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Appalachian health

Mountain Air: Youth Help Identify Causes Of Ohio Valley’s High Lung Disease Rates

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Participants documented many exposures to cigarette smoke. Kentucky and West Virginia have the nation’s highest smoking rates. Photo: Courtesy of the Mountain Air Project

This article was originally published by Ohio Valley ReSource.

Isabella Back, 18, pulls her jacket tight around herself as she crosses the gravel driveway. “So we’re going about 10 feet from my house to my dad’s workshop,” she says, and pushes through a door in a big, red barn.

The Kona, Kentucky, shop is crowded with cluttered work tables and hulking machines, and the sound of whirring and grinding fills the air. The shop smells of paint and other chemicals. Back’s dad, Rod, started this metal fabrication shop after he got laid off from coal mining. He mostly makes signs for local businesses. He waves a friendly hello.

Isabella Back at her father’s workshop in eastern Kentucky. Photo: Sydney Boles/Ohio Valley ReSource

“He uses so many chemicals to paint the metal, strip the metal, stuff like that,” Back said. “It scares me a little bit, because I don’t want him to get sick.”

Back documented the shop for the Mountain Air Project, a study with the University of Kentucky that explores potential environmental contributors to lung disease in the southeast corner of the state.

Spray paints in the Back’s workshop. Photo: Courtesy of the Mountain Air Project

According to the Centers for Disease Control and Prevention, 15 percent of adults in Letcher and Harlan Counties reported having an asthma diagnosis, compared to 8 percent nationally. Rates of COPD were also higher in eastern Kentucky.

Higher rates of smoking explain some of that disparity, said Mountain Air Project manager Beverly May, but not all of it. “The question from a research perspective is,” May asked, “what other things might be contributing to the disease, and could it be our environment?”

In addition to an epidemiological study, researchers employed a research practice called Photovoice, which asks people in a given community to use photography to share their experiences and perspectives with researchers who are typically not from that community. After receiving photography lessons from esteemed Appalachian photographer Malcolm Wilson, 10 young people between the ages of 12 and 18, all attending Letcher County schools, set out with digital cameras to document contributors to lung disease in their communities.

“To our knowledge, this is the first Photovoice project in the Appalachian region to specifically involve youth focusing on environmental health,” said University of Kentucky researcher Katie Cardarelli.

Health vs. Livelihood

Researchers analyzed the students’ photographs to identify larger themes that might have gone unnoticed in a traditional health study. One such theme was the choices many east Kentuckians have had to make to earn a living.

Several photographs expressed deep concern for the dangers that coal mining posed not only to individual coal miners, but to whole communities exposed to particulates from resource extraction. One student submitted a photo of a coal-transport railroad visible from their backyard. “Our area has been coal country for years,” wrote the student photographer, “exposing us to things that people in most parts of the country are not exposed to.”

Participants were also concerned about coal dust exposure. Photo: Courtesy of the Mountain Air Project

Several earlier studies show a higher incidence of disease in communities near large-scale strip mines. This one, however, did not. UK researcher Jay Christian said his analysis of the current contributors to lung disease did not point to environmental exposure from coal mining or oil and gas drilling. “We’re not finding clear evidence of population-level exposures that appear to be driving the high rates of lung disease,” Christian said. But previous exposure may still have contributed to current instances of disease.

“Coal mining has decreased very rapidly in the region,” he said. “So it’s hard to know how airborne particulate levels in the region now compare to those 20 years ago.”

Occupational exposure to coal dust remains a significant factor in the region, with rates of black lung disease skyrocketing in recent years.

Cultural Legacies 

“There were a lot of photos that our participants shared with us that took place on porch settings,” Cardarelli said. “A lot of these youth talked about, for example, if they wanted to spend time with their families, that might have to occur on a porch where a lot of smoking was going on.”

Smoking rates in Kentucky are among the highest in the nation, behind only Guam and West Virginia.

