Lowy ​1

Alessandra Lowy  

Misery in the Mountain State: An Overview of the Intersectional Impacts of Mountaintop Removal 
on Rural Appalachian West Virginia  

In  Boone  County,  West  Virginia,  residents  learn  at  a  young  age  to  avoid  all  contact  with  the  tap 
water  flowing  from  pipes  in  their homes. Ryan Hall-Massey, a seven-year-old boy, has had half of his  teeth 
capped  to  replace  enamel  decimated  from  brushing  his  teeth  with  it.  An  18-year-old  neighbor  fared  even 
worse:  he  has  only  one  tooth  remaining.  Ryan’s  brother  is  covered  with  painful  lesions  on  his  arms,  legs 
and  chest  from  bathing  in  the  water.​1  ​In  a  span of 10 houses in his neighborhood, six people have had  brain 
tumors. ​30 percent of the area residents have had to have their gallbladders removed.  

Boone  County  residents  noticed  changes  in  their  water  right  about  when  nearby  coal  companies  
began  to  inject  toxic slurry into abandoned underground mine shafts. When EPA tests found that their  ​wells 
had arsenic, barium, lead, and manganese well over the healthy rates, nobody was surprised.​2  

Boone County, West Virginia is not an isolated case. Rather, it is emblematic of an entire region 
— home to 25 million people — that has suffered at the hands of an oppressive fossil fuel industry that 
prioritizes short-term profits over long-term rights to existence.  

In this paper, I will offer a comprehensive, intersectional review of the effects of mountaintop 
removal on communities in rural Appalachian West Virginia, including environmental, economic and 
health impacts. I will argue that these impacts are disproportionately levied on the most vulnerable 
populations, by explaining how an array of issues – such as inadequate infrastructure, lack of medical 
care, and the opioid crisis – collectively worsen life outcomes for these communities.  

Background: Mountaintop Removal  

Mountaintop removal (MTR) is a form of surface coal mining primarily used in the Appalachian 
mountains of North America, one of the oldest mountain ranges on Earth. Currently, MTR operations   

  
1​
​ lue Ridge Outdoors, March 3, 2016, 
Jess Daddio, “​Ain’t Nothin’ Livin’ in There,” B
https://www.blueridgeoutdoors.com/go-outside/aint-nothin-livin-in-there/​.  
2​
Charles Duhigg, “​Clean Water Laws Are Neglected, at a Cost in Suffering” N​ ew York Times, 
September 12, 2009, ​https://www.nytimes.com/2009/09/13/us/13water.html​. 
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span  a  large  territory,  roughly  equivalent  to  the  size  of  New  Hampshire  and  Vermont  combined.3  The 
amount  of  forest  cleared  for  MTR  to  date  is  2,300  square  miles:  approximately  three  times  the  size  of  the 
Great  Smoky  Mountains  National Park.​4 ​MTR has obliterated more than 500 mountaintops and buried  more 
than 2,000 streams.​5  

The  process  of  MTR  involves  clearcutting  —  and  often  burning  —  forests,  and  using  explosives 
and  heavy  machinery  to  detonate  hundreds  of  feet of rock from mountaintops, exposing coal layers that  are 
inaccessible  via  other  mining  techniques.  It  is  primarily  practiced  on  steep  terrain,  where  coal  layers  are 
deep and spatially disparate, which makes other forms of mining impractical.​6  

Standing  atop  a  MTR  site  in  southern  West  Virginia  this  past  October,  an  Appalachia  native 
explained  it  as  such:  “if  fracking  and  traditional  mining  are  drawing  blood  or  removing  organs  from  a 
mountain, mountaintop removal is crushing its bones.”​7  

Appalachia  is  home  to  25  million  people,  three  million  of  whom  live  in  counties  where  MTR  is 
practiced.​8  ​Most  reside  in  valley  bottoms  along  rivers  and  streams  or  in  other  small,  flat  areas  downslope 
from  the  mountains.  Once  exposed  to  oxygen  and  rain,  the  newly  uncovered  rocks  and  soil  begin  to  leach 
long-sequestered  metals  and  chemicals.  As  a  result,  the  water  emerging  from  the  base  of  these  valleys  is 
often  contaminated  by  chemicals,  which  can  spread  to  groundwater,  the  source  of  most  household  tap 
water.​9  

  
3​
Michael Hendryx, “​Poverty and mortality disparities in Central Appalachia: Mountaintop mining and 
environmental justice​,” Journal of Health Disparities Research and Practice​, 4, 3, (2011): 44-53. 4​
Andrew Pericak et al., “Mapping the yearly extent of surface coal mining in Central Appalachia using 
Landsat and Google Earth Engine,” PLoS ONE, 13, 7, (2018).  
5​
Hendryx, “Poverty and mortality disparities,” 45-46.  
6​
N.a., “The Coal Mine Next Door: How the U.S. government’s Deregulation of Mountaintop Removal 
Threatens Public Health” Human Rights Watch, December 10, 2018,   
https://www.hrw.org/report/2018/12/10/coal-mine-next-door/how-us-governments-deregulation 
mountaintop-removal-threatens​.  
7​
Kayford Mountain “Mountain Justice” Summit, October 25-27, 2019, Kayford Mountain, West Virginia 8​
N.a., “Ecological Impacts of Mountaintop Removal,” Appalachian Voices, n.d., 
http://appvoices.org/end-mountaintop-removal/ecology/​.  
9​
David Holzman, “Mountaintop Removal Mining: Digging Into Community Health Concerns,” 
Environmental Health Perspectives, 1​ 19, 12, (2011). 
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Following  MTR,  the  excavated  gravel  and  dirt  debris  –  spoil  –  is  deposited  near  the  mining  pits, 
often  in  nearby  valleys  adjacent  to  headwater  streams.  MTR  spoil  deposits  have buried ​almost 2,000  ​miles 
of headwater streams that ultimately feed the Mississippi River.​10  

The  residue  from  cleaning  the  unearthed  coal  –  slurry  –  is  impounded  in  ponds  or  injected  into  
abandoned  underground  mine  shafts,  where  it  often  leaches  chemicals  like  arsenic,  lead,  manganese,  iron, 
and sulfate.​11  

MTR  operations  began  in  the  1970s,  but  did  not  take  off  until  the  ‘90s,  incidentally  as  a  result  of 
Clean  Air  Act  amendments  made  to  curtail  acid  rain.  Because  acid  rain  results  in  part  from  anthropogenic 
emissions  of  sulfur,  in  1990,  the  EPA  amended  the  Clean  Air  Act  to  limit  sulfur  emissions.  One  way  to 
reduce acid rain is to use coal with a lower sulfur content. Coal buried deep in the Appalachian mountains  is 
naturally  lower  in  sulfur  than  that  of  Western  coalfields,  which  made  MTR  an  attractive  alternative  to 
mining.​12  

Justified  by  research  highlighting  the  adverse  effects  of  air  pollution,  the  Clean  Air  Act  seeks  to 
quell  the  health  impacts  of  ​burning  ​coal,  but  neglects  to  address  the  implications  of  ​mining  i​ t.  In effect, by 
regulating  coal  production  on  a  national  level, the Clean Air Act exacerbated environmental injustice in  the 
nation’s mining capital: central Appalachia.​13  

