Murray on Morrone, 'Ailing in Place: Environmental Inequities and Health Disparities in Appalachia'

Michele Morrone
Savannah Paige Murray

Michele Morrone. Ailing in Place: Environmental Inequities and Health Disparities in Appalachia. Athens: Ohio University Press, 2020. 204 pp. $55.00 (cloth), ISBN 978-0-8214-2420-9

Reviewed by Savannah Paige Murray (Appalachian State University) Published on H-Environment (November, 2020) Commissioned by Daniella McCahey (Texas Tech University)

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In Ailing in Place: Environmental Inequalities and Health Disparities in Appalachia, Michele Morrone explores the relationship between place and health, and specifically, draws readers’ “attention to the connection between inequitable environmental exposures and health in Appalachia” (p. viii). Hoping to strengthen the connections between studies of environmental conditions and public health, Morrone suggests that this work provides evidence “to show that Appalachian people are ailing in the place in which they live” and that not all of the health concerns afflicting Appalachian residents can be entirely attributed to individual behaviors (p. viii). In other words, Morrone states, “you may be prone to getting cancer because of your family history, but your chances of actually getting and dying from cancer increase because of where you live” (p. 3). Morrone maintains throughout the book that while health disparities within Appalachia (as compared to the rest of the United States) have been well documented, the connection between these health disparities and environmental conditions has been less clear. She elaborates that the connection between environment and health is often difficult to definitively point out because many health issues like, “for instance, cancer, are chronic and linked to myriad factors” (p. 146). Despite the difficulties inherent in this approach to the study of environmental health, Morrone argues that “when a place has the highest rates of a specific type of cancer and the highest amount of reported releases of toxic pollutants,” as is the case for Appalachia, “we should examine the connection between the two” (pp. 146-47). While Morrone effectively draws connections between public and environmental health, her focus on the Appalachian region is far less productive. 

In the introduction, Morrone emphasizes that her approach to the study of environmental health in Appalachia does not revolve around individual choices regarding health, such as smoking, for example, but is instead more concerned with the environmental conditions which can harm residents’ health. Morrone suggests that she writes “about Appalachian populations who face health disparities because of where they live, not because of how they live” (p. 15). Unfortunately, in many instances, Morrone does not abide by this admirable methodology, and instead includes numerous instances of individual behaviors that contribute to health issues in Appalachia. For example, she incorporates obesity rates in Appalachia in nearly every chapter (see pp. 61, 79, 91, 125, and 145). However, it is not just these repetitions that are troublesome. Instead, it is the overall tone of many of these passages that gives readers the impression that Morrone is, at least to some degree, placing blame on Appalachian residents, in terms of both how and where they live. For example, Morrone writes, “in some instances, residents in rural Appalachian communities contribute to projects that create harmful environmental exposures” because, according to her, “In places with persistently bad economic conditions, communities may support any kind of development offering the potential for quick economic returns, especially if jobs are on the table” (p. 12). Equally as frustrating as Morrone’s lack of compassion for Appalachian residents seeking jobs while she reinforces the false dichotomy of jobs versus the environment, are her broad comments about Appalachian residents’ feelings toward climate change. Morrone writes, “People who live in the Appalachian region tend to be even more skeptical” than the broader US populace “of humans’ role in climate change” (p. 132), a claim which she does not support with any citations or evidence. Morrone, in fact, does not effectively engage with place-based scholarship about Appalachia in either her citations or her discussion within the book. 

Morrone’s work is very clearly steeped in scholarship surrounding public health. She effectively integrates published scholarship in public and environmental health throughout the book, citing the Center for Disease Control and the Environmental Protection Agency quite often, in addition to other reliable sources pertaining to public health. The book is not, however, as clearly steeped in the study of place as Morrone claims. Morrone briefly explains the role of place and provides a reductive one-paragraph description of the Appalachian region in the book’s introduction. In doing so, she misses several opportunities throughout the book to engage with the impressive body of place-based scholarship in Appalachian studies. Since the 1970s, Appalachian studies scholars have built place-based knowledge surrounding this complicated and beautiful region, and a deeper engagement with this body of knowledge would have not only enhanced Morrone’s argument but also made her work more valuable to scholars outside field of public health. For example, Morrone mentions in passing that some have referred to Appalachia as a Third World country (p. 26). In this instance she does not provide any discussion of the internal colony model of Appalachian development[1]or any commentary on how that model has fallen out of favor based on some critiques that it does not fully encapsulate Appalachia's involvement in the broader global economy.[2] While a more vibrant discussion of the socioeconmic development of Appalachia would have increased the strength of Morrone's argument, particularly in terms of the myriad economic barriers to improving environmental health in the region, her lack of involvement with Appalachian studies scholarship surrounding coal more seriously undermines the present work. Although Morrone frequently alludes to coal mining and its historical roots and sociological impact, she does not cite or engage with any Appalachian studies experts on the history of coal mining or with Shannon Elizabeth Bell’s more recent and award-winning scholarship on the sociocultural impacts of coal on Appalachian culture, health, and environmental quality.[3]. For many of us in the environmental humanities, this book would be much stronger were the element of place made more prominent through attention to Appalachian studies scholarship, rather than Morrone’s reliance on bureaucratic data related to public health. Morrone’s work does contain a few references to work in Appalachian studies, but it is not necessarily the type of scholarship one would expect in a published monograph. Morrone cites a handbook on Appalachia and encyclopedic sources about the region. 

Morrone’s methodology for this study is also unclear. At times she alludes to a survey that she gave to both “residents and environmental health professionals” in Appalachia (e.g., p. viii). In the introduction, makes strong claims based on this survey data, suggesting that nearly all the professionals who completed the survey, “believe environmental health problems in Appalachia differ from those in other places” (p. 5). While this survey data may have emphasized the existence of health disparities, because the readers are not privy to any more detail about who completed this survey, or what, specifically, it included, it is hard to understand the context and legitimacy of these data. At other places in the monograph, Morrone suggests that she conducted interviews, but it is unclear who was interviewed and for what purpose, in terms of her overall argument. Surprisingly, in the book’s epilogue, the methods become even more muddied, as she suggests that she surveyed environmental health professionals “for background” research in the book. However, she begins each chapter with several quotes which seemingly stem from these surveys. Additionally, she ends the book with a bulleted list of quotes which she states originate from environmental health professionals in Appalachia. Owing to the ambiguity surrounding her research, it is hard for readers to envision what these data mean in terms of the book’s broader context. Ailing in Place may be useful for scholars in public health hoping to learn more about the challenges facing rural residents, but based on its shallow exploration of place, for those interested in the Appalachian environment, this book should be supplemented with much more reading in Appalachian and environmental studies.


[1]. Helen M. Lewis and Edward E. Knipe, “The Colonialism Model: The Appalachian Case,” in Colonialism in Modern America: The Appalachian Case, ed. Helen Matthew Lewis, Linda Johnson, and Donald Askins (Chapel Hill: Appalachian Consortium Press, 1978), 9-26.

[2]. Wilma A. Dunaway, Transition to Capitalism in Southern Appalachia, 1700-1860 (Chapel Hill: University of North Carolina Press, 1996).

[3]. Fighting King Coal: The Challenges to Micromobilization in Central Appalachia (Cambridge, MA: MIT Press, 2016); Our Roots Run Deep as Ironweed: Appalachian Women and the Fight for Environmental Justice (Urbana: University of Illinois Press, 2013).

Citation: Savannah Paige Murray. Review of Morrone, Michele, Ailing in Place: Environmental Inequities and Health Disparities in Appalachia. H-Environment, H-Net Reviews. November, 2020. URL:

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