Kentucky had the dubious distinction of placing three counties among the country’s top 10 for highest rates of smoking in 2012. Eastern Kentucky’s Clay County had a smoking rate of 37 percent. In Letcher County, where Back lives, 30 percent of adults smoked cigarettes.

Credit: Alexandra Kanik/Ohio Valley ReSource

Back said the health impact of smoking weighed heavily on her. “It’s not just second-hand smoke you’re exposed to; you’re exposed to that way of life,” she said.

Back recalls an instance from when she was 17, driving home with a member of her family who smokes. The pair stopped at a gas station, and Back wanted some water and some chips. But she knew her family member only had enough money for gas and a pack of cigarettes. So she kept silent. “I didn’t want them to not be able to get their cigarettes,” she said. “I didn’t want to inconvenience them like that.”

Back documented the incident in a photograph for the study. In the image, a package of cigarettes lies open on a table next to a scattered handful of coins.

“It’s not an everyday thing for me to choose between food and a pack of cigarettes, but I know for so many people in eastern Kentucky, it is,” Back said.

An image Isabella Back provided for the Mountain Air Project.

A Voice’s Value 

The Photovoice project wasn’t the only part of Mountain Air to use alternative research methods. The researchers collaborated with a community advisory board made up of east Kentucky residents to make sure local people’s perspectives were taken into account.

Roy Silver is a professor at Southeast Kentucky Community and Technical College, and he served as the chair of the advisory board. “Frequently, when researchers want to research what’s going on here in the mountains, they don’t work with the local people to figure out what are the best ways to do that, and also how to take that research and make it of use to people locally to improve the quality of life.”

One day in 2014 when researchers and community members were gathered together on someone’s porch, they stumbled upon a novel approach to collecting and analyzing: Hollers.

Those narrow valleys, with their central streams and single-access roads, define the mountain way of organizing communities.

“Wouldn’t you think, if you’re concerned about environmental exposures, that the people who all live in the same holler would have pretty much the same exposure? And that’s just us talking as hillbillies,” researcher May said.

Back at the University of Kentucky, Christian took the idea and found that where county-level environmental health averages may obscure variations of exposures, hollers corresponded neatly with federally recognized 14-digit hydrologic unit codes – that is, small segments of creeks and streams that all lead into the same body of water.

“They tend to be formed around these little valleys and areas with little creeks running down them, which is why they line up so well with hollers,” Christian said.

May said innovations like that, coupled with the community involvement, meant that the project “helps us dig down into how people really live.”

The community advisory board also suggested including local young people in the research.

Although the Mountain Air project considered Photovoice an “exploratory study,” students identified factors contributing to poor air quality that the researchers might not otherwise have considered. Students photographed citronella candles, moldy showers, dusty air vents and heavy pollen. Those factors are unlikely to be significant contributors to eastern Kentucky’s higher rates of lung disease, Cardarelli said, but the researchers may include at least some of them in a second iteration of its household survey.

“My colleagues and I were so impressed with the youth participants from Letcher County,” Cardarelli said. She hopes to involve youth in the next Mountain Air project, and is already working to involve young people in some data collection. “They clearly have a role in the future to make their communities better.”

Mountain Air Project participant Isabella Back at her Letcher Co., KY, home. Photo: Sydney Boles/Ohio Valley ReSource

The project brought lasting value to participant Back. “I don’t think there’s a lot of young people to talk about things like our environment,” she said. “You don’t have a class in high school to teach you to speak up about things like this.”

Now a freshman at Georgetown College in central Kentucky, Back hopes one day to move home to help the community move forward. “I feel like I have a greater appreciation for using my voice as a young person, because people will listen to you, and people will take your ideas and your perspectives into account.”

The youth Photovoice study was published in October in the International Journal of Environmental Research and Public Health. An article on the novel use of hollers for conducting epidemiological research will be published this month in the Journal of Progress in Community Health Partnerships. The full epidemiological study is forthcoming.