Impacts of Mountaintop Removal  

Ecological Impacts  

MTR  has  wreaked  ecological  destruction  throughout  Appalachia,  annihalating  forest  and  riparian 
ecosystems.  By  2012,  MTR  had  destroyed  1.4  million  acres  of  Appalachian  forest.  After  the  topsoil  and 
upper  portions  of  rock  on  a  mountain  has  been  removed,  the  remaining  soil  is  unable  to  produce  native 
hardwood forest.​14  

  
10 ​
Holzman, “Mountaintop Removal Mining.”  
11 ​
Daddio, “Ain’t Nothin’ Livin’ in There.”  
12 ​
Michael Hendryx & Benjamin Holland, “Unintended Consequences of the Clean Air Act: Mortality 
rates in Appalachian coal mining communities,” ​Environmental Science & Policy, ​63 (2016), 1-6. 13
​
Hendryx & Holland, “Unintended Consequences” 2-3.  
14 ​
Jedediah Britton-Purdy, “The Violent Remaking of Appalachia,” the Atlantic, March 21, 2016, 
https://www.theatlantic.com/technology/archive/2016/03/the-violent-remaking-of-appalachia/474603/​. 
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Coal  companies  are  not  required  to  reforest  the  land as part of their post-mining reclamation  work, 
under  the  Surface  Mining  and  Reclamation  Act  of  1977.  Thus,  flat  fields  of  non-native  grasses  replace 
previously  lush  terrain  that  once  supported  enormous  biodiversity.​15  ​The  Appalachian  forests  take  much 
longer to grow back, if they ever do.   

Only  2%  of  land  disturbed  by  mining  in  the  U.S. has been reclaimed. In the Appalachian coal  belt, 
reclaimed  areas  have  only  seen  regrowth  of  around  3%  of  nonsoil  carbon  (vegetation) in the past 15  years. 
Post-MTR, the vegetation and soil are replaced by compacted mining spoil, which inhibits plant growth.​16  

MTR  thwarts  biodiversity  by  obliterating  what  were  once  ​diverse  hardwood  forests  teeming  with 
life.  ​The  Appalachian  mountains  are  home  to  some  of  the  most  temperate  forest  biodiversity  in  the  world, 
and  are  virtually  unrivaled  in  aquatic  species  diversity.​17  ​After  mountaintops  are  obliterated  —  and  all  the  
life  they  inhabit  destroyed  —  the  carnage  is  dumped  into  streams, decimating the species that inhabit  ​them 
— rare salamanders, crayfish, mussels, and the like. The toxins from mining flow downstream,  
killing  wildlife,  and  poisoning  the  animals  that  survive,  which  spreads  toxins  to  the  animals  that  consume 
them.  Water  birds  and  mammals  that  eat  poisoned  riparian  life  may  die  themselves,  or  lose  the  ability  to  
reproduce.​18  

Flooding  

Another  common  impact  of  MTR  is  flooding  in  valley  towns  beneath  MTR  sites,  due  to  the 
removal  of  mountaintop  vegetation,  a  natural  buffer  that  absorbs  excess  water  after  storms.  In  2009,  flash 
flooding  in  Mingo  County,  West  Virginia  —  an  area  downslope  from  an  MTR  site  —  destroyed  300 
hundred  homes  and  damaged  hundreds  more,  necessitating  emergency  disaster  relief  from  the  National 
Guard.​19  

  
15 ​
Elizabeth McGowan, “Reclaiming Appalachia: A Push to Bring Back Native Forests to Coal Country,” 
Yale Environment 360, December 14, 2017, ​https://e360.yale.edu/features/reclaiming-appalachia-a-push 
to-bring-back-native-forests-to-coal-country​.  
16 ​
Rob Perks, “The Carbon Footprint of Mountaintop Mining,” Natural Resources Defense Council, 
March 16, 2010, ​https://www.nrdc.org/experts/rob-perks/carbon-footprint-mountaintop-mining​. 17 ​ ​Rob 
Perks, “Appalachian Heartbreak: Time to End Mountaintop Removal Coal Mining,” Natural Resources 
​ ​Perks, 
Defense Council, November 9, 2009, ​https://www.nrdc.org/sites/default/files/appalachian.pdf​. 18
“Appalachian Heartbreak.”  
19 ​
Molly Moore, “Flooding Takes Its Toll in West Virginia,” Appalachian Voices, June 10, 2009, 
http://appvoices.org/2009/06/10/flooding-takes-its-toll-in-west-virginia/​. 
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McRoberts,  Kentucky  experienced  something  similar.  In  1998,  Tampa  Energy  Company  sheared 
the  vegetation from ​a nearby mountaintop and replaced it with rubble from a valley fill. Four years later,  ​the 
once-forested watershed experienced three “hundred-year floods” over the course of ten days.​20  

In  2016,  West  Virginia  was  inundated  by  a  “thousand-year  flood.”  It  was  the  ​third-deadliest 
flooding  in  the  state’s  history,  devastating  several  counties,  claiming  23  lives  and  destroying  hundreds  of 
homes,  roads  and  buildings.​21  ​Many  experts  argue  that  bulldozed  mountaintop  vegetation  throughout  the 
state amplified the storm’s destruction.​22  

Climate Change   

MTR’s  role  in  fueling  anthropogenic  climate  change  is  not  to  be  understated.  The  uptick  of  MTR 
operations  in  recent  years  is  driven  by  the  American  fossil  fuel  industry’s  insatiable  thirst  for  natural 
resources,  after  much  of  the  Appalachian  coal  supply  extracted  through  traditional  methods  has  been 
depleted. In fact, over the past two decades, MTR has removed 6.8% of the forests in Appalachia to  produce 
23% of the coal in the United States.​23  

Coal  has  catastrophic  impacts  on  the  climate.  Burning  coal  in  the  U.S.  contributes  more  than  two 
billion  tons  of  carbon  dioxide  to  the  Earth's  atmosphere  annually.​24  ​In  fact,  coal  production  releases  more 
CO2  than  both  oil  and  natural  gas  (the  two  other  major  fossil  fuels),  which  is  to  say  that  coal  is  the  fossil 
fuel that contributes most to climate change.​25  

  
20 ​
N.a., ​“Mountaintop-removal mining is devastating Appalachia, but residents are fighting back,” Grist, 
February 17, 2006, ​https://grist.org/article/reece/​.  
21 ​
Jason Samenow, “West Virginia flood was ‘one in a thousand year event,’ Weather Service says; more 
heavy rain forecast,” Washington Post, June 27, 2016, ​https://www.washingtonpost.com/news/capital 
weather-gang/wp/2016/06/27/w-va-flood-was-one-in-a-1000-year-event-weather-service-says-more 
heavy-rain-forecast/​.  
22 ​
David Manthos, “Come Hell & High Water: Flooding in West Virginia,” SkyTruth, July 8, 2016, 
https://skytruth.org/2016/07/hell-and-high-water-wv/​.  
23 ​
Perks, “The Carbon Footprint of Mountaintop Removal Mining.”  
24 ​
N.a., “How the Coal Industry Flattened the Mountains of Appalachia,” the New York Times, February 
16, 2016, ​https://www.nytimes.com/2016/02/16/opinion/how-the-coal-industry-flattened-the-mountains 
of-appalachia.html​.  
25 ​
N.a., “How much carbon dioxide is produced when different fuels are burned,” American Geosciences, 
N.d., ​https://www.americangeosciences.org/critical-issues/faq/how-much-carbon-dioxide-produced 
when-different-fuels-are-burned​. 
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Not  only  does  MTR  perpetuate  an  inherently  unsustainable  coal  economy,  but  it  removes  a  forest 
system that absorbs carbon dioxide, a “carbon sink.” MTR-induced forest loss equates to an addition of  3.14 
million  tons of carbon dioxide that would have been sequestered annually.​26 ​The trees cleared for the  mining 
are typically burned on-site — which releases more carbon than harvesting trees.  

