About Sick, Broke and Left Behind

For the past six months Luanne Rife has been spending time in Virginia’s coalfields learning about why people living along Virginia’s western border are among the least healthy in the nation.

The people living in Central Appalachia, which includes counties in Virginia, Tennessee and Kentucky, die younger and have higher incidents of diseases and higher rates of illicit drug use than anywhere else in the United States. And those are just a few of the problems.

Against this backdrop, the two primary hospital systems serving southwestern Virginia and northeastern Tennessee sought permission from the states to merge. Ballad Health was formed in 2018 after Virginia and Tennessee agreed to grant what amounts to a monopoly, but under the condition that it do what neither system had done before: measurably improve the health of the people living in its region.

Rife has been looking at the economic and social conditions that play a role in community health, at what efforts are already underway to improve health outcomes, at how Ballad intends to meet its mandate and at what actions Virginians living elsewhere can take to lend their support.

Rife was awarded a national fellowship through the Dennis A. Hunt Fund for Health Journalism, a program of the University of Southern California Center for Health Journalism, to assist with this reporting project. Photographer Heather Rousseau and data editor Kate Owens are assisting with the project.