Tuesday, November 1, 2011

Biocultural Perspectives on Appalachian Anthropology

My road to scholarly work in Appalachia has been bumpy with many turns along the way. In fact, if you had asked me two years ago if I thought I’d be working in the region I would have said “no.” However, sometimes we are just as surprised as our advisers, friends, and family members where our research takes us. This is a personal account of my intellectual journey and how Appalachian Studies plays an important role in my academic career.

Entering the Field
As a new anthropology PhD student in 2010, I was offered a funded graduate research assistant (RA) position in the department of behavioral sciences. A past graduate of the anthropology program, friend, and co-author of mine had recommended meeting with faculty outside the department when I visited the university before I had received my acceptance letter to the program. I am very glad I did meet with so many faculty that day, and that I apparently didn’t make a total fool of myself, because that opportunity has led me on the path that I follow today.

When I entered the program, my goal was to study malnutrition in Africa but my RA work took me to the hills of Eastern Kentucky to work on community-based participatory research (CBPR) health projects. What started as a very successful faith-based cervical cancer screening project evolved into multiple projects that now aim to increase cancer screening, fruit and vegetable intake, and physical activity while reducing body mass index (where appropriate) by reaching community members within their churches  (Schoenberg et al. 2009). Community-based participatory work often engages local communities with academics who strive for a partnership approach to research that result in high participation and program success as well as community capacity building (Israel et al. 2010). I had done CBPR work for a few years before starting with these projects in Eastern Kentucky but the work in Appalachia was somehow different, transformative. I became much more interested in the structural barriers to healthy living that I was witnessing in this remote, rural environment.

“They Made Themselves Fat”
Most public health work in the region (well in the nation, really) is frustratingly focused on individual behaviors, in what anthropologists usually refer to as “blaming the victim” (Moffat 2010) because individuals are blamed for making themselves unhealthy. This is most evident in the recent obesity “epidemic” discourse where lifestyle is a “choice” and unhealthy behaviors become conflated with risk factors that do not account for structural barriers to healthy living. Common misconceptions are that Appalachians do not know how to eat healthy, lay around all day and collect welfare, and so maybe they deserve the extraordinarily high rates of morbidity and mortality experienced in the region. For example, in 2008, 70% of Kentucky’s adults were overweight or obese, 30% of adults that had been screened had high blood pressure, 39% had high cholesterol, and 10% had diabetes, with even higher percentages existing in Eastern Kentucky counties (CDC 2008). But of course these percentages cannot include many of the rural residents who have not been screened or surveyed and these rates have been increasing in recent years.

Since individual food choices are often implicated in obesity and chronic disease research, I became interested in the other factors that contribute to unhealthy eating. For example, I am currently working on a project to measure the food environment in several Eastern Kentucky counties. This form of “ground truthing,” which involves visiting grocery and convenience stores to assess the food options (Sharkey and Horel 2008), has not been attempted in Eastern Kentucky and should allow us to evaluate access to grocery stores and the quantity and quality of healthy foods available to rural residents (Glanz et al. 2007). In this way, researchers can measure how far people must drive to get to to a store (which is of course difficult to impossible without a car or reliable public transportation), what kind of stores are within a reasonable driving distance (convenience, grocery, or dollar stores), and the types of foods that are available in these venues. Once this these barriers are measured and published, it should become difficult to blame low-income rural residents for eating poorly when the evidence indicates they must drive for 45 minutes to get to a grocery store with any produce.

“This is the Price We Pay for Living in the Mountains”
As a biocultural anthropology student, I am very interested in the role the environment plays in rural health. The environment limits access to healthy food and opportunities for physical activity. However, the environment itself can make people sick. This was especially salient for me working in Martin County, KY during the summer of 2011. With a number of other social science graduate students, I conducted survey research about the 2000 coal sludge spill that leaked over 300 million gallons of coal waste into the Coldwater and Wolf Creeks, which made it 30 times the magnitude of the Exxon Valdez spill (Scott et al. 2005). Receiving little to no national recognition, this coal sludge spill is implicated by community members in poor water quality, environmental degradation, and high rates of cancer in the region (Scott et al., forthcoming; B.M. Howell field notes).

What I found especially interesting about this follow-up research is that anger and distrust toward the coal companies has waned significantly over the past 10 years since the spill. Some people believe that things are back to the way they were before the spill, with a few commenting that things might even be better now that large-scale clean-up efforts have improved the local environment. A number of people were hostile to our research, stating that they were “friends of coal” and they didn’t want to take our surveys. One individual even commented that environmental disasters are the price they pay for their livelihoods in Martin County. Of course, that is not to mention that this livelihood makes Martin County one of the poorest counties in the state of Kentucky, Appalachia, and even the nation. In fact, as of May 2011 Martin County is ranked at 39 among the lowest income per capita counties in the entire nation. Only four of Kentucky’s 120 counties are poorer than Martin County (U.S. Census Bureau 2010).