Research  suggests  that  rampant  deforestation in central Appalachia could convert the region from  a 

net  carbon  sink  to  a  net  carbon  source  by  2025  to  2033.​27 ​One study concluded that MTR land  disturbance, 
coal  extraction,  and  transport  in  southern  Appalachia  collectively  increase  climate  change  pollution  by 
between 7 and 17 percent.​28  

Economic Impacts   

MTR  perpetuates  poverty  and  leads  to  mass  migration  out  of  Appalachian  cities.  Most  central  
Appalachian  towns  have  seen  gradual  population  decline  since  the  1950s.​29  ​Economic  studies  in  West 
Virginia  and  Kentucky  have  shown that MTR costs the states more revenue than it produces.​30 ​Compared  ​to 
traditional  mining,  MTR  ​is not only more expensive, but is ​highly mechanized and employs fewer  ​people -- 
heavy  machines  do  most  of  the  clear-cutting,  excavating,  loading,  and  bulldozing of rubble.​31 ​In  ​Kentucky, 
coal-related  employment  has  dropped  60  percent  in  the  last  15  years. Areas in Central  ​Appalachia with the 
highest MTR rates also have the highest unemployment rates in the region.​32  

As former Senator Robert Byrd put it, in 2009: “The Central Appalachian coal seams that remain​ ​to 
be mined are becoming thinner and more costly to mine. Mountaintop removal mining, a declining   

  
26 ​
Perks, “The Carbon Footprint of Mountaintop Removal Mining.”  
27 ​
Elliott Campbell, James Foxx & Peter Acton, “Terrestrial carbon losses from mountaintop coal mining 
offset regional forest carbon sequestration in the 21st century,” ​Environmental Research Letters, ​7, 4 
(2012).  
28 ​
James Foxx & Elliott Campbell, “Terrestrial Carbon Disturbance from Mountaintop Mining Increases 
Lifecycle Emissions for Clean Coal,” ​Environmental Science & Technology,​ 44, 6 (2010), 2144-2149. 29  ​
N.a., “How the Coal Industry.”  
30 ​
Eric Bowen et al., “An Overview of the Coal Economy in Appalachia,” Appalachian Regional 
Commission, January 2018, ​https://www.arc.gov/assets/research_reports/CIE1-  
OverviewofCoalEconomyinAppalachia.pdf​.  
31 ​
John McQuaid, “Mining the Mountains,” Smithsonian Magazine, January 2009, 
https://www.smithsonianmag.com/science-nature/mining-the-mountains-130454620/​. 
32 ​
Hendryx, “Poverty and Morality Disparities.” 
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national demand for energy, rising mining costs and erratic spot market prices all add up to fewer jobs in​ ​the 
coal fields.”​33  

Compared  to  underground  mining,  not  only does MTR cost more and employ fewer, but it  ​requires 

more  space  to  get  the  same  amount  of coal, and is gradually becoming more costly. Geologists  ​predict that, 
as  coal  companies  mine  the  thickest and shallowest coal seams, they will produce more waste  ​rock, making 
MTR  more  expensive.​34  ​As  the  coal  becomes  more  difficult  to  extract,  MTR  needs  more   ​space  to produce 
the  same  amount  of  coal.  For  instance,  before  1998,  it  took  about 10 square meters to  ​produce a metric ton 
of coal. By 2015, that number was up to about 30 square meters.​35  

Coal companies claim that MTR flattens space for future development, but only 3 percent of  ​former 
mine  sites  have  been  developed.​36  ​The  major  developments  on  MTR  sites  across  Appalachia  have  ​been 
maximum-security  federal  prisons,  which  exposes  inmates  to  all  of  MTR’s  adverse  health impacts,  ​like air 
and  water  pollution.​37  ​Federal  prisons  are  not  the  sort  of  meaningful  employment  opportunities  ​that  will 
stimulate local economies and bring large swaths of Appalachia out of poverty.  

Furthermore,  MTR  eliminates  the  potential  for  development  based  on  ecotourism  and  sustainable 
forest  products.  ​The  environmental  degradation  of  MTR  makes  the  land  unattractive  for  future  alternative 
economic  development.​38  ​One  study  compared  GIS  data  of  West  Virginia  strip  mines  to  demographic  and 
economic  data  to  see  if  proximity  to  mining locations increased a community’s level of employment by  ​the 
coal  industry.  It  found  that,  contrary  to  pro-MTR  arguments,  MTR  did  not  positively  contribute  to  
employment  in  surrounding  areas;  in  fact,  MTR  counties  had  lower  income  levels  and  higher  
unemployment rates than non-MTR regions.​39  

  
33 ​
JW Randolph, “Impacts of Coal 101: Mountaintop Removal = Job Removal,” Appalachian Voices, 
January 21, 2011, ​http://appvoices.org/2011/01/21/impacts-of-coal-101-mountaintop-removal-job 
removal/​.  
34 ​
McQuaid, “Mining the Mountains.”  
35 ​
James Bruggers, “Mountaintop Mining Is Destroying More Land for Less Coal, Study Finds,” Inside 
Climate News, July 26, 2018, ​https://insideclimatenews.org/news/25072018/appalachia-mountaintop 
removal-coal-strip-mining-satellite-maps-environmental-impacts-data​).  
36 ​
N.a., “How the Coal Industry Flattened the Mountains of Appalachia.”  
37 ​
Sam Adler-Bell, “Appalachia vs. the Carceral State,” the New Republic, November 25, 2019, 
https://newrepublic.com/article/155660/appalachia-coal-mining-mountaintop-removal-prison-fight​. 
38 ​
Bowen et al., “An Overview of the Coal Economy.”  
39 ​
Pericak et al. “Mapping the yearly extent of surface coal mining.” 
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I​njuries  

In  addition  to  its  concerning  health  impacts,  MTR  is  downright dangerous. Its blasts shake  ​houses, 
crack  windows,  demolish  wells,  send  boulders  cascading  into  homes,  and  blanket  everything in  ​their wake 
in  a film of coal dust. In 2004, a three-year-old child was killed in his sleep when a boulder  ​from a mine site 
crashed into his home.​40 ​In West Virginia, 14 people died over three years from MTR  
induced mudslides. In Kentucky, 50 people have been killed and over 500 injured in the last five years by  
coal trucks, almost all of which were illegally overloaded.​41  

Air pollution  

Because MTR operations release significant amounts of toxic chemicals, they create disturbances  in 
local  air  quality.  MTR  surface  explosives  utilize  ammonium-nitrate and diesel fuel, expelling coal dust  and 
flyrock containing sulfur, fine particulates and metals, and nitrogen dioxide. Thus, MTR areas have  elevated 
levels  of  ambient  particulate  matter,  sulfur  dioxide,  nitrous  oxide,  benzene,  and  carbon  monoxide.​42  ​High 
levels  of  ambient  particulate  matter  and  gaseous  air  pollutants  have,  historically,  been  linked  to  fetal 
development problems and fetal gene mutations. Central Appalachia is no exception.  

