Gendered Poverty and the History of the Community Health Movement in the Appalachian South

In the 1970s antipoverty activists in the Appalachian South built a regional community health, from the recognition of occupational and environmental health to breaking down sexist, racist, and classist barriers to health care. Advocates of “community health” sought to provide new models of care by opening clinics; focusing on primary care and preventive services; and building relationships with community members in order to address environmental and social concerns related to health. Leading activist Dr. H. Jack Geiger has argued that community health campaigns used “social and political change to affect those powerful determinants of health status that lie in the economic and social order.” Focusing on the coalfields of eastern Kentucky, I show how the community health movement challenged power dynamics in the region, as it brought into relief the region’s gendered poverty. For example, men suffered with black lung disease while women managed the unpaid care work that was part of living in the “disability belt.” Drawing upon networks established during the federal War on Poverty, disabled miners and poor mothers came together to argue for a wider social safety net that included social insurance for ailing miners, their dependents, and widows. Moreover, mothers argued for forms of employment that did not threaten lives. Although shifting state and federal politics blunted their most ambitious goals, as community health groups in the Mountain South secured funding for clinics, pursued legal campaigns, and conducted health fairs, they fundamentally altered the gendered class relationships that had long defined the coalfield political economy.