The Appalachian people are a very proud people that believe that they can take care of their own and don’t believe in accepting charity. They have a great distrust of the health care and of health care professionals. This is because of the high rate of illiteracy that affects this minority group. According to Ludke, Obermiller, Jacobson, Shaw and Wells (2006) in the greater Cincinnati area “Appalachian adults appear to be at greater risk for low functional health literacy” and that this illiteracy causes problems with this minority group’s ability to interact with health care professionals.
One thing that I came across while researching was Ohio’s new Wellness program that individuals link to gain information on various health issues Ohioans face. Over 1. 5 million has been given to this program. But what if you don’t read or have low literary skills or maybe don’t understand how to use the internet. There are three distinctive groups among the Appalachian population, according to Cratis Williams, a native and expert in Appalachian Studies. The first he termed to town oriented elite and city fold, who are little different, he said from the rest of the middle-class Americans.
Members of this group are the region’s elite and the professional and commercial people. The second group is the substantial farmers in the region’s more fertile valleys. This is a quite prosperous group Williams says and is a group almost as numerous as the town and city folk. The last group is the least numerous but by fare are the most unusual and the group about whom so much had been written and upon whom the well-known regional stereotypes had been written and upon whom the well-known regional stereotypes have been based.
Williams calls them the “Branchwater Mountaineers” and live in the region’s more remote areas, at the end of the hollows or hollers along the ridges and the worst roads, and where the farmers who have tried to farm the region’s most marginal lands (Williams, 1999). A professor of Cumberland College, Ann Marie Johnston came up with a similar three category description of the Appalachian social structure. These three groups are common within any county in the Appalachian.
The first group he called the “town folk”, these are the lawyers, doctors, teachers and businessmen of the county seat towns who run things. There is a contrasting group to this elite controlling group which Johnston termed the “hollow folk” or those who live in the county’s most remote sections. They are the ones who present the major problems to the town folk of the county. Their children are the school dropouts and the problems for the truancy officers. Overall, they are not very dependable employees and they are often the ones whose petty crimes cause them to fill the county’s small jails.
The third group Johnston says is the “Big Road Folk. ” These are the people that live in the small houses that line the county’s main roads where transportation is relatively easy. Basically these are the “hollow folk on their way to town. ” These “Big Road Folk” usually live with some economic precariousness, but they work hard. Their children attend school with some regularity, and they represent a middle group between the culture of the town fold and the culture of the hollow folk (Johnston, 2005).
Most sociologists and anthropologists who have looked into small Appalachian rural communities have found that the local community is mostly democratic and is divided by family reputation, income differentials and the degree of urban sophistication. One analysis traces the distance from urban ways, placing the person closest to the city as superior, with the rural middle class places next and the remote holler as the poorest and least powerful.
Sociologist John Stephenson found that the traditional folk of his community also had highest regards for “good church folk” with steady jobs. Within this community there were four family structures that stepped down to “no-good families” meaning these are the families that do not have steady employment. Many scholars and observers have focused on the region’s problems, such as lack of income and low educational level and in fact seeing the region itself as identified by the appearance of several negative indicators in a county’s statistics.
Such scholars also make much of the convergence of such indicators as the proportional of persons accepting a premillennial approach to religion or a general hostility to the agencies of government, which all seems to appear from the same county statistics. At the same time those fleeting urban violence have found in many truly remote counties in Appalachia a caring neighborhood that clearly looks out for the welfare and respects the property of the residents (Walls & Stephenson, 1972).
Every county has county-seat elite who seem to control the county’s major institutions like banks, stores, the courthouse and the schools. Usually they attend mainstream churches like Christian and even some Episcopal church. In earlier settled parts of the Appalachia there tends to be churches of the German religious tradition such as Brethren and Lutheran Churches. These county seat town churches are quite different from most of the rural churches in the region, for most rural churches share a very conservative Baptist or Pentecostal faith.
This denominational differentiation sets up a religious difference that increases the distance between hollow folk and town folk. Sometimes Catholic churches along with very few Orthodox Church’s and Jewish synagogue’s can be found in this region, but make no mistake that Baptist is a very central religion in this region with very strong roots. Town elites are the market driven, commercial folk who have broad family and social connections across the United States (Denham, 2002). The place of blacks in Appalachia is an often overlooked part of regional life.
While it is true that in some mountain counties, blacks are almost totally absent, and that during Jim Crow era, some mountain counties drove blacks from the county entirely, in other areas of the Appalachian Mountains, blacks were a significant minority, but in the beginning of the 1900 most of the black population of the region resided in northern Alabama as well as West Virginia and Kentucky where coalfields began developing and many Alabama black miners were recruited and the black population in Appalachia became much more widely dispersed.