Scott  Simonton,  an  environmental  scientist who studied homes in Mingo and Boone County,  found 

hydrogen sulfide gas in more than half of them, which he attributed to bacteria reducing sulfate  form mining 
runoff.  Simonton  measured  concentrations  in homes up to 21 ppm, compared with a  tolerable concentration 
of 0.071 ppm for exposure durations of less than two weeks.​43  

Water contamination  

Perhaps  the  most  egregious  impact of MTR on these montane communities is water  contamination, 

which  makes  itself  felt  through  an  array  of  peculiar  health  impacts  in neighboring  communities. Pollutants 
can reach groundwater through a number of different pathways. Some leach into   

  
40 ​
N.a., “Ending Mountaintop Removal,” Appalachian Voices, n.d.,   
https://www.biologicaldiversity.org/programs/public_lands/mining/mountaintop_removal/​. 41 ​
Vivian Stockman, “The Social and Cultural Effects of Mountaintop Removal,” Ohio Valley 
Environmental Coalition, May 20, 2019,   
https://ohvec.org/issues/mountaintop_removal/articles/EIS_social_cultural.pdf​.  
42 ​
Melissa Ahern et al., “The association between mountaintop mining and birth defects among life births 
in Central Appalachia, 1996-2003,” ​Environmental Research, ​111, 6 (2011), 838-46. 43​ ​Holzman, 
“Mountaintop Removal Mining.” 
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streams from the spoil that is dumped into valleys, while others find their way into the slurry that is injected 
into old mine shafts or impounded in ponds.​44  

Mountaintop  removal  “valley  fills”  are  responsible  for  burying  more  than  2,000  miles  of  vital 
Appalachian  headwater  streams,  and  poisoning many more.​45 ​In the words of U.S. District Judge Charles  H. 
Haden  II:  “If  there  is  any  life  form  that  cannot  acclimate  to  life  deep  in  a  rubble  pile,  it  is  eliminated.  No 
effect  on  related  environmental  values  is  more  adverse  than  obliteration.  Under  a  valley  fill,  the  water 
quantity of the stream becomes zero. Because there is no stream, there is no water quality.”​46  

Post-MTR,  toxic  slurry  has  leached  arsenic, chromium, mercury, and lead into groundwater,  which 

has  led  to  elevated  rates  of  these  chemicals  in  groundwater  and  in  residents’  private  wells.  Compared  to 
non-MTR  regions,  the  groundwater  in  MTR  areas  has  elevated  levels  of  sulfate,  calcium,  magnesium, 
bicarbonate  ions,  selenium,  and  hydrogen  sulfide.​47  ​Many  of  these  pose  threats  to  health  in  nearby 
communities – including increased rates of cancer, and risks to reproductive health and fetal development.​48  

Indeed,  in  large  swaths  of  Eastern  Kentucky  and  Southern  West  Virginia,  the  dearth  of  clean,  safe 
drinking  water  is  a  regular  fact  of  life.  In  West  Virginia,  a  boil-water  notice  is  posted whenever a system’s 
water  quality  is  compromised  by  factors  like  chemical  contamination,  line  breaks  that  lead  to  sediment 
build-up,  or  inadequate  disinfection.  Boil-water  notices  urge  residents  to  boil  water  coming  from  their 
household  pipes  before  using  it,  or  avoid  using  it  until  further  notice.  From  2013  to  2018,  West  Virginia 
counties  posted  more  than  7,000  boil-water  notices,  many  of  which  lasted  months,  and  even  years.​49  ​In 
O’Toole  –  a  small  town  in  the  heart  of  coalfield  country  –  residents  were  on  a  continuous  boil-water  for 
more than 17 years.​50  

  
44 ​
Richard Schiffman, “A Troubling Look at the Human Toll of Mountaintop Removal Mining,” Yale 
Environment 360, November 21, 2017, ​https://e360.yale.edu/features/a-troubling-look-at-the-human-toll 
of-mountaintop-removal-mining​.  
45 ​
McQuaid, “Mining the Mountains.”   
46 ​
N.a., “Ecological Impacts of Mountaintop Removal Mining.”  
47 ​
Ahern et. al, “The association between mountaintop mining and birth defects.” 
48 ​
Schiffman, “A Troubling Look at the Human Toll.”  
49 ​
Kristi Fedinick, Steve Taylor & Michele Roberts, “Watered Down Justice,” Natural Resources Defense 
Council, September 2019, ​https://www.nrdc.org/sites/default/files/watered-down-justice-report.pdf​. 50
​
Associated Press, “West Virginia Town Gets Access to Clean Water After 17 Years,” US News, August 
19, 2019, ​https://www.usnews.com/news/best-states/west-virginia/articles/2019-08-19/west 
virginia-town-gets-access-to-clean-water-after-17-years​. 
Lowy ​10

One  EPA  study  found  iron  and  manganese  concentrations  exceeding  drinking  water  guidelines  in  
over  40%  of  Appalachian  wells,  a  figure  that  increases  to  70%  for  reclaimed  surface  coal  mines  in  the  
area.​51  

Another  EPA  study  ​found  that  90%  of  27  Appalachian  streams  below  valley  fill  sites  were 
impaired,  as  per  Clean  Water  Act  standards,  while  none  of  the  streams  sampled  in  unmined  valleys  were  
impaired.  The  Clean  Water  Act  states  that  streams  must  be  suitable  for  “designated  uses,”  which  include 
recreation, safe fish consumption, and protection of the health of aquatic life.​52  

One  study,  which  sampled  wells  surrounding  a  site  where  coal slurry was injected into the  ground, 
found  that  half  the  wells  had  lead  above  drinking  water  standards,  while  some  had  elevated  arsenic,  and 
almost  all  violated  iron  and  manganese  standards.  Manganese  concentrations  reached  up to  4,063 parts per 
billion (the EPA recommends that manganese in drinking water not exceed 50 parts per billion).​53  

Residents  of  these  communities  recount  bizarre  experiences  reminiscent  of  horror  movies,  such  as 
Fanta  orange-colored  water  flowing  from  sinks,  children  emerging  from  baths  covered  in  bleeding  sores, 
and sudden, inexplicable cases of incontinence.​54  

For  months  on  end,  Appalachians  are  denied  the  comfort of showering and bathing in their  homes; 
they  collect  rainwater  in  buckets; and must buy bottled water or drive to natural springs in search  of potable 
water.  

