Facts about health in the mountains of Appalachia have been slow to emerge. The formation of the Appalachian Regional Commission in the 1960s led to increased efforts to combat known precursors to poor health (e.g., low income, limited education, geographic isolation) (1). From New York’s southern counties to the foothills of Mississippi, mountain counties were eligible to participate in various federal health programs because of their poor economic status. Critical private investments in health care occurred infrequently during the 1960s and still lag because of Appalachia’s low population density and high percentage of residents without health insurance or with high-deductible plans. Health care is largely organized, funded, and monitored through political channels. Public health programs