Appalachian health

Tobacco Use Among High School Students is Skyrocketting. The Likely Culprit is E-Cigarettes.

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Republican state Sen. Brandon Smith speaks to a legislative committee in Kentucky with some students from Johnson County Middle School on Wednesday, Feb. 27, 2019, in Frankfort, Kentucky. The students asked lawmakers to pass a bill that would set up an anonymous tip line for students to report when other students are vaping or using e-cigarettes at school. After their testimony, Republican Sen. Steve Meredith vowed to amend the bill to ban all e-cigarettes and vaping products for anyone under 21. Right now, the smoking age is 18. Photo: AP Photo/Adam Beam

In one year, from 2017 to 2018, tobacco usage among American youth skyrocketed by almost 40 percent. The culprit? E-cigarettes. 

The trend reverses decades of public health efforts to combat tobacco consumption, which alarms people like Mercer County Commissioner Greg Puckett. 

At his office, Puckett pulls out a box filled with tobacco products confiscated during one month this spring at a local high school. 

“So we’ve got Juul pods here, we’ve got snuff of course, we’ve got a couple packs of cigarettes, just a lighter, some additional juice that goes into the vapes.” He sifts through the contents with a hand, holding up some of the items one by one.  

County commissioner Greg Puckett in his office at Community Connections in Mercer County. Photo: Kara Lofton, West Virginia Public Broadcasting

“And this is just indicative of the one school,” he said. “Now we know other schools use products more and it’s not like these are the only ones — these are just the ones that got caught.”

Both in and out of school suspensions related to tobacco products doubled from 2016 to 2018 in West Virginia, according to the Department of Education. It is worth noting the coding doesn’t break out vaping-specific data, but anecdotally e-cigarettes are responsible for the uptick. 

Puckett points to a cartridge filled with liquid containing flavor and nicotine — called a Juul pod that looks, to the untrained eye, not dissimilar to a USB drive. Which most older teachers, assume it is. 

“So the whole philosophy is to make it as accessible as possible, as concealable as possible,” he explained. 

The rate of kids in America using vaping devices between 2017 and 2018 grew from about 30 percent of high school kids to almost 40 percent.

There isn’t data specific to West Virginia yet for the same time period, but anecdotally, the problem is just as bad, if not worse here. 

Credit: Courtesy of the West Virginia Department of Education

“We have a tobacco class once a year that if you get caught with tobacco products on school property, you have to go to this class and I think this year there was like 150 kids who had to attend,” said Bailee Darago, a 16-year-old student at Princeton Senior High School. Her high school only has about 300 kids. 

School officials didn’t respond by time of publication to verify that statement.

But in an email, a representative from the West Virginia Department of Education said there isn’t a specific course code for tobacco/nicotine discipline consequence classes, but school staff can refer students to a tobacco cessation program if they’re caught with tobacco on school property.

In Mercer County, West Virginia, where Princeton Senior High School is located, referrals to the cessation program increased from 1 in 2017-18 to 24 the following year. 

Credit: Courtesy of the West Virginia Department of Education

“You know over [the] years, and the last 15-20 years, we were seeing tobacco use decline among our youth and really seeing some dramatic progress in that arena, which was so exciting,” said Dr. Catherine Slemp, the new West Virginia commissioner for public health. “But with the introduction of vaping and e-cigarettes and Juuls, that students really think of as not a problem or that it’s cool to do that, we are reversing that trend dramatically. That has really significant long-term implications.” 

E-cigarettes hit the market in the early 2000s, but an e-cigarette product called Juul, launched in 2015,  has taken the industry by storm — mostly by marketing itself as a sleek, low-profile way to quit smoking. 

While some people might benefit from switching from cigarettes to e-cigarettes, Slemp said for kids, e-cigarettes can have the opposite effect. 

