Echoes of Appalachia

In a lot of places across Appalachia, healthcare isn’t a right—it’s a gamble. You weigh your options carefully: Can I afford to see the doctor this month, or do I just hope this chest pain goes away on its own? Should I fill my prescription, or should I buy groceries and heating oil instead? For a region that’s given so much—coal, timber, labor, and culture—it sure gets the short end of the stick when it comes to healthcare.

The Politics of Neglect

Healthcare in this region has always been political. Whether it’s Medicaid expansion, the price of insulin, or the closure of rural clinics, nearly every healthcare issue in Appalachia is tied to a vote someone cast in a distant capital. And most of the time, that vote doesn’t benefit the people in the hollers, on the mountain ridges, or in the forgotten backroads of these counties.

Several Appalachian states refused to expand Medicaid, even though it would’ve given thousands of people access to basic care. That decision alone has had deadly consequences. Folks who would’ve qualified for coverage under expansion now go without it. Some are just over the income limit for assistance but nowhere near able to afford private insurance. Others work jobs that don’t offer benefits at all.

In places where the nearest clinic is an hour’s drive and the nearest hospital even further, people don’t just suffer—they’re ignored. Politicians promise change during campaign season, but once elected, they focus their attention on cities and swing votes. Appalachia rarely gets a seat at the table. And when money does show up, it’s often too little, too late—or gets eaten up by administrative costs and red tape.

Medicine You Can’t Afford

One of the most heartbreaking realities here is how many seniors are forced to ration their medications. Social Security barely covers the bills, let alone a $400-a-month prescription. So they cut their pills in half, skip days, or go without entirely.

You hear it all the time: “Doc said take one every day, but I make it last longer that way.” It’s not a choice anyone wants to make—it’s the only one they’ve got.

It’s not just the elderly, either. Working-age folks with diabetes, high blood pressure, COPD, or other chronic conditions are doing the same thing. When you’re uninsured or underinsured, even a basic prescription can put you in the red. And forget about specialty care—seeing a heart doctor or endocrinologist might mean driving 100 miles and paying hundreds of dollars out of pocket.

Food Deserts and Obesity

Obesity is a crisis in Appalachia. But it’s not because folks here are lazy or don’t care—it’s because fresh, healthy food is hard to come by. Many rural areas are food deserts. The nearest full grocery store might be miles away, and even then, the prices are steep. Gas stations and dollar stores are often the only nearby options, and they’re not selling kale and salmon. They’re selling boxed meals, sodas, and processed snacks.

When your budget is tight, you don’t pick the healthiest food—you pick what fills the most bellies for the least money. And when that cycle continues for years, it leads to serious health issues: diabetes, heart disease, joint problems, and more.

And even if someone wants to eat better or exercise, they’re often working two jobs or caring for grandkids. Add in the lack of sidewalks, parks, and gyms, and the odds are stacked even higher.

Closing Hospitals, Opening Wounds

Rural hospitals are closing at an alarming rate. In some counties, the only emergency room shut down years ago. That means if someone has a heart attack, stroke, or serious injury, they may not survive the drive to the next closest facility.

That’s not an exaggeration—it’s reality. People are dying not because their conditions are untreatable, but because help was too far away. And when a hospital closes, it doesn’t just take away emergency care. It takes away jobs, maternity care, specialists, physical therapy, mental health support, and a safety net for the entire community.

Mental Health: A Silent Emergency

Mental health struggles are everywhere in Appalachia. Depression, addiction, and anxiety are often untreated, either because of stigma or lack of access. There are counties with no therapists, no inpatient care, and no one to call when the walls start closing in. The opioid crisis hit this region hard, and the scars are still fresh. But while the media moves on, families here live with the fallout every day.

A System That Doesn’t Work for Us

Appalachians are used to making do. They’ve been patching holes in the roof, in their boots, and in their health for generations. But it shouldn’t be this way. No one should have to decide between taking their medicine or keeping the lights on. No one should have to suffer in silence because there’s no doctor within 50 miles who takes their insurance—or any insurance at all.

It’s easy for people outside the region to make assumptions or throw around phrases like “personal responsibility.” But when the system is broken from the top down, when resources are stripped away, and when leaders ignore the people they’re supposed to serve, the blame doesn’t belong to the folks struggling to survive.

It belongs to the ones who could fix it and choose not to.