_August_2017.pdf. Retrieved December 3, 2020.
2. Population Reference Bureau. https://www.prb.org/appalachias-current-strengths-and-vulnerabilities/. Retrieved December 9, 2020.
3. Tickamyer, A., Duncan, C. (1990). Poverty and Opportunity Structure in Rural America. Annual Review of Sociology. 16:67-86.

Human Rights in Appalachia: The Battle of Blair Mountain and Workers’ Rights as Human Rights

In a region that has so often felt the brunt of capitalist, industrial exploitation, it follows that there ought to be a response on the part of the workers to protect their rights. This has been the case in Appalachia since the industrialists first started setting up shop in the mines and hollers throughout the Appalachian Region. Of particular note are the Coal Wars, which took place in Appalachia from the late nineteenth century to the early twentieth century, from 1890-1921.

Preceding the Coal Wars, workers’ conditions were already very poor. Though the conditions heavily depended on the level of apathy the owners of the coal towns felt or did not feel for their workers (which was usually high), it was nearly universal that coal camps were remote, unhealthy, and unsafe, both due to frequent industrial accidents and poverty-driven crime. Companies often owned the homes of the workers, and eviction was a constant threat. Further, the usage of company stores, in which the only form of currency for the price-gouged goods was company scrip or coal scrip, forced the workers into a monopolistic, unbalanced form of trade where they were always at the mercy of their company. Companies often employed private detectives, public law enforcement, and strikebreakers who used violence, harassment, intimidation, and espionage to crack down on workers’ rights advocates’ activities (Athey).

There was also an ethnicity-based social hierarchy enforced by the companies. Despite all the workers being low-paid, blue collar workers, Welsh and English miners were considered to have the highest prestige and received the best jobs, followed by the Irish. More recent immigrants from Italy and Eastern Europe were treated the worst, with the poorest jobs. However, all groups recognized that it was them against the companies for which they worked. From the mid-nineteenth century forward, coal miners built a strong reputation for radical engagement with politically left ideologies and for militant unionization (Rowland).

Battle of Blair Mountain, 1921

It was under these pretenses of repression and disregard for workers’ rights that the Coal Wars occurred. While entire books could be written about the Coal Wars, I am going to focus on the Battle of Blair Mountain, which was the largest labor uprising in the history of the United States, as well as the largest armed insurrection since the Civil War, and occurred from late August to early September of 1921. Since 1890, coal mines in Mingo County, West Virginia had hired only non-union workers and specifically denied their miners the right to unionize. When three-thousand miners unionized in spite of this, they were summarily fired. The Baldwin-Felts Detective Agency was brought in to effect the evictions of the miners’ families from the company town. Police Chief Sid Hatfield, along with a group of deputized miners, confronted them and a gunfight ensued, killing the mayor of Matewan and Albert and Lee Felts, among others. Later, Hatfield went to stand trial in McDowell County for an unrelated incident and was assassinated by Baldwin-Felts agents on the courthouse stairs. A friend of Hatfield’s, Ed Chambers, was also killed by a Baldwin-Felts detective who shot him execution-style after he was wounded in the melee. When word got back to the miners that Hatfield had been killed, they began to take up arms and organize, commandeering trains and moving to fortify areas surrounding Blair Mountain.

miners with machine gun — Blair Mountain machine gun nest. Wikicommons.

The Battle of Blair Mountain saw some forty-thousand combatants engage in armed conflict in Logan County, West Virginia. Ten-thousand striking coal miners led by Bill Blizzard faced off with Baldwin-Felts Detective Agency strike breakers, Logan County Sheriff’s deputies led by Don Chafin, West Virginia State Police, and the West Virginia Army National Guard. Approximately one million rounds of ammunition were fired and over one-hundred people were killed, with nearly a thousand miners arrested for murder, conspiracy to commit murder, and treason against the State of West Virginia (Savage).

miners surrender arms to troops — Miners surrender arms to federal troops in Logan County, W. Va. Wikicommons.

Decline in Labor Union Membership

It is hard to believe that something like this occurred less than a hundred years ago in our country. Most people, I think, are unaware of the bloody history of labor rights in the United States. Further, it appears that anti-labor sentiment and large industries have prevailed in America. The Battle of Blair Mountain unfortunately led to a decline in membership for the United Mine Workers of America, even if it also led to a greater public knowledge about the conditions in which they worked. In spite of any greater awareness, unions have, since then, continued to hemorrhage members. In 2015, NPR reported that in 1965, almost a third of all workers in the US belonged to a union. By 2015, that number had shrunk to one in ten. Their research indicated that, even at the height of membership, the South/eastern United States saw drastically reduced numbers of union members compared to the Northeast, Midwest, and West. One contributing factor to this may be “right to work” laws, more common in the South, which are state laws that prohibit union security agreements between unions and employers. Right to work laws are misleading in that they are not general guarantees of employment, but are government bans on contractual agreements between employers and union employees requiring workers to join unions if they benefit from their protection.