“When teenagers begin to use tobacco at an early age, they are far, far, far more likely to become lifelong smokers,” said Slemp. “Because the brain is still developing, it’s developing its connections and how it works, when we’re young and into our early 20s actually. And so it actually changes the chemistry and the addiction of the brain. So by youth having access to these products we are addicting our next generation to tobacco at higher rates than ever.” 

Bailee Darago (16), Audrie Helmondollar (17) and Naomi Gills (15) pose in front of Community Connections in Mercer County. All three are members of the anti-substance abuse program Students Against Destructive Decisions. They say since they began high school two-three years ago, kids have started vaping in class, in the hallway, in bathrooms and after school. Photo: Kara Lofton, West Virginia Public Broadcasting

A 2018 study from West Virginia University School of Medicine found that if teenagers vape into adulthood, the cardiovascular effects are just as bad as if they’d smoked cigarettes. 

Of course, kids often don’t think that it’s a big deal. 

“I think that people think that vaping is actually safer than actually smoking and that’s not the case,” said 16-year-old Darago, who is a member of the anti-substance abuse program Students Against Destructive Decisions. 

“The science says that one Juul pod contains as much nicotine as a pack of cigarettes and the flavoring has chemicals in it that’s also harmful to your body,” she said. 

Upstairs at Community Connections, commissioner Greg Puckette reads a label aloud as he begins putting the box of confiscated tobacco products away.

“Candy king, on salt. It’s sweetish, you can take it and smell it, it’s got a particular flavor to it. If I can get it open…so you can see it’s a very sweet smell and of course it’s very attractive to someone who’s young and says ‘Oh, that’s just like candy — it’s got it even here — candy king on salt!’” 

There’s also a warning that says, “this product contains nicotine, nicotine is an addictive chemical.” But Puckett said kids don’t pay any attention to it.

“Because young people think they live forever.” 

Yet health commissioner Slemp says tobacco has massive economic consequences for the state.

“We spend in West Virginia a billion dollars a year on tobacco-related health care costs alone, another billion dollars on productivity loss.”

In an effort to curb the epidemic of youth vaping, San Francisco just became the first U.S. city to ban the sale of e-cigarettes. Students like Darago say laws in West Virginia don’t discourage vaping at all.

“It’s easier for high school students because high school students are turning 18 and it’s legal for them to do stuff like that, but it’s still not safe.” 

In the past legislative session, the state Senate did pass a bill that would raise the minimum tobacco age to 21. It died in committee in the House. 

This article was originally published by West Virginia Public Broadcasting.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

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Appalachian health

Amid Measles Outbreaks, Debate Grows Over Religious Exemptions from Vaccination

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Measles, mumps and rubella vaccines are seen in a cooler at the Rockland County Health Department in Pomona, N.Y., Wednesday, March 27, 2019. Photo: Seth Wenig/AP Photo

This article was originally published by the Ohio Valley ReSource.

Toni Wilkinson has seven children, three of them under six, and all of them home-schooled. So her house on a Lexington, Kentucky, cul-de-sac is rarely quiet.

Listen to the story.

Just inside the front door are bins filled with shoes, piles of jackets on a long bench. Across the room is the family library, crammed with school books. Crowded among them are controversial titles critical of vaccinations, the books Wilkinson used in her own homework researching vaccines.

“I just started to have questions, it was just this lingering doubt that I can’t really explain,” she said.

Toni Wilkinson said faith guided her decision not to vaccinate her three youngest children. Courtesy: Toni Wilkinson

As those doubts grew over the years, vaccinations for her children decreased. Her two oldest children are fully vaccinated. The next two received the required shots only until middle school. Her three youngest are not vaccinated at all.

Wilkinson said her faith ultimately informed her choice. She learned that stem cell tissue from abortions had been used to produce some vaccines.

“And so that became a big issue for me because we’re very pro-life,” she said.

Kentucky is among 47 states that allow some form of religious exemption from vaccination requirements for children to attend public schools. Kentucky is also among 22 states that have reported cases of measles this year.