As  contamination  takes  its  toll  across  the  state,  many  counties  fall  short  of  federal  water  quality 
standards.  One  2019  study  found  that  more  than  65  percent  of  West  Virginia  counties  consistently  rank 
among  the  top  third  in  the  nation  for  violations  of  the  Safe  Drinking  Water  Act,  a  federal  law  that protects 
the quality of drinking water.​55  

  
51 ​
N.a., “Community Impacts of Mountaintop Removal,” Appalachian Voices, n.d., 
http://appvoices.org/end-mountaintop-removal/community/​.  
52 ​
Perks, “Appalachian Heartbreak.”  
53 ​
Holzman, “Mountaintop Removal Mining.”  
54 ​
Fedinick, Taylor & Roberts, “Watered Down Justice.”  
55 ​
Emily Allen & Brittany Patterson, “Study Finds West Virginia Counties Among ‘Worst in Nation’ For 
Drinking Water Violations,” West Virginia Public Broadcasting, September 24, 2019, 
https://www.wvpublic.org/post/study-finds-west-virginia-counties-among-worst-nation-drinking-water 
violations#stream/0​. 
Lowy ​11

Health Impacts  

The  health  impacts  of  MTR  are  well-documented.  Research  shows  that  MTR-related  toxins  found 
in  water  can  jeopardize  human  health,  even  when  the  water  is  not  directly  consumed,  but  merely  used  for 
activities like bathing, brushing teeth, and washing clothes and dishes.  

One  study  –  which  examined nearly 2 million live birth records in central Appalachia over a  period 

of  7  years  –  found  that  communities  near  MTR  sites  had  higher  rates  of  six  out  of  seven  types  of  birth 
defects  (235  per 100,000 births, as opposed to 144 per 100,000 in non-mining areas). Heart defects  were the 
most  common.  The  effect  of  mothers  living  in  a  mining  region  on  fetal  heart  defects  was  six  times higher 
than the effect for mothers who smoke.​56  

Communities  near  underground  mines  also  had  above-average  incidence  of  birth defects,  although 
not  as  high  as  their  MTR  counterparts.  These  results  persisted  even  after  controlling  for  socioeconomic 
disadvantage.  Within  MTR  regions,  researchers  found  a  spatial  relationship  to  be  present  –  residents  in 
closer proximity to MTR sites saw higher rates of birth defects.​57  

In  one  study,  researchers  found  that  ecological  impairment of stream ecosystems is correlated  ​with 

human  cancer  mortality  rates  in  surrounding  areas,  after  accounting  for  the  impacts  of  poverty,   ​smoking, 
and  urbanization.  The  cancers  that  increased  with  declining  stream  conditions  included  ​respiratory, breast, 
and urinary cancers.​58  

Another report – which studied health data from rural and urban communities across the country 
from 1969 to 2011 – found that cancer mortality rates declined for all regions except for rural Appalachia. 
In all but one state studied, rural Appalachians had higher cancer mortality rates than urban non 
Appalachians.​59  
  
56 ​
Melissa Ahern, et al., “The association between mountaintop mining and birth defects among live 
births in central Appalachia, 1996–2003,” ​Environmental Research, ​111, 6 (2011), 838-846. 57 ​ ​Ahern 
et al., “The association between mountaintop mining.”   
58 ​
Nathan Hitt & Michael Hendryx, “Ecological Integrity of Streams Related to Human Cancer Mortality 
Rates,” ​Eco Health,​ 7 (2010), 91-104.  
59 ​
Nengliang Yao et al., “Cancer Disparities in Rural Appalachia: Incidence, Early Detection, and 
Survivorship,” ​Journal of Rural Health,​ 33, 4 (2017), 375-381. 
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While  some  cite  lifestyle  factors  (such  as  cigarette  smoking  or  unhealthy  diets)  as  an  explanation, 
researchers  have  adjusted  for  these variables and found the same results. One study, which looked at  excess 
mortality – adjusting for lifestyle factors – found that MTR communities experience 1,200 extra  deaths each 
year,  compared  to areas of Appalachia where MTR does not take place, due to the air and  water pollution of 
MTR  operations.​60  ​It  found that the most prevalent diseases accounting for these deaths  were cardiovascular 
disease, lung cancer, and chronic obstructive pulmonary diseases, like bronchitis and emphysema.  

Another  study  –  which  adjusted  for age, smoking rates, poverty, obesity, and physician supply,  and 

analyzed  data  over  a  46-year  time  period  –  concluded  that  MTR  regions  (compared  to  non-MTR  regions 
and  regions  outside  of  Appalachia)  saw  a  disproportionate  increase  in  mortality  rates  related to  respiratory 
cancer, respiratory disease, and other causes after the passage of the Clean Air Act.​61  

A  further  study – which analyzed health outcomes over 30 years -- calculated that people who  lived 

in  MTR  mining  areas  had  a  31%  higher  risk  of  reduced  health-related  quality  of  life  (HRQOL)—or 
perceived  physical  and  mental  health  over  time—compared  with  people  living  in  nonmining  areas  in  the 
same  states.  This  difference  came  out  to  18  more  unhealthy  days  per  year  than  those  in  other  nonmining 
counties,  which  adds  up  to  4  additional  years’ worth of impaired health over a 78-year lifespan. The  results 
–  which  accounted  for  socioeconomic  differences  --  suggest  that  previously  documented  HRQOL 
disparities in Appalachian coal-mining areas are concentrated in MTR mining areas.​62  

Other  research  has  found  that  proximity  to  surface  mining  has  been  linked  to  heightened  risk  of 
cardiovascular  disease  mortality, lung cancer mortality, leukemia, colon cancer, bladder cancer, and  chronic 
depression.​63  

  
60 ​
Schiffman, “A Troubling Look at the Human Toll.”   
61 ​
Hendryx & Holland, “Unintended consequences.”  
62 ​
Keith Zullig & Michael Hendryx, “​Health-related quality of life among central Appalachian residents​ ​in 
mountaintop mining communities,” ​American Journal of Public Health, 1​ 01, 5, (2011), 848-853.​ 63​ ​Laura 
Esch & Michael Hendryx, “Chronic Cardiovascular Disease Mortality in Mountaintop Mining Areas of 
Central Appalachian States” ​Journal of Rural Health, ​27, 4, (2011), 350-357; Melissa Ahern & Michael 
Hendryx, “Cancer mortality rates in Appalachian mountaintop coal mining areas,” ​Journal of 
Environmental and Occupational Science, ​1, 2 (2012), 63-70; Michael Hendryx, Kathryn O’Donnell & 
Kimberly Horn, “​Lung Cancer Mortality Is Elevated in Coal-Mining Areas of Appalachia,” ​Lung Cancer, 
62, 1 (2008), 1-7; Paige Cordial, Hilary Lips & Ruth Riding-Malon, “The Effects of Mountaintop Removal 
Coal Mining on Mental Health, Well-Being, and Community Health in Central Appalachia,” 
Ecopsychology, ​4, 3 (2012), 201-208. 
Lowy ​13

Dawn  Seeburger,  a  toxicologist  and  environmental  consultant in Southern West Virginia,  ​surveyed 

the  medical  records  of  parties  to  an  MTR  lawsuit  against  a  coal  company.  Seeburger  concluded  ​that  the 
most  frequent  health  complaint  was  chronic  diarrhea,  while  other  conditions  frequently  reported   ​included 
thyroid  failure,  neurological  disorders,  miscarriages,  lesions,  kidney  stones,  rotting  teeth,  and  ​some 
cancers.​64  ​These  symptoms  describe  what  Carl  Werntz,  professor  of  medicine  at  West  Virginia  ​University, 
deems  “slurry  syndrome.”  Werntz  described a number of symptoms characteristic of this  ​ailment, including 
unremitting ​diarrhea, rash, changes to teeth, and increasing frequency of kidney stones.​65  

Intersectionality  

It  is  important  to  note  that  MTR  is  only  one  of  several  compounding  factors  –  along with fracking 
and  frequent  chemical  spills  –  that  make  residents  of  central  Appalachians  particularly  vulnerable  to  a 
continually compromised quality of life.  

