Chapter 38 Further Reading: Health, Despair, and Resilience — Healthcare from Company Doctors to Rural Hospital Closures

Case, Anne, and Angus Deaton. Deaths of Despair and the Future of Capitalism. Princeton, NJ: Princeton University Press, 2020. The full-length treatment of Case and Deaton's "deaths of despair" thesis — expanding their influential 2015 paper into a comprehensive analysis of how the American economy has failed working-class Americans, with devastating health consequences. The book connects rising mortality from drug overdoses, alcohol-related liver disease, and suicide to deindustrialization, the decline of labor unions, the inadequacy of the healthcare system, and the political choices that have widened inequality. Essential for understanding the structural context of the health crisis described in this chapter.

Breckinridge, Mary. Wide Neighborhoods: A Story of the Frontier Nursing Service. New York: Harper & Brothers, 1952; reissued University Press of Kentucky, 1981. Mary Breckinridge's own account of the founding and development of the Frontier Nursing Service — written with the same combination of determination, humor, and practical intelligence that characterized her life's work. Breckinridge's narrative provides irreplaceable firsthand detail about the challenges of providing healthcare in the most remote communities of Appalachian Kentucky, and her descriptions of the nurse-midwives' work remain vivid and compelling.

Barney, Sandra Lee. Authorized to Heal: Gender, Class, and the Transformation of Medicine in Appalachia, 1880-1930. Chapel Hill: University of North Carolina Press, 2000. A study of how the professionalization of medicine in the late nineteenth and early twentieth centuries affected healthcare in Appalachia — including the displacement of traditional healers (granny women, midwives) by licensed physicians, and the ways in which gender and class shaped access to care. Barney's work provides essential context for understanding the transition from community-based to institutional healthcare described in this chapter.

Derickson, Alan. Black Lung: Anatomy of a Public Health Disaster. Ithaca, NY: Cornell University Press, 1998. The definitive history of coal workers' pneumoconiosis (black lung disease) in America — tracing the decades-long denial of the disease by the coal industry and its company doctors, the grassroots movement that forced recognition and compensation, and the ongoing struggle for adequate protection and treatment. Derickson's account is essential reading for understanding the company doctor system's conflict of interest and its consequences for worker health.

Gavrilova, Natalia S., et al. "Mortality Disadvantage Among the US Working-Class Population." SSM - Population Health 14 (2021): 100809. An epidemiological study that provides quantitative context for the deaths-of-despair thesis, documenting the mortality disadvantage experienced by working-class Americans relative to their counterparts in other developed countries. The study's data on geographic variation in mortality support the chapter's argument that Appalachian health disparities are structural rather than cultural.

Behringer, Bruce, and Gilbert H. Friedell. "Appalachia: Where Place Matters in Health." Preventing Chronic Disease 3, no. 4 (2006): A113. A foundational public health analysis of the relationship between place and health in Appalachia — documenting the health disparities, identifying their geographic correlates, and arguing that effective health policy must account for the specific conditions of the Appalachian region. The article provides data context for the health indicators discussed in this chapter.

Meit, Michael, et al. Appalachian Diseases of Despair. Washington, DC: Appalachian Regional Commission, 2017. An ARC-commissioned report that applies the deaths-of-despair framework specifically to Appalachia, documenting the elevated rates of drug overdose, alcohol-related mortality, and suicide in the region and analyzing the socioeconomic factors that drive them. The report provides the most Appalachia-specific quantitative analysis of the deaths-of-despair phenomenon available.

Cavender, Anthony. Folk Medicine in Southern Appalachia. Chapel Hill: University of North Carolina Press, 2003. An ethnographic study of traditional healing practices in the southern Appalachian Mountains — documenting the herbal remedies, folk beliefs, and community-based care practices that constituted the primary healthcare system for mountain communities before the arrival of institutional medicine. Cavender's work provides essential context for understanding the granny women and herbal tradition described in this chapter.

Thomas, S. R., et al. Rural Hospital Closures Since January 2010. Chapel Hill: Cecil G. Sheps Center for Health Services Research, University of North Carolina. Ongoing, updated regularly. Available at shepscenter.unc.edu. The Sheps Center maintains the most comprehensive and up-to-date tracking of rural hospital closures in the United States, including detailed data on the characteristics of closed hospitals, the communities they served, and the circumstances of their closure. This database is the primary source for the closure data referenced in this chapter and in Case Study 2.

Ulrich, Laurel Thatcher. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812. New York: Knopf, 1990. Though set in Maine rather than Appalachia, Ulrich's Pulitzer Prize-winning study of an eighteenth-century midwife's practice provides essential context for understanding the midwifery tradition that the Frontier Nursing Service drew upon and formalized. Ulrich's detailed reconstruction of a community-based healthcare practitioner's work illuminates the skills, the knowledge, and the social role that granny women and midwives performed in mountain communities.

Rosenblatt, Roger A., and L. Gary Hart. "Physicians and Rural America." Western Journal of Medicine 173, no. 5 (2000): 348-51. An analysis of the physician shortage in rural America that provides context for understanding why Appalachian communities struggle to attract and retain healthcare providers. The article documents the economic, professional, and lifestyle factors that make rural practice unattractive to physicians and evaluates strategies for addressing the shortage.

Dwyer-Lindgren, Laura, et al. "Inequalities in Life Expectancy Among US Counties, 1980 to 2014: Temporal Trends and Key Drivers." JAMA Internal Medicine 177, no. 7 (2017): 1003-11. A landmark epidemiological study that documented widening life expectancy gaps between US counties, with many Appalachian counties experiencing stagnating or declining life expectancy while the rest of the country improved. The study identifies the "deaths of despair" phenomenon as a major driver of the divergence and provides the county-level data that underpin the health disparities discussed in this chapter.