Two decades after the U.S. had essentially eliminated measles, the viral disease is roaring back. Health officials recently reported nearly 700 cases of measles in the U.S., the most in 20 years, and they point to a growing trend against childhood vaccination as a cause. Some measles outbreaks in New York and Ohio have been associated with religious communities opposed to vaccination, and that has intensified the debate about religious exemptions.

Kentucky and neighboring states in the Ohio Valley provide a case study and the potential for some timely lessons on the public health implications of vaccination exemptions. While Kentucky and Ohio allow the exemptions, West Virginia does not.

Vaccine History

According to the Centers for Disease Control and Prevention, a few vaccines were developed using human cell cultures derived from two legal abortions in the 1960s. Researchers maintain those cell lines in laboratories and no additional fetal tissue has been added since they were originally created.

A 3D graphical representation of a spherical-shaped, measles virus particle. Courtesy: CDC

But Wilkinson’s concerns resonate with others who staunchly oppose abortion.

Kentucky and Ohio allow parents with religious objections such as these to enroll a child in school without proof vaccination. West Virginia does not.

“West Virginia started having state laws about vaccines in the late eighteen hundreds and there’s never been any type of religious or personal belief exemption in our laws,” said Jamie Lynn Crofts, a civil rights attorney in Charleston, West Virginia. She said with its 98 percent vaccination rate, well above the national average, West Virginia could be a model for other states.

“Looking at our scheme and how effective it’s been could be a great guide to states who are looking to reform their laws to stop outbreaks in the future,” she said.

Vaccination rates in Kentucky and Ohio are 92.6 percent and 92.1 percent, respectively, both below the national median rate of 94.3 percent.

Crofts said how you feel about vaccination can depend on when you were born. Most Millennials, for example, have no personal experience with measles and may not see it as a threat.

The CDC reports that before the measles vaccination program started in 1963, an estimated 3 to 4 million Americans got measles each year. Only about 500,000 cases were reported each year to the CDC. Of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles.

While the current outbreak seems insignificant against those historic numbers, health officials are concerned. The public health benefit of a vaccination depends in part on what’s called “herd immunity,” achieved only when a high percentage of vaccination keeps the disease at bay. A study from Oxford University found that 19 out of 20 people need to be vaccinated to maintain herd immunity against measles.

Religious Reservations

No major American religion explicitly seeks to forbid vaccines. Some within the Catholic church encourage vaccination. But a subset of church members like Wilkinson reject vaccines on moral grounds because of the past use of fetal cells in some vaccine development.

That religious belief is a key part of a lawsuit brought by the parents of a student at Assumption Academy, a private school in northern Kentucky. Most of the students were not vaccinated, resulting in a recent outbreak of 32 cases of chickenpox. When the Northern Kentucky Health Department curtailed school activities to curb the spread of disease, some students and parents sued, arguing that it violated their rights. The school posted a press statement on the outbreak on its website explaining its beliefs about the vaccine.

“While the Catholic Church does not oppose vaccinations in principle, it does consider as morally illicit the development of vaccines from aborted fetal tissues,” the statement read.

It’s not the first time outbreaks have been linked with a specific religious community.

The CDC connected unvaccinated members of the Amish communities in Ohio to the last record-breaking outbreak in 2014. Researchers found that people in those communities made up nearly half of the cases in the national outbreak.

Dr. James Gaskell is commissioner of the Athens City-County Health Department in Ohio. He remembers that the 2014 outbreak had a lingering impact on the Amish community.

The Amish were resistant to vaccination at first. But, he said, after a few cases of measles, when they recognized the severity of the disease, some changed their minds and began to immunize their children.

Gaskell said that outbreak began after Amish men traveled to the Philippines, which still has a high number of measles cases.

A current measles outbreak in New York has similar origins, Gaskell said. Orthodox Jewish men traveled to Israel and some returned infected with measles, which spread into their community where many others are not vaccinated. The New York outbreak has sparked debate over limiting or eliminating religious exemptions there.

