Life in the Sickest Town in America
Content
Life in the Sickest Town in America
Donald Rose has no teeth, but thats not his biggest problem. A camouflage hat droops over his
ancient, wire-framed glasses. Hes only 43, but he looks much older.
I met him one day in October as he sat on a tan metal folding chair in the hallway of Riverview
School, one of the few schoolsfew buildings, reallyin the coal-mining town of Grundy, Virginia. That
day it was the site of a free clinic, the Remote Area Medical. Rose was there to get new glasseshes
on Medicare, which doesnt cover most vision services.
Remote Area Medical was founded in 1985 by Stan Brock, a 79-year-old Brit who wears a tan AirForce-style uniform and formerly hosted a nature TV show called Wild Kingdom. Even after he spent
time in the wilds of Guyana, Brock came to the conclusion that poor Americans needed access to
medical care about as badly as the Guyanese did. Now Remote Area Medical holds 20 or so packed
clinics all over the country each year, providing free checkups and services to low-income families
who pour in from around the region.
When I pulled into the school parking lot, someone was sleeping in the small yellow car in the next
space, fast-food wrappers spread out on the dashboard. Inside, the clinics patrons looked more or
less able-bodied. Most of the women were overweight, and the majority of the people I talked to
were missing some of their teeth. But they were walking and talking, or shuffling patiently along the
beige halls as they waited for their names to be called. There werent a lot of crutches and
wheelchairs.
Yet many of the people in the surrounding county, Buchanan, derive their income from Social
Security Disability Insurance, the government program for people who are deemed unfit for work
because of permanent physical or mental wounds. Along with neighboring counties, Buchanan has
one of the highest percentages of adult disability recipients in the nation, according to a 2014
analysis by the Urban Institutes Stephan Lindner. Nearly 20 percent of the area's adult residents
received government SSDI benefits in 2011, the most recent year Lindner was able to analyze.
According to Lindners calculations, five of the 10 counties that have the most people on disability
are in Virginiaand so are four of the lowest, making the state an emblem of how wealth and work
determine health and well-being. Six hours to the north, in Arlington, Fairfax, and Loudoun
Counties, just one out of every hundred adults draws SSDI benefits. But Buchanan county is home to
a shadow economy of maimed workers, eking out a living the only way they canby joining the nations
increasingly sizable disability rolls. On certain days of the month you stay away from the post office,
says Priscilla Harris, a professor who teaches at the Appalachian School of Law in Grundy, because
that's when the disability checks are coming in.
Just about everyone I spoke with at the Grundy clinic was a former manual worker, or married to
one, and most had a story of a bone-crushing accident that had left them (or their spouse) out of
work forever. For Rose, who came from the nearby town of Council, that day came in 1996, when he
was pinned between two pillars in his job at a sawmill. He suffered through work until 2001, he told
me, when he finally started collecting his check, as its often called. He had to go to a doctor to prove
that he was truly hurtinghe has deteriorating discs, he says, and chronic back pain. He was turned
down twice, he thinks because he was just 30 years old at the time. Now the government sends him
a monthly check for $956.
Each classroom at Riverview School had a different specialist tucked insidein one, an optometrist
measured eyes with her chart projected on the classroom wall. She showed me a picture she took in
a nearby town of a man who, unable to afford new glasses and rapidly losing eyesight, had taped a
stray plastic lens over his existing glasses. The clinic had brought along two glasses-manufacturing
RVs where technicians could make patients like Rose a fresh set of glasses, including frames, in just
a few hours.
As for his teeth? Roses diabetes loosened them. They went ahead and pulled them all, he said. He
assured me that being toothless was not as grave a life-change as the toothed might imagine it to be.
I can still eat a steak, trust me, he says. I use my tongue and my gums.
Grundy, which is located at the tip of Virginia that jabs into Kentucky, is sheltered by the steep,
wooded Appalachians and cut through by the mighty Levisa Fork River. (The river is so mighty that
the area has suffered nine major floods in the past century, and recently the entire town had to be
relocated to higher ground.)
In October, the sun-dappled mountains blazed with red and orange as the leaves turned. If you
wanted to send someone a postcard to convince them of the merits of Virginia, this would be it.
But if this place has the scenery of the Belgian Ardennes, it has the health statistics of Bangladesh.
People here die about five years earlier than they should. About a third of people smoke, and a third
are obese. A quarter of the people live in poverty, compared with about 11 percent in the rest of the
state.