Fracking  

Hydraulic fracturing (“fracking”) – the process of pumping toxic chemicals, water, and sand into 
porous rock formations in order to extract natural gas – is also common in Appalachia. This has historically 
jeopardized water quality, as toxic sludge can easily find its way into streams and aquifers.​66​ ​Rife with holes 
from deep mining in the 1900s, and residents left impoverished by the departure of Big Coal, Appalachia 
proved an ideal fracking destination for opportunistic natural gas giants.​67  

One West Virginia Public Radio segment tells the heart-wrenching story of a single father, Bryan 
Latkanich, emerging from a coma, steeped in medical expenses, offered thousands of dollars from   

  
64 ​
Stephen Wussow, “Coal Sludge Disposal Under Scrutiny in WV Legislature,” Appalachian Voices, 
October 20, 2006, ​http://appvoices.org/2006/10/20/1507/​.  
65 ​
Stephen McQuaid, “Mountaintop Mining Legacy: Destroying Appalachia’s Streams,” Yale 
Environment 360, July 20, 2009,   
https://e360.yale.edu/features/mountaintop_mining_legacy_destroying_appalachian_streams​.  
66 ​
Cristina Nunez, “How Has Fracking Changed Our Future?” National Geographic, December 13, 2019, 
https://www.nationalgeographic.com/environment/energy/great-energy-challenge/big-energy 
question/how-has-fracking-changed-our-future/​.  
67 ​
Gwynn Guilford, “The 100-year capitalist experiment that keeps Appalachia poor, sick, and stuck on 
coal,” Quartz, December 30, 2017, ​https://qz.com/1167671/the-100-year-capitalist-experiment-that 
keeps-appalachia-poor-sick-and-stuck-on-coal/​. 
Lowy ​14

Chevron  to  frack  in  his  backyard.  In  the  following  years,  his  well  water  would  take  on  a  metallic  taste,  he 
would  develop  peculiar  stomach  problems  and  become  incontinent,  and  his  6-year-old  son  would  emerge 
from  baths  with  open,  bloodied  sores.  Latkanich’s  well  would  be  one  of  1,655  in  his  small county alone to 
be  hydraulically  fractured  in  the  following  decade.​68  ​Latkanich’s  story  is  one  of  many  in  Appalachia  that 
follows  a  similar  trajectory:  in  a  geographically  fragmented,  economically  deteriorating  region  where 
misinformation  is  commonplace,  citizens  are  politically  disempowered,  and  local  governments  are  not 
accountable to constituents, fossil fuel interests reign supreme.  

In  the  past  two  decades,  fracking  has  expanded  under  a  series  of  political  leaders  beholden  to 
natural  gas  industry  interests.  In  2005, during George W. Bush’s second presidency, Congress amended  the 
Energy  Policy Act to prohibit the EPA from safeguarding drinking water harmed by fracking and  even from 
determining  which  chemicals  companies  were  using.​69  ​This  amendment  was  rationalized  by  a  2004  study 
interpreted  by  the  Bush  EPA  to  mean  that  fracking  did  not pose a significant threat to drinking  water. (The 
report’s  authors  repeatedly  claimed  that  their  results  did  not  justify  that  conclusion,  and  went  so  far  as  to 
remove their company’s name – and their own – before the report was published.​70​)  

This  exemption  for  natural  gas  companies  is  widely  known  as  the  “Halliburton  Loophole,”  named 
after  the  first  company  to  commercially  frack,  of which Bush’s Vice President, Dick Cheney, was  formerly 
the CEO.  

In  exchange  for  bankrolling  political  allies  in  Washington,  the  natural  gas  industry  has  peddled  a 
number  of  legal  exemptions  for  itself  to  enable  its  unfettered  expansion.  One  of  the  most  egregious  is  the 
fracking  industry’s  exemption  from  federal  oversight  under  the  Safe  Drinking  Water  Act, which applies  to 
nearly every other industry whose activities threaten to compromise water quality.​71  

  
68 ​
Neela Bangerjee, “Industrial Strength: How the U.S. Government Hid Fracking’s Risks to Drinking 
Water,” West Virginia Public Radio, November 20, 2017, ​https://www.wvpublic.org/post/industrial 
strength-how-us-government-hid-frackings-risks-drinking-water#stream/0​.  
69 ​
N.a., “The Halliburton Loophole,” the New York Times, November 2, 2009,   
https://www.nytimes.com/2009/11/03/opinion/03tue3.html​.  
70 ​
N.a., “The Halliburton Loophole,” Earthworks, N.d.,  
https://earthworks.org/issues/inadequate_regulation_of_hydraulic_fracturing/​.  
71 ​
Susan Phillips, “Burning Question: What Would Life Be Like Without the Halliburton Loophole?” 
National Public Radio, December 5, 2011, ​https://stateimpact.npr.org/pennsylvania/2011/12/05/burning 
question-what-would-life-be-like-without-the-halliburton-loophole/​. 
Lowy ​15

Chemical Spills   

As  a  hub  for  extraction,  Appalachia  is  home  to  a  host  of  environmental  hazards  that  fall 
disproportionately  on  the  most  vulnerable.  In 2014, a storage tank leaked more than 10,000 gallons of  toxic 
chemicals  into  the  Elk  River  of  West  Virginia,  leaving  300,000  residents  without  drinking  water  for  more 
than  a  week.  In  the  wake  of  the  spill,  government  officials  focused  mostly  on  delivering  clean  water  to 
population  centers,  while  rural  coalfield  communities  remained  without  safe  water  for  months  (and  even 
years)  to  come.​72  ​These  residents  have  grassroots  community groups — who delivered bottled water  during 
this crisis — to thank for their lives.​73  

Not  only  is  central Appalachia an extractive hotspot – replete with natural resources to be  exploited 

–  but  its residents exist at the intersection of a number of social and economic barriers that  prove difficult to 
overcome.  In  West  Virginia,  a  lack  of  connectivity,  inadequate  medical  care,  reproductive  injustice,  the 
opioid  epidemic,  and  inadequate  utility  infrastructure  combine  to  exacerbate  the  impacts  of  MTR  felt  by 
rural Appalachian communities.  