Law Changes

In Kentucky and Ohio, lawmakers are moving in the other direction even though both states have vaccination rates below the national average.

“There has not been any talk about eliminating exemptions to vaccines in Kentucky that I’m aware of at this point,” Kentucky’s Public Health Commissioner Dr. Jeffrey Howard said.

Howard said he supports vaccines and that there are a lot of misunderstandings and myths surrounding them. But, he says, Kentucky is a place where people want to protect personal liberties such as whether or not to vaccinate a child.

He said requests for exemptions are rising and lawmakers are making access to exemptions easier.

In 2017 Kentucky legislators removed the requirement that a physician must sign a request for a religious exemption. Now parents simply sign and submit a notarized form. A bill pending in Ohio would make similar changes to increase access to exemptions.

Dr. Scott Gottlieb was commissioner of the federal Food and Drug Administration from 2017 until earlier this month. He is now a resident fellow at the American Enterprise Institute.

Gottlieb said religious exemptions are on the rise along with the number of cases of measles.

“I think it would be highly unfortunate if we started to see governments take a more activist role, particularly the federal government, in terms of mandating vaccines, because I think these are issues that have long been held left to state supervision for a lot of good reasons,” he said.

Gottlieb said the surge in the number of infections reflects “a tragic reluctance to embrace what is one of our most effective and safest vaccines.” And that will soon force health officials to make tough policy decisions.

“We’re at the point right now where we’re starting to see outbreaks of such a scope that we are going to reach a tipping point and perhaps some point soon.”

Belief and Backlash

Toni Wilkinson is aware of the controversy around vaccination decisions such as hers.

Wilkinson said her decision has come with backlash, including conflicts within her family and, scathing comments on social media. She and her friends who have made similar choices have become wary of even discussing vaccines with people.

Amid the home school library at her house are books on vaccination like Miller’s Review of Critical Vaccine Studies. Photo: Mary Meehan/Ohio Valley ReSource

“You read some of the stuff that people say and it can get really nasty. Like, you know, ‘These people shouldn’t be able to have children if they’re not going to vaccinate them.’ It can get very ugly.”

She said she feels certain in her decision. “God places children in families for a reason,” she said. But she adds that she still has brief moments of doubt.

“I think there was still a little fear of like, what if my child got what is considered a vaccine-preventable disease, what am I going to feel?”

“I think there was still a little fear of like, what if my child got what is considered a vaccine-preventable disease, what am I going to feel?”

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Appalachian health

2019 County Health Rankings Cite Housing as a Foundation for a Healthier Future

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Overlook North, a 60-unit low-income housing tax credit family development built in 2002 in Oakland, Maryland. Photo: Courtesy Garrett County Community Action Inc.

Healthy living begins in the home. Secure, affordable housing is critical to living long and well.

That’s according to the recently released 2019 annual County Health Rankings, a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Ranking the health of nearly every county in the nation, the report’s authors write that their findings “illustrate how where we live affects how well and how long we live,” and underscore “what each of us can do to create healthier places to live, learn, work, and play – for everyone.”

The focus of this year’s report is housing. Health outcomes, the authors continue, “are shaped by a range of factors that are heavily influenced by where we live,” including our behaviors, access to care and nutrition and social and environmental factors.

If housing costs exceed 30 percent of monthly household income, that household is considered severely cost burdened. Nationwide, according to the report, more than one in 10 households spend more than half of their income on housing. This burden is associated with food insecurity, child poverty and self-assessments of poor health, according to the authors.

Communities across the country are rising to this challenge with comprehensive strategies that include housing rehabilitation loans and grants, rapid rehousing initiatives, mixed-income development and civic engagement.

One such is the Appalachian community of Garrett County, Maryland, where affordable-housing initiatives are not only meeting immediate needs but promoting economic development.

