Ailing in Place

Book excerpt: In Ailing in Place, Michele Morrone explores the relationship between environmental conditions in Appalachia and health outcomes that are too often ascribed to individual choices only. She applies quantitative data to observations from environmental health professionals to frame the ways in which the environment, as a social determinant of health, leads to health disparities in Appalachian communities. These examples—these stories of place—trace the impacts of water quality, waste disposal, and natural resource extraction on the health and quality of life of Appalachian people. Public health is inextricably linked to place. Environmental conditions such as contaminated water, unsafe food, and polluted air are as important as culture, community, and landscape in characterizing a place and determining the health outcomes of the people who live there. In some places, the state of the environment is a consequence of historical activities related to natural resources and cultural practices. In others, political decisions to achieve short-term economic objectives are made with little consideration of long-term public health consequences.