Lack of Connectivity   

Also  troubling  for  residents  of  remote  areas  is  the  consistent  absence  of  modern  systems  of 
connectivity  that  provide  information  about  environmental  and  health  concerns.  Lack  of  access  to 
information  is  largely  a  product  of  geography:  in  Southern  West  Virginia,  disparate,  towns  remain 
geographically  isolated  from  one  another,  and  fall  victim  to  poor  cell  phone  service  (if  any  at  all),  an 
absence  of  high-speed  internet,  outrageously  high  internet  prices,  and  a  general  lack  of  government 
accountability to provide information about environmental risks.​74 ​One 2015 study found that 74 percent   

  
72 ​
Kara Leigh Lofton, “Three Years After the Elk River Chemical Spill, Advocates Continue to Work to 
Protect Drinking Water,” West Virginia Public Broadcasting, January 9, 2017,   
https://www.wvpublic.org/post/three-years-after-elk-river-chemical-spill-advocates-continue-work 
protect-drinking-water#stream/0​.  
73 ​
On my Kayford Mountain tour, my tour guide personally attested to having developed ulcers on her 
face from drinking well water contaminated for months after the spill. The government failed to bring 
clean water to her small town in the coalfields, which was without clean water until a community 
organizations came to the rescue nearly three months after the spill.  
74 ​
Julie Taboh, “Lack of Internet Access Hurting West Virginians,” June 21, 2019, VOA News, 
https://www.voanews.com/silicon-valley-technology/lack-internet-access-hurting-west-virginians​. 
Lowy ​16

of  rural  West  Virginia  lacks  broadband  internet  meeting  today’s  speed  requirements.​75  ​Thus,  remote  coal 
towns  suffer  from  an  isolation  that  renders  them  politically  disempowered  and  without  access  to  adequate 
information about risks to their environment and health.  

Lack of Medical Care  

This  remoteness  has  another  fatal  consequence:  removal  from  adequate  medical  services.  One 
public  health  professor  at  Virginia  Tech,  Susan  Marmagas,  whose  research  focus  is  cancer  in  Appalachia, 
claims  that  most  Appalachians  don’t  get  diagnosed  in  the  area;  rather,  they  must  journey  long  hours  to 
hospitals  like  Duke  or  Wake  Forest  in  North  Carolina  for  treatment.  Marmagas  cites  the  region’s  lack  of 
advanced  technology  and  clinical  trails  as  a  reason  for  this,  as  patients  know  that  they  will  need  to  drive 
hours for an optimal chance of survival.​76  

Reproductive Injustice  

The  intersection between reproductive justice and reproductive threats posed by extractivism is  also 

noteworthy.  As  West  Virginia  conservatives  have  crusaded  against  obgyn  care,  Appalachian  women  have 
lost  even  more  control  over  their  reproductive  health  in  recent  years.  Currently,  only  one  abortion  clinic 
exists  in  the  entire  state  (in  the  densely-populated, urban capital, Charleston), a decrease from ten  clinics in 
1982.​77  ​Last  year, residents passed a referendum to bar federal aid money (i.e. Medicaid) from  being used to 
fund  abortions.​78  ​Due  to  abstinence-only  sex  education;  geographic  remoteness;  Christian  anti-abortion 
rhetoric;  a  conservative  state  government  that  minimally  funds  obgyn  services;  a  lack  of  adequate  health 
care; and widespread poverty, Appalachian mothers are some of the youngest in the   

  
75 ​
Daniel Tyson, “More Than Half of W.Va. Homes Lack Adequate Internet Capabilities,” Government 
Technology, February 4, 2015, ​https://www.govtech.com/local/More-Than-Half-of-WVa-Homes-Lack 
Adequate-Internet-Capabilities.html​.  
76 ​
Lyndsey Gilpin, “Cancer Rates Are Dropping, But Not in Rural Appalachia,” Five Thirty Eight, 
February 14, 2017, ​https://fivethirtyeight.com/features/cancer-rates-are-dropping-but-not-in-rural 
appalachia/​.  
77 ​
N.a., “State Facts About Abortion: West Virginia,” Guttmacher Institute, September 2019, 
https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-west-virginia​.  
78 ​
Lori Kersey, “Implications of Abortion Amendment Go Beyond Funding, Opponents Say,” Charleston 
Gazette-Mail, October 27, 2018, ​https://www.wvgazettemail.com/election_2018/implications-of 
abortion-amendment-go-beyond-funding-opponents-say/article_58a0d729-9fb3-5531-b9b6- 
ee93c741211d.html​. 
Lowy ​17

country.​79 ​When toxic waste compromises reproductive health, these young women are faced with the 
challenges of raising children with developmental problems and birth defects.  

The Opioid Epidemic  

Reproductive  injustice  is  complicated  by  the  staggering  amount  of  Appalachian  babies  born 
addicted  to  opioids.  So  too  does  the  opioid  crisis  play  an  important  role  in  the  cyclical,  systemic 
disempowerment of West Virginians afflicted by the horrors of extractive industries.  

In  1996,  Purdue  Pharma  used  West  Virginia  as  a  dumping  ground  for  the  prescription  painkiller 
Oxycontin.​80  ​It  is  widely  accepted  that,  at  the  onset  of  the  opioid  epidemic,  doctors  around  the  country 
receive  pay-outs  from  pharmaceutical  companies  to  prescribe  painkillers  that  had  not  been  proven  to  be 
non-addictive.  West  Virginia  was  no  exception.  However,  in  West  Virginia,  the  crisis  was  complicated  by 
other  factors,  namely:  the  high  supply  of  pain  and  the  high  demand  for  relief  from  it.  There  is  ample 
evidence  to  suggest  that  coal  companies  used  painkillers to exploit those already suffering from the  horrors 
of  extractivism.  First-hand  accounts  speak  of  mining  companies  slipping  Oxy  pills  into miners’  paychecks 
in exchange for miners keeping quiet about their injuries.​81 ​In a state with rampant poverty —  
and thousands left sick and injured from extractive industries — it is no surprise that a quick escape from 
pain would prove appealing.   

Rampant  unemployment  and  a  disproportionate  amount  of  jobs  involved  in  manual  labor  (like 
manufacturing,  timbering,  and  mining),  which  are  likely  to  cause  chronic  pain,  are  ripe  conditions  for 
painkiller  addiction,  which  West  Virginia  exemplifies.​82  ​A  2009  Appalachian  Regional  Commission  report 
concluded  that  joblessness  and  high  rates  of  job-related  injuries  are  correlated  with  opioid  abuse  in  West 
Virginia.​83  

  
79 ​
Zullig & Hendryx, “Health-Related Quality of Life.”  
80 ​
Debbie  Cenziper  et  al.,  “Inside  West  Virginia’s  Opioid  Battle,”  Washington  Post,  October  18,  2019, 
https://www.washingtonpost.com/graphics/2019/investigations/west-virginia-opioid-legal-battle-foster 
care/​.  
81 ​
Kyle Younker & Taylor Harrison, “Appalachia’s coal comeback collides with grime opioid reality,” 
Debt Wire, January 12, 2018, ​http://investigations.debtwire.com/appalachias-coal-comeback-collides 
with-grim-opioid-reality/​.  
82 ​
Harris​on Jacobs, “Here’s why the opioid epidemic is so bad in West Virginia — the state with the 
highest overdose rate in the US,” Business Insider, May 1, 2016, ​https://www.businessinsider.com/why 
the-opioid-epidemic-is-so-bad-in-west-virginia-2016-4​.  
83 ​
Kate Beatty et al., “Health Disparities Related to Opioid Misuse in Appalachia,” Appalachian Regional 
Commission, April 2019,  
Lowy ​18