View west along U.S. Route 40 Alternate (National Pike) crossing into Garrett County, Maryland from Allegany County, Maryland. Photo: Famartin/wikimedia

One ‘Unforeseen Event’ from the Street

For Aliana Havrilla, a community coach with the County Health Rankings and Roadmaps program, the single-most disturbing statement in this year’s report is that hundreds of thousands of households are but one unforeseen event – an illness, a job loss or even just a drop in hours – from losing their home.

According to the report, in 2016 nearly 900,000 households faced evictions.

That so many families and individuals have such a tenuous hold on secure housing, Havrilla asserted, “is a conversation that we don’t often have, but that we should be having.” It’s a conversation this report aims to advance.

For those who are able to remain in their home, struggling to meet a mortgage payment often means foregoing medical care or extending a few groceries beyond their capacity to nourish, triggering a cascade of health concerns.

While no region or demographic has been immune, the researchers determined that half of all rural counties have experienced an increase in severe housing cost burden since the housing crisis of 2006 to 2010, and that nearly one in four black households spend more than half of their income on housing.

Garrett County is Maryland’s westernmost county, abutting the state’s West Virginia and Pennsylvania borders. According to the County Health Rankings, it ranks 15th among the state’s 24 counties in health outcomes, health behaviors and clinical care, and 17th in quality of life.

The Garrett County Community Action Committee is a private nonprofit agency that works to build economic security for lower-income families and households. Affordable housing has been an area of concerted focus.

Duane Yoder, the agency’s president, said that while the home-ownership rate in the county is high, much of the housing stock is mobile homes that are in poor condition.

“One of the things that’s happened is that the community has been successful in creating jobs,” Yoder said. The county’s unemployment rate was once three times that of the state and the nation; it’s now roughly equal to those rates. But many of those jobs are in the services industry, and the pay is moderate to low.

“What that does in terms of housing,” Yoder explained, “is that it has created what our economic-development people and the business community are saying is an absence of affordable workforce housing. That’s become the big economic-development issue in the county.”

Affordable workforce housing is housing that is considered to be reasonably affordable for moderate to middle-income workers.

A primary concern for Garrett County, like for so many rural Appalachian communities, is the aging of its population – young people leaving in search of more and better opportunities. A declining population has a ripple effect, with implications for a community’s health. It can make it more difficult to recruit health care professionals and result in the closing of the local hospital.

So the community asked itself, Yoder said, “Can we do something to promote affordable housing that is targeting workforce-level incomes, and see if that stabilizes the population – see if that creates a younger population with children and a new economic energy that comes out of the younger households.”

The county commission has appropriated more than a million dollars the past couple of years to the Garrett County Community Action Committee for a down-payment assistance program. The stipulation is that the house must be in Garrett County.

The groundbreaking for a 90-unit senior housing development called the Meadows at Mountain Lake, completed in 2017 in Mountain Lake Park, Maryland. Photo: Courtesy Garrett County Community Action Inc.

The community has also invested in mixed-income rental housing, with units available for different income levels.

So while striving to bolster its residents’ quality of life in the here and now, the community is aiming toward a healthier future.

“It’s an economic-development strategy trying to address the issue of the decline in our population,” Yoder said. “We’re using housing as a strategy to promote economic development.”

Reason for Hope

The County Health Rankings authors write that “when too much of a paycheck goes toward the rent or mortgage, it makes it hard to afford the doctor, cover utility bills, or maintain reliable transportation to work or school. Owning a home can help build savings, providing stability and wealth over time.”

This is the 10th year of the rankings, Aliana Havrilla notes. “What gives me hope, broadly, is that we have knowledge and understanding of what drives better health.” That knowledge is now being coupled with practical strategies, she said. “We see a lot of these promising approaches and ideas across the country.”

“We’re really starting to understand both the drivers and the opportunities. That’s what gives me hope.”

Taylor Sisk is 100 Days in Appalachia’s health correspondent.

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