As I discussed in my last post, unions have been shown to raise wages, reduce wage inequality, and protect rights for workers. Higher rates of union membership tends to indicate greater respect for human rights in industry.

graph of union membership and income inequality — Union membership and income inequality. Wikicommons.

So why are states limiting the function and growth of unions? It seems a shame to me that the interests of large corporations are being given priority to the interests of their workers. This is something we should all be concerned with because workers’ rights are human rights. Workers’ rights encompass things like freedom of association, the right to strike, the prohibition of forced or compulsory labor, and the right to fair working conditions. Because most of us spend most of our time working, this should matter to all of us. Unfortunately, only a few workers’ rights are specifically enumerated in international documents protecting civil and political rights, such as the right to form and join unions. Other rights are mentioned in treaties dealing with economic and social rights. Some good news on the front of labor rights is that, recently in Europe, workers’ rights advocates have been successful in taking cases to the European Court of Human Rights, which ruled that the right to strike is contained in freedom of association.

In my next blog post, I will write about the broader picture of socioeconomic inequity in Appalachia and the ways in which that disparity has led to human rights failures in the region.

Other References:

Athey, L. (1990). “The Company Store in Coal Town Culture,” Labor’s Heritage Vol. 2 #1 pp 6-23.
Savage, L. (1990). Thunder in the Mountains: The West Virginia Mine War, 1920–21. Pittsburgh: University of Pittsburgh Press. ISBN 978-0-8229-3634-3.
Podobnik, B. (2008). Global Energy Shifts: Fostering Sustainability in a Turbulent Age. Temple University Press. pp. 40–41. ISBN 9781592138043..
Rowland, B. (1965) “The Social Order of the Anthracite Region, 1825-1902,” Pennsylvania Magazine of History & Biography Vol. 89 #3 pp. 261-291.

Human Rights in the Appalachian Region of the United States of America: an introduction

People living in the Appalachian region of the United States have been victims of a number of failures to protect their basic human rights since at least the nineteenth century. As a result, in nearly every measurable socioeconomic category, the Appalachian region lags behind the rest of the United States in development, or even shows signs of decline. This, in combination with their remoteness and social isolation, has led to a remarkably divided society evidenced over the last hundred or so years. Outdated and incorrect perceptions of the Appalachian people have led to antagonism and a struggle to implement democratic institutions that protect some of America’s most vulnerable populations.

The Appalachian mountains in the Eastern United States extend across thirteen states and are home to over twenty-five million people. Appalachia struggles with problems typical of rural poverty: social stratification, unemployment, lack of social services, poor education, and poorly developed infrastructure. The Appalachian region, and its perceived separateness from the rest of the Eastern and Southern United States, is especially relevant in contemporary times of remarkable social division. Healthcare disparities, income inequality, and extensive exploitation of Appalachian communities by outside corporations have all contributed to distrust and frustration among their inhabitants. In the late 19th and early 20th centuries, a large number of Appalachians sold their rights to land and minerals, leading to a massive disparity in ownership and control of the land. Ninety-nine percent of the residents of Appalachia control less than half of the land — despite the area’s vast natural resources, inhabitants remain poor (Hurst).

The Appalachian region has had a higher poverty rate and a higher percentage of working poor than the rest of the nation since at least the 1960s, in addition to low wages, low employment rates, and low-quality education. To address this, the Appalachian Regional Commission (ARC) was established in 1965, as a joint effort of ten governors of Appalachian states seeking federal government assistance. Still, by 1999, nearly twenty-five percent of the four-hundred twenty counties in the region qualified as “distressed”, the ARC’s lowest status ranking. Fifty-seven percent of adults in central Appalachia did not graduate high school, compared to less than twenty-percent for the rest of the United States. According to ARC, thirty-three percent of Appalachians suffer from poverty and their income was twenty-three percent lower on average than the level of American per capita income. There has been some improvement, however, with levels of economic distress reaching lows not seen since before the recession in 2007 (ARC.gov).

graph of distressed counties in appalachia — Number of distressed counties in Appalachia by year

In addition to economic inequalities, political inequalities are present in Appalachia. Racial divisions have often been stoked to divide workers and pit races against each other. During Reconstruction, the period after the American Civil War in which Southern states were radically reformed, coal corporations discouraged education and civic action, forcing workers to become indebted to company stores, live in company housing, and generally become vulnerable to their employers. Community members regularly experienced punishment as a reprisal for speaking out against their employers. In his study of culture and poverty in Appalachia, Dwight Billings suggests that this has resulted in a fatalistic attitude in the Appalachian people, based on a history of political corruption and disenfranchisement, leading to a sense of powerlessness.