These Appalachians, many of them former coal miners, are among the nearly nine million American
workers receiving disability payments today, compared with 1.4 million in 1970. Spending on the
program has risen nine-fold over the past four decades. Clusters of recipients can be found from
California to Maine, though as Lindner points out, the states with the highest numbers tend to be in
the South and Southeast.
Critics say the programs expansion is partly driven by Americans who are perfectly capable of
working but are unwilling to do so. Since the mid-1980s, government spending on the elderly and
disabled has ballooned, even as tightened eligibility rules have slashed welfare aid for needy
mothers and children. Even advocates of big-government-style welfare acknowledge that some
people use the program because its the only form of income available to them. At the clinic, people
who were themselves on disability complained about others who they saw as lazy fakers who milked
the system.
But visiting a place like Grundy reveals a more complicated picture. There are undoubtedly some
who exaggerate their ailments in order to collect their checks. But many of the coal workers here
have experienced horrific on-the-job accidents and cant go back to the mines. Other residents have
been battered by diabetes, obesity, and tobacco. Others still suffer from severe depression and
intellectual disabilities that would preclude most kinds of work. And most importantly, there are no
other options here: no orthodontists office where someone can work the front desk; no big firms
brimming with entry-level secretarial jobs. Its not even clear how a person would go about calling
around for a job here: My iPhone stopped working a few miles outside the county line.
Few white-collar people understand the degree to which manual labor chews up workers bodies.
And in Grundy, theres nowhere for them to go afterward.
Here you have a Pandora's box of every social issue that might contribute to disability, said Martin
Wegbreit, the director of litigation at the Central Virginia Legal Aid Society. Before coming to
Richmond in 2004, Wegbreit worked in southwest Virginia for nearly 20 years.
These are jobs that even if they don't injure people, they wear people down, he told me. It's hard on
the back, it's hard on the knees, it's hard on the entire body.
Residents of Grundy and surrounding areas wait to be seen at the Remote Area Medical free clinic.
(Olga Khazan)As I drove around Buchanan, trailer homes seemed to be the predominant form of
housing. I passed a Dairy Queen, a Long John Silvers, a Pizza Hut, and not much else. Locals blame
the towns economic slump on the decline of coal, which they in turn blame on the Environmental
Protection Agencys regulations. Several yards were dotted with campaign signs urging passers-by to
Stop Obama/Vote Gillespie. (Sixty percent of Buchanan county voted for Ed Gillespie, the Republican
candidate for Senate, though he lost in the state overall.)
The place had its boom years. Coal first came in the 1930s, displacing poor farmers who tilled the
tough mountain dirt. In the 1970s, United Coal expanded rapidly by snapping up cheap land all
across Buchanan county. A 1978 New York Times article describes a never-ending rush hour on
Grundys lone highway as convoys of coal trucks with names like The Lord Is My Leader roared
through town. The Island Creek Coal Company made plans for a development of 1,600 Swiss-chale-style houses on a nearby hilltop.
The population of the county has shrunk by about 15,000 people since that year. In May alone, 188
workers were laid off in a mine near Grundy. The industry has been slammed by the newfound
natural gas reserves and is expected to contract further by 2020. Still, coal remains the largest
private employer in Buchanan, and its heavy impact continues to be felt even by those who no longer
work in the mines.
Though we sometimes associate the dangers of coal with big, splashy incidents like 2010s Upper Big
Branch Mine Disaster in West Virginia, in which a violent explosion killed 29 men, most coal-induced
disabilities are banal, and some are hard to detect. Among the most dangerous types of coal
environments is low coalso called because the seams are just 36 inches high. Workers in these mines
spent their days crawling through the vast, dark caverns. For a miner who avoids being crippled,
burned or buried alive, wrote John C. Tucker of Buchanan county in May God Have Mercy, the usual
question is which will give out firsthis lungs, his back, or his knees.
All types of mines require incessant bending and lifting; a bag of rock dust can weigh up to 50
pounds. Many of the former miners I spoke with complained of back pain, a condition thats both
excruciating and difficult for doctors to diagnose. Theres also plenty of hearing loss, says John
Gifford, a local disability attorney. It's loud as hell down there.
Other injuries are even more gruesome. Ive had men who had their hand trapped, fingers crushed,
fingers amputated, Gifford adds. One man didn't duck in time, so a cable pulled him off the mining
car and he suffered paralysis in both legs. Harris, the law professor, says a former student of hers
worked as a coal miner until he was trapped in a collapse and had to have his foot amputated.