Despite  the  severity  of  the  crisis  in  West  Virginia  in  the  early  2000s,  pharmaceutical  companies 
continued  to  pour  pills  into  its  pharmacies.  In  2006,  one  pharmaceutical  company  —  McKesson 
Corporation  —  was  supplying  one  pharmacy  in  the  town  of  Kermit,  West  Virginia  —  with  only  400 
inhabitants  —  10,000  painkiller  pills  a  day.​84  ​The  year  prior,  the state’s unemployment rate increased  more 
than  any  state  in  the  country.  Prescription  pills  proved  a  means  to  cope  with  chronic  injury;  but,  when 
pharmaceutical  companies  finally began to crack down on liberal prescribing — causing prices on  the black 
market  to  skyrocket  — much of the state was already addicted. Cheap heroin dealers flooded in  to meet this 
demand. The head of the West Virginia University addiction program attested to this —  
claiming  that  his  patient  base  switched  from  90  percent  alcoholism  in  the  early  1990s  to  90  percent 
prescription  painkiller  addiction  by  2002,  to  a  vast  majority  heroin  addiction  by  2010,  which  remains  the 
case to this day.​85  

West  Virginia  now  has  the  highest  opioid  overdose  rate  in  the  country  by  a  landslide  —  it  is more 
than  double  the  national  average.  In  West  Virginia,  opioids  kill  more  people  annually  than  guns  and  car 
accidents combined.​86  

In  essence,  MTR  —  which  creates  unemployment  and  health  problems  —  exacerbates  the  opioid 
crisis,  which,  in  turn,  heightens  unemployment  and  health problems, making communities more  vulnerable 
— and less resilient — to further extractive exploitation.   

Corporate Reliance and the Departure of Industry  

Extractive  industrial  companies  are  not  only  to  blame  for  current  economic  and  health  impacts  in 
rural Appalachia, but for the extincence of mass unemployment and subpar utility services in the first place.   
 By 2016, only 3,600 coal mining jobs remained in eastern Kentucky and 6,200 remained statewide, 
numbers not seen since the late 17th century. The once-thriving tobacco industry was also   

   
https://www.arc.gov/assets/research_reports/HealthDisparitiesRelatedtoOpioidMisuseinAppalachiaApr20 
19.pdf​.  
84 ​
Cenziper et al., “Inside West Virginia’s Opioid Battle.”  
85 ​
J​acobs, “Here’s Why the Opioid Crisis.”  
86 ​
Jacobs, “Here’s Why the Opioid Crisis.” 
Lowy ​19

gone. With nothing to replace these industries, unemployment rates in Appalachian are some of the highest 
in the country, and per capita income has been on a steady decline.​87  

The  West  Virginia  coalfields  have  fared  similarly.  Once  the  largest  coal-producing  county  in  the 
U.S.,  McDowell  County  now  has  a  38  percent  poverty  rate;  an  8.7  percent  unemployment  rate;  the  lowest 
life  expectancy  for  men in the country – 64 – and the second lowest for women; a college graduation rate  of 
less  than 6 percent; and the highest opioid overdose rate; teenage pregnancy rate; and childhood  obesity rate 
in  the  state.​88  ​Despite  major  advancements  in  medicine  globally,  McDowell  is  one of the only  places in the 
country where life expectancy declined for both men and women from 1985 to 2010.​89  

There  are  nearly  80,000  fewer  people  living  in  McDowell  County  today  than  there  were  in  the 
1950s.  Its population is currently the lowest it has been since 1900, prior to the county’s coal boom after  the 
turn  of  the century.​90 ​McDowell County’s economic woes can be explained in part by the Appalachian  trend 
of  local  reliance  on  industry,  whose  departure  left  utility  systems  underfunded  and  ill-equipped  to  support 
human health. One town in McDowell County that exemplifies this is Gary, West Virginia.   

Before  it  was  a  city,  Gary  was  a  web  of  small  towns  surrounded  by  more  than a dozen coal mines, 
all  owned  by  the  U.S.  Steel  Corporation.  Until  1970,  the  company  owned  all  the  land  and  property  within 
the  region.  The  company  operated  the  water  plant,  collective  garbage,  provided  electricity,  and  performed 
maintenance  on  the  system,  addressing  any  problems  that  arose.  As  coal  production  slowed,  U.S.  Steel 
retracted its resources from the city. In 1970, the company incorporate five coal camps into one, creating  the 
city  of  Gary.​91  ​The  company donated its water plant to the city in an effort to minimize maintenance  and tax 
costs.  Without  company  support,  the  town  lacked  funding and expertise to maintain utility  systems; trained 
engineers  were  some  of  the  first  to  leave  when  coal  mines  began  to  close.  As  U.S.  Steel  contracted  its 
operations,  Gary  received  less  money  to  pay  its  bills.  As  Big  Coal  departed,  no  other  industry rose to take 
its place, leaving many residents jobless. In 1982, after all seven of Gary’s coal   
  
87 ​
Bill Estep, “​Coal jobs have dropped in Eastern Kentucky. Income has followed, new report shows,” 
Lexington Herald-Leader, August 18, 2018,   
https://www.kentucky.com/news/state/article216946520.html​.  
88 ​
Trip Gabriel, “50 Years Into The War on Poverty, Hardship Hits Back,” New York Times, April 20, 
2014, ​h​ttps://www.nytimes.com/2014/04/21/us/50-years-into-the-war-on-poverty-hardship-hits 
back.html​.  
89 ​
N.a., “The Great Divide: Life in McDowell County,” Bernie Sanders: U.S. Senator for Vermont, N.d., 
https://www.sanders.senate.gov/life-in-mcdowell-county​.  
90 ​
Michael Boothe, “McDowell County population at 116-year low,” West Virginia Press, March 25, 
2016, ​h​ttps://wvpress.org/breaking-news/mcdowell-county-population-116-year-low/​. 91​ ​Boothe, 
“McDowell County population.” 
Lowy ​20

mines closed down, the unemployment rate was at a staggering 90 percent.​92 ​Today, Gary residents rely  on a 
water  system  consisting  of  the  same  pipes  donated  to  the  city  a  half-century  ago,  with  minimal  upgrades. 
Throughout  the  Appalachian  coalfields,  different  towns  who  relied  on  different  companies  tell  strikingly 
similar stories.  

Conclusion  

In  this  paper,  I  have  reviewed  the  intersectional  impacts  of  mountaintop  removal  on  rural 
Appalachian  communities,  including economic, environmental, and health consequences. I have argued  that 
these  burdens  are  exacerbated  by  other  issues  –  like  inadequate  access  to  information,  inadequate  utility 
services,  poor  medical  care,  reproductive injustice, and the opioid epidemic – which make  residents of rural 
West Virginia even less resilient to the devastating impacts of MTR.   
   
92 ​
William Robbins, “90 Percent Jobless Rate Grinds West Virginia Coal Town,” New York Times, April 
10, 1983, ​https://www.nytimes.com/1983/04/10/us/90-jobless-rate-grinds-west-virginia-coal-town.html​. 
Lowy ​21

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