Despite what might be seen as fairly good race relations in the region, many examples of clear racism and stubborn prejudice must also be recognized. During the Jim Crow era, some 125 blacks were lynched in the region, and the many examples of the racial cleansing of rural counties in the region demonstrate a situation that not only sent blacks from their traditional homes but also left a legacy of racial and fear hatred that was not soon forgotten (Ludke, 2003).
An important aspect of any society is the fact of change. Even a reasonably stable society is not totally static, and Appalachia, particularly since WWII has been a society that has experienced rapid social change. Gender relations, for example, as in the rest of the nation, have undergone dramatic changes in the region. The traditional Appalachian family had been clearly paternalistic, with the father’s authority sanctioned by religion, law and tradition.
Yet even in traditional times, there were women whose force of personality led them to be dominant in the churches and even in their families and communities. As schooling began showing up in the region women saw the opportunities to attend and in numbers that exceeded the boys, because boys were needed for farming and coal work. This put a strain on the family structure that can be seen today (Ludke, Obermiller, Jacobson, Shaw & Wells, 2006). In traditional times the more isolated the family the more completely the family itself dominated the life of its members.
But this also meant that other institutions such as the church, the county store, and the agencies of local government played little if any role in the life of the especially isolated family. As isolation broke down these other institutions played increasingly important roles like the school in education and socialization, the store in trade and the agencies of local government in law enforcement and order; the coming of the schools brought a broadening of opportunities and a wider awareness of the world.
And in government’s tasks of justice and order, particularly interesting political patterns developed, all of which had a very close relationship to the families of the region. The family structure that was operative for the earliest, isolated families was built upon a mix of inherited European patterns and the demands of the Appalachian frontier environment. The frontier’s complete wilderness, along with the resources of soil, stone, rainfall, the presence of wildlife and the remoteness of government gave the family its earliest patterns.
Europe’s paternalistic family norm was the beginning with the father figure with authority. Tasks were related to his strength abilities and preferences like the planting and the tending of the fields and animals and trading whatever surpluses were grown. The wife being responsible for the home, its care and cleaning, the cooking, the care of small children and frequent childbearing, as well as the never ending demands of the textile arts.
The gender task division line was just outside the walls of the house, usually including the garden and chicken yard within the women’s domain and all beyond, including the fields are considered the man’s work (Urban Appalachian Council, 2002). As the twentieth century’s modernization proceeded, the influence of roads, schools, the coming of coal in parts of this region, radio and television all broke down the family’s isolation and changed most aspects of the lives of the family’s members. It often seemed as if everything was changing. The children were attracted to other neighborhoods, interests and vocations.
The wife was attracted to other tasks more in keeping with her special interests, often under the influence and guidance of mission schools. And the men, kept from schooling in the early days because they were needed on the farm, are often more unprepared for the modern world. This disparity caused by the man’s poorer educational preparation, while remembering their traditional authority and responsibilities drove many to drink and depression. Modernization clearly brought dramatic change with remarkable successes mixed with tragic failures (Greelee, 2007).
The health revolution in Appalachia during the twentieth century has paralleled in many ways the growth of the health industry in the United States, thought in the regions more remote sections there has been a remarkable leap from a health system depending upon folk remedies and “grannywomen” to the more male-oriented medical system of doctors, nurses and hospitals. Still, in some areas the folk system persists, and the emergence of a modern medical system in the more remote areas lags considerably behind the rest of the nation. Modern medicine came to the Appalachia’s more remote areas in the early decades of the twentieth century.
Since the 1950’s and 1960’s with thanks going to mostly local efforts and federal grants through the Hill-Burton Act and various War on Poverty initiatives, especially the Appalachian Regional Commission, many hospitals and clinics were established and enlarged throughout the region. The National Health Service Corps scholarships have been offered to new medical school graduates as an opportunity for service in the region, as well as to pay off their costs of medical school. A number of foreign doctors have set up practice in the region.
The present movement in health services has been to form various hospital alliances and to build a growing networking of health services tied to major medical centers. Appalachian people have been particularly aware of the aggressive networking generated by the medical centers of University of Kentucky, the University of Tennessee, the University of Virginia, Vanderbilt University, and the University of North Carolina (Ergood & Kuhre, 1979). Dramatic change has clearly come even to the more remote areas in the southern mountains during the early and mid years of the twentieth century, but still lack considerably more the rest of the nation.