In the schools cafeteria, I met a middle-aged man named Robert who told me he began working in
the mines when he was 8 years old to help his family. (He asked me to use only his first name.) In
1999, he and some co-workers were repairing a piece of machinery and a metal chunk the size of a
small table swung off a hook and came crashing down onto him, taking the entire apparatus down
with it.
"My forehead hit the ground, and the metal hit the back of my head, he said. I had a hard hat on. The
first time it hit me, it knocked my hard hat off. The second time, it knocked my head into the ground
and landed on top of me and bent me over."
After the initial recovery came the bad headaches and the prescription painkillers that he couldn't
tolerate. An x-ray revealed a herniated disc. He tried to go back to work three times, he says, but
after four or five days back on the job, hed be puking from the pain. It took him five years to get his
disability check. He now says he and his wife make about $2,000 a month from disability.
We were within two, three days of losing our home, his wife, Vicki, said. If he hadnt got it when he
did, we would have.
Vicki was also applying for disability after quitting her job as a nursing assistant. Years of lifting
300-pound men, she said, inflamed the arthritis and bone spurs in her spine. She doesn't have health
insurance, which is why she comes to clinics like this. The couple had been there since 4 a.m.
Working in a mine has gotten safer over the years. But even if a coal worker manages to escape a
freak accident, standing in clouds of coal dust can be treacherous for the lungs over time. In a back
room of the elementary school, I met with Joe Smiddy, a retired pulmonologist who now volunteers
for Remote Area Medical doing chest x-rays.
He showed me an image of a pair of lungs mottled with tiny white speckseach of them a piece of coal
dust with a scar around it. This is coal workers' pneumoconiosis, or black lung disease. This
gentleman has a lung full of dust, he said.
Coal workers are supposed to be offered masks to wear, Smiddy said, but for a 12-hour shift in a
coal mine, there's almost nobody who can wear a mask. They say, It's heavy on my face, I can't
breathe with it on.
No matter how much gunk is clogging their airways, Smiddy said his patients often avoid
complaining to their bosses or letting on that theyre sick. Unless, that is, theyre ready to go on
disability.
Coal mining is the only job available to them, and they're feeding their family, he said. They're going
to not raise any sand.
A street scene in Arlington County, Virginia, one of the wealthiestand healthiestcounties in the
United States (hrvargas/Flickr)Compare all of this with Arlington County, 400 miles away in the
northern part of the state, which has one of the nations lowest rates of disability. Only 1 percent of
people in Arlington are on disability, and its regularly ranked one of the overall healthiest (and
richest) counties in the nation. Here, there are well-paved bike routes and a Metro-accessible Whole
Foods. People complain when they cant take their tiny dogs into Starbucks.
Virginia, in other words, is a state divided not only by politics, professions, and mountains, but also
by how run-down its citizens are. While Buchanan countys fortunes have been inextricably tied to
coal, those of Northern Virginia are hitched to the government. A large portion of its residents
belong to the vast army of contractors, lobbyists, lawyers, PR people, and other auxiliary workers
who orbit the federal government and rake in generous salaries for their efforts. As Dylan Matthews
pointed out in the Washington Post, theres been a $1.7 billion increase in lobbying spending
between 1998 and 2010 alone, which correlates neatly with the rise in incomes of Washington-area
residents.
Whats more, the eye-popping growth of contracting in the 90s that was intended to downsize the
government resulted in private workers doing the same work for exponentially more money.
Northern Virginia counties are now home to these wealthiest Washingtonians.
One day recently I visited an Arlington lululemon. Inside, a man gazed at a wall of performance tank
tops selling for $58. He hailed a beanie-clad associate and said he needed help finding a gift for his
girlfriend.
She does something with a machine, the boyfriend said.
Pilates? he associate offered.
Yeah.
Do you know which size she is?
Im going to guess, the boyfriend said confidently.
Sounds good. If you see a girl behind the counter who you think might be the same size as her, the
associate offered, they have no problem with you asking.
Unsurprisingly, Buchanan county has no similar high-end shops. In 2011, it got a Wal-Mart that
employs 230 people. At minimum wage, an entry-level job there pays as much as disability would,
but even retail jobs require standing for long hours. I searched Monster.com for jobs nearby, and
most of the 78 listings were in retail or home healthcare. Only two of the positions were actually in
Grundy.
We have no factories, we have nothing here, said Celeste Barrett, a social worker in Grundy. Coal
mining is all we have. Barrett was one of two women from the local department of social services
sitting in front of tables bearing heaps of donated clothes. The goods were destined for the families
of out-of-work miners, they said.