The plight of the Appalachian people is deeply ingrained in me and will remain always of academic and personal interest. My own paternal kin originally settled in the Appalachian Mountains in North Carolina after arriving in America. As far as we can tell, my ancestors passed through the Cumberland Gap in the mid-eighteen-hundreds or earlier, finally homesteading in the foothills of the Appalachian Mountains on Sand Mountain, in northeast Alabama. On the other side of my family, my maternal ancestors shared many of the same challenges living as sharecroppers and later as miners in north-central Alabama. Eventually, both sides of my family came to work in blue-collar industrial jobs in mining and steel-work, industries that would become encumbered by the same failures, oppression, and corruption that were endemic in their Appalachian cousins. My great-grandfathers and my paternal grandfather were heavily involved in the labor movement in the American South and leaders of rights-protecting unions, such as the United Mine Workers of America and United Steelworkers, even as those same unions fell into disorder and ineffectiveness.

My research has indicated that one of the best ways we could better protect workers and their human rights would be to focus on the renewal of unions in the Southern and Appalachian Regions of the United States. Unions have been shown to raise wages, reduce wage inequality, and protect rights for workers. Higher rates of unionization and collective action generally tends to be an indicator for greater respect of human rights in industry. After declining membership from its peak in 1954, a once-thriving union movement had shrunk to nearly a third of its size by the turn of the 21st century.

graph of union membership — Union membership in the US, 1930-2010.

Corresponding with this drop in membership, middle class incomes shrank accordingly. The Labor Department did report the first increase in union memberships in twenty-five years in 2007, which was also the largest increase since 1979, but it appears that this was a short-term gain in the larger scheme of things. Taking a broader look shows that from 1983, union membership has been on a steady decline.

chart of union membership — Union membership by category, 1983-2018

One silver lining is that there seems to be a slight turning of the tide among women and Black people, whose membership in unions is stabilizing at least, if not increasing slightly. If unions are meant to preserve and protect the rights of workers, it should inspire some optimism that some of the most vulnerable workers, BIPOC and women, are seemingly joining unions at higher rates than other demographics.

In a series of blog posts for the Institute for Human Rights, I will explore some of these challenges with which the Appalachian region are faced — workers’ rights challenges and the possibility of renewal for unions, socioeconomic disparity and the ensuing human rights failures in the region, and the political inequalities that are especially present in the region. In my next post, I will tell the story of the Battle of Blair Mountain, and describe the ways corporations have exploited workers and prevented unionization in the past. We will analyze how these barriers affect workers’ rights in some of the most vulnerable populations in America.

References:

Hurst, Charles. (1992). Inequality in Appalachia. Social Inequality: Forms, Causes, and Consequences, 6th Edition. Pearson Education. pp 62-63.
Speer, Jean Haskell (January 1, 2010). “Appalachian Regional Commission”. Tennessee Encyclopedia of History and Culture. Nashville: Tennessee Historical Society and University of Tennessee Press.
Denham, Sharon. Mande, Man. Meyer, Michael. Toborg, Mary. (2004). Providing Health Education to Appalachia Populations. Holistic Nursing Practices 2{X)4:I8(6):293-3O1.
“ARC History”. Arc.gov. Appalachian Regional Commission. Retrieved July 12, 2020.
Duncan, Cynthia Mildred. (1999). Civic Life in Gray Mountain. Connection: New England’s Journal of Higher Education & Economic Development, Vol. 14, Issue 2, Retrieved July 12, 2020.
Billings, Dwight. (1974). Culture and Poverty in Appalachia: a Theoretical Discussion and Empirical Analysis. Social Forces vol. 53:2. Retrieved July 12, 2020.
Madland, Walter, and Bunker, “As Union Membership Rates Decrease, Middle Class Incomes Shrink.”, AFL-CIO, May 24, 2013.
Freeman, Sholnn (January 26, 2008). “Union membership up slightly in 2007; Growth was biggest in Western states; Midwest rolls shrank with job losses”. The Washington Post. p. D2