It’s All about Structural Inequalities
These two disparate Appalachian research projects coalesce around issues of structural inequalities that lead to poor health. In Martin County, economic dependence on the coal companies has resulted in acceptance, and even some fatalistic attitudes, of environmental toxins. In southeastern Appalachian Kentucky, many people have little access to high quality and varied fresh produce and other healthy foods (this is probably true throughout Eastern Kentucky, but I am only working in the southeast). By revealing the underlying structures that create these inequities, many Appalachian researchers hope to eliminate victim blaming, especially when Appalachians have come to blame themselves for situations that they cannot fully control.
Both of these Appalachian projects utilize CBPR approaches to empower local communities to take action regarding their health and the environment. Althought access to healthy food and a toxin-free environment are basic human rights (United Nations 1948), many Appalachian communities are not granted these conditions. However, many Appalachian communities are willing and able to make changes that they deem important. I argue that the best research approach to research in the region is with CBPR which involves community members in all phases of the process, from formulating questions to data analysis, interpretation, and dissemination (Vaughn, Forbes, & Howell 2009).

Appalachia and Beyond
My work in Appalachian Kentucky has been integral for the development of my current research interests and future PhD dissertation work. Although I will be conducting dissertation research in Alaska, very similar issues of rural access to food and complex dietary decision-making link the two regions. In Alaska, these issues of food are complicated further by the harsh arctic environment and discourses of race involving the rights of low-income indigenous residents to continue obtaining traditional lifestyles and foods, such as seal and whale (Loring & Gerlach 2009). But, it is my work in Appalachia that helps me (begin to) grasp the structural inequalities in rural regions that I hope to investigate throughout my career.
Additionally, my work in the region has helped me find my roots. Growing up in the Detroit area, I was never really aware of my own heritage in the mountains. My father made a few references to family members “down south,” but it meant little to me because I had never met them. During my entire childhood I only visited relatives in Pikeville, KY once and all I remember is my brother having a pretty serious trampoline accident and my first encounter with wood ticks. However, working in Eastern Kentucky has helped me form a deeper relationship with my own father and to understand him and his family in a different way. In fact, his family was part of one of the major waves of migrations out of the mountains and into local industrial centers such as Cincinnati, OH and Detroit, MI (Obermiller 2004). Because he was not born in the mountains, my father was not aware of the term “Appalachian” and its current local meaning. We have had many interesting and rich conversations in the past two years due to my work in Eastern Kentucky. While it seems by accident that I ‘fell’ into Appalachian studies, it is for these and many more reasons that I am not struggling to get out of it.

Britteny M. Howell


CDC. 2008. Kentucky: Burden of Chronic Disease. Retrieved on 10/8/11 [link].

Glanz, K., J.F. Sallis, B.E. Saelens, and L.D. Frank. 2007. Nutrition Environment Measures Survey in Stores (NEMS-S): Development and Evaluation. American Journal of Preventive Medicine 32(4):282-289.

Israel, B.A., C.M. Coombe, R.R. Cheezum, A.J. Schulz, R.J. McGranaghan, R. Lichtenstein, A.G. Reyes, J. Clement, and A. Burris. 2010. Community-Based Participatory Research: A Capacity-Building Approach for Policy Advocacy Aimed at Eliminating Health Disparities. American Journal of Public Health 100(11):2094-2102.

Loring, P. A., and S.C. Gerlach. 2009. Food, Culture, and Human Health in Alaska: An Integrative Health Approach to Food Security. Environmental Science and Policy 12(4): 466-478.

Moffat, Tina. 2010. The “Childhood Obesity Epidemic”: Health Crisis or Social Construction? Medical Anthropology Quarterly 24(1):1-21.

Obermiller, P.J. 2004. Migration. In High Mountains Rising: Appalachia in Time and Place. R.A. Straw and H.T. Blethen (eds), pp. 88-100.

Schoenberg, N.E., J. Hatcher, M.B. Dignan, B. Shelton, S. Wright, and K.F. Dollarhide. 2009. Faith Moves Mountains: An Appalachian Cervical Cancer Prevention Program. American Journal of Health Behavior 33(6):627-638.

Scott, S.L., S. McSpirit, S. Hardesty, and R. Welch. 2005. Post Disaster Interviews with Martin County Citizens: “Gray Clouds” of Blame and Distrust. Journal of Appalachian Studies 11(1&2):7-29.

Scott, S.L., S. McSpirit, B.M. Howell, and M. Irvin. Forthcoming. “A Blessing in Disguise” (?) Reform of Public Water Management in Post-Disaster Martin County, Kentucky.

Sharkey, J.R., and S. Horel. 2008. Neighborhood Socioeconomic Deprivation and Minority Composition Are Associated with Better Potential Spatial Access to the Ground-Truthed Food Environment in a Large Rural Area. Journal of Nutrition 138:620-627.

United Nations.  1948.  The Universal Declaration of Human Rights. Retrieved on 10/8/11 [link].

U.S. Census Bureau. 2010.  Per Capita Income by County. Retrieved on 10/8/11 [link].

Vaughn, L.M., J.R. Forbes, and B.M. Howell. 2009.  Enhancing Home Visitation Programs: Input from a Participatory Evaluation Using Photovoice. Infants and Young Children 22(2):132-145.

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