By: Marcus J. Hopkins
In March of this year (2020, in case this is being read in some post-apocalyptic hellscape where Internet access has finally been restored), I attended a conference in Raleigh, NC, along with CEG’s Founder & Executive Director, A. Toni Young. The day before we got on the plane, we both conferred over the phone:
“So…have you heard anything about this conference being cancelled,” asked Toni.
“Nope, which actually surprises me, given that this is a conference about preventing the spread of infectious disease among People Who Inject Drugs (PWIDs),” I relied.
“Well, you’re still going, right?”
“Unless you tell me that we shouldn’t go, I plan on being there,” I hedged.
“I’ll see you, tomorrow.”
By the day the conference was scheduled to end, the organizers had fundamentally changed the final day’s activity to discuss COVID-19, and the fact that many of us were headed back to states where the public health infrastructures were not prepared to deal with a pandemic outbreak – Kentucky, North Carolina, Tennessee, Virginia, and West Virginia. Outside of the handful of urban areas, once you get outside the suburbs, access to healthcare in Appalachia becomes not only scarce, but virtually non-existent.
But our discussions on that final day weren’t about the spread of COVID-19, itself, but how potential shutdowns were going to impact the lives of those whom our organizations were committed to serving.
When looking at rural and suburban areas where opioid (and occasionally meth) addiction is high, there are certain factors that tend to coalesce to create an environment ripe for the growth of addiction: lower incomes, higher rates of unemployment, areas where industries have left, lower levels of educational attainment, less access to economic resources, and areas where industries that require hard labor are the drivers of the economy (Office of Disease Prevention & Health Promotion, 2020).
Those factors essentially are Appalachia.
An economy built upon hard labor? Coal mining, logging, and agriculture.
Areas where industries have left? Coal mining’s not quite dead, yet, but it’s been dying for decades, and the fossil fuel industry’s hold on this part of the country is lessening, every day.
Lower levels of educational attainment? For the percentage of residents reporting less than high school completion, Kentucky (15.5%), Tennessee (14.2%), and West Virginia (14.4%) all have percentages of their population higher than the national average (13.1%) (Appalachia Regional Advisory Committee, 2016).
Less access to economic resources? Most of Appalachia is typified by bucolic scenery, the majority of which is geographically isolating.
Lower incomes? While the national poverty rate is 15.6%, the combined Appalachian regions of Alabama, Kentucky, Tennessee, Virinia, and West Virginia is 19.7% (Federation of Appalachian Housing Enterprises, n.d.).
When I brought my last partner, a born and bred Los Angeleno, to West Virginia to visit family over the holidays, in 2010, we drove up from Tennessee, through Virginia and West Virginia, to get to Morgantown. Along the way, he got an education in what “poverty” means, in Appalachia, versus Southern California.
For him, his perception of poverty existed in an urban desert: rundown apartment complexes, neighborhoods whose shopfronts were mostly boarded up or empty, and food being bought from “liquor stores,” because grocers had long since departed the area.
While driving through Preston County, WV, he turned to me and asked in horror, “Is that a shack?!”
“No…that’s someone’s home, and they likely have neither electricity, nor running water.”
Many of the clients served by 501(c)(3) organizations, Community-Based Organizations, and other non-profits in Appalachia live in these kinds of conditions. Whenever I go to conferences on HIV, Viral Hepatitis, and other infectious diseases, I keep trying to explain to people that the numbers coming out of West Virginia (e.g. – the highest rates of new Hepatitis B and Hepatitis C infectious in the U.S. per 100,000) are only a fraction of the story.
Because of the geographically isolated nature of Appalachia, there are tens of thousands of residents who are not reached for testing, alone, much less treatment. This is where small, community-based organizations – Rural Health Service Providers (RHSPs) – come into play. They serve as the links that get isolated populations to services, or, in most cases, take those services to the isolated.
So, when shutdown protocols were being announced, we immediately predicted two outcomes:
- Feelings of social isolation would increase, driving many people to overindulge in drugs, thus increasing the number and rate of overdose deaths;
- Delivering services to these people would become both more vital, and more difficult to achieve, as the delivery model largely depends upon isolated people coming to more central areas to access services (meaning that house calls would become necessary.
Though both predictions came to fruition – overdose deaths did increase, particularly in Appalachia – the second issue has proven to be the most difficult to overcome.
The issue that exists, for many of these small groups, is that their entire operations often rely upon both volunteers, and individual donations, meaning that there are no consistent sources of revenue. A lot of these organizations are put together by local people doing their best to bring resources to local residents, and they all have day jobs. In the past month, I received an E-mail from one of these organizers asking for a personal donation; another organizer told us that her group received a grant of $350 to purchase supplies.
$350 is awesome, but it falls extremely short of what is needed to combat the problem.
Moreover, while the people who organize these groups have hearts full to bursting and are dedicated to their missions, what they often lack are the kinds of resources they need to apply for and receive private and federal grant monies that could support their organizations.
Whenever federal funds are allocated for use in “rural health,” they are almost instantly gobbled up by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Look-a-Like (LALs) who have staff members whose jobs are dedicated to finding, applying for, and receiving grants.
So, how do these organizations compete?
Right now, they largely don’t, and that is a serious problem that CEG, along with TruEvolution, Inc. (Riverside, CA), is trying to address.
In the coming month, we will be unveiling a new national project that is aiming to create a way for these organizations to access federal, state, and local funds that would allow them to build, repair, expand, modernize, and mobilize their operations to meet clients and patients where they live, rather than expecting them to travel to urban areas to access services.
That’s all I can say, right now, but look forward to this unveiling in the coming weeks, because I think this one has a lot of great potential.
Appalachia Region Advisory Committee. (2016, October). Identifying and Addressing Regional Education Needs, Figure 1. Educational attainment by state, 2014. A-1. Washington, DC: United States Department of Education: Appalachia Regional Advisory Committee. Retrieved from: https://www2.ed.gov/about/bdscomm/list/rac/appalachian-region.pdf
Federation of Appalachian Housing Enterprises. (n.d.) Appalachian Poverty. Berea, KY: Federation of Appalachian Housing Enterprises: Appalachian Poverty. Retrieved from: https://fahe.org/appalachian-poverty/
Office of Disease Prevention and Health Promotion. (2020). Substance Abuse Across the Life Stages. Washington, DC: United States Department of Health and Human Services: Office of Disease Prevention and Health Promotion: Leading Health Indicators: 2020 LHI Topics: Substance Abuse: Life Stages & Determinants. Retrieved from: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Substance-Abuse/determinants
Disclaimer: Blog posts on CEG’s Community Perspectives blog do not necessarily reflect the views of the Community Education Group, its grantors, its corporate sponsors, or its organizational partners, but rather they provide a neutral platform whereby each author serves to promote open, honest discussion about issues specific to their personal expertise, lived experience, and perspective. Please note that some of the content on Community Perspectives may be graphic due to the nature of the issues being addressed by the author.