If you make any money in Buchanan county, you're a coal miner, said the other woman, Amanda
Coleman. These coal miners who were making $80,000 to $90,000 and they go down on disability,
where a household of one gets $1,200 [per month].
It's just such a hard job, Barrett added. By the time they get a certain age, most of them are humped
over.
An outmigration of the young and talented has left behind an aging population that is ill-equipped to
deal with a changing economy. Thirty-two percent of Buchanan's residents never graduated from
high school, compared with 15 percent nationwide.
What's more, the same landscape that makes the area so gorgeous can also, perversely, make it
harder to stay healthy. Compared with large Virginia cities, Buchanan has fewer roads, sidewalks,
and modes of public transportation, health workers said.*
The health problems cascade from there. The economy is built on physically grueling jobs. An injury
causes pain, which causes depression. Depression makes it harder to work. People gain weight. The
weight gain leads to sleep apnea and sometimes to diabetes. Diabetes can exacerbate vision
problems.
To top it all off, there are few doctors in the region, and Virginia rejected the Obamacare Medicaid
expansion, which would have insured an additional 170,000 people. Because getting to a doctor is
hard and expensive, people self-medicate with prescription painkillers, alcohol, and tobacco.
Eventually, said Smiddy, the pulmonologist, they become dysfunctional. They're weaving behind the
car. They're setting the stove on fire. It's not that they're bad people. Theyre probably faith-based
people, family people. Most are just trying to function.
Those who argue that the disability system has become choked with exaggerated claims are not
entirely wrong. In 2011, the Wall Street Journal reported on David Daugherty, a West Virginia judge
who had seemingly rubber-stamped approval for all but four of the 1,284 disability appeals that
came before him. He appeared to be colluding with a lawyer named Eric Conn, who had advertised
his services on billboards as Mr. Socialsecurity and sometimes brought an inflatable replica of
himself to events. Its faster for disability judges to approve a disability claim than to reject one, so its
easy to see how less-than-deserving cases would sneak through.
Because of rising income inequality, poor people can now earn almost as much on disability as they
can at minimum-wage jobsas long as they can prove theyre sick enough. In a 2006 analysis, the
economists David Autor and Mark Duggan found that the main reason disability rolls have swollen is
that the programs rules were liberalized in 1984. The Social Security administration was directed to
weigh applicants pain and discomfort more heavily and to relax its mental illness screening. (The
government has four different sets of standards: one for people under the age of 50, another for
those between 50 and 54, another for 55-59-year-olds, and a final one for those 60 and older.)
To sign up, applicants first state their disabilities and the names of their doctors. Each application is
reviewed by state officials and sometimes by an independent doctor. Two-thirds of applicants are
rejected after this step because they lack medical documentation that their ailments will keep them
out of work for at least a year. From there, an applicant can appeal, and a different official will
review his or her paperwork. After that, another 11 percent of applications are approved.
The rejected cases are seen by administrative judges in courtrooms across the country. According to
a recent Washington Post investigation, the entire process can take years. If they make it through,
beneficiaries will receive $13,740 annually, on average.
The problem is, even if society were to decide that there should be fewer people on disability, that
the system has become too bloated with sneaky pretenders, it isnt clear what a fifth of the
population of Grundy would do to survive. Its entirely possible that some of the towns residents are
faking their disability claims, but its hard to imagine that most of them are. People who are rolling in
undeserved government dough generally dont line up at the crack of dawn to get their teeth fixed in
an elementary school cafeteria.
Residents of Grundy sometimes run into problems during their legal proceedings, which take place
via video chat from a courthouse over the mountains in Bluefield. The judge, who is listening to the
arguments remotely, must consider age, education, and whether the applicants skills can be
transferred to another line of work. If you are physically or mentally able to do a job, you don't meet
the test for disability, Wegbreit says. It doesn't matter if that job does or doesn't exist in your region
of the country. And that job doesn't exist in Buchanan county.
Enough applications get through that disability benefits provide an economic safety net to Buchanan
county residents. But the high number of recipients also depresses the area further by keeping new
businesses away. Companies arent eager to hire sick, worn-out miners.
This area is a nightmare of disability, Smiddy says. Any company starting a business here knows that
a substantial percentage of workers are going to have dust on their lungs, they're going to be obese,
they've already smoked a pack a day.
Once people get on disability, they usually dont go back to gainful employment. Though theyre not
counted in unemployment statistics, functionally, they become like the long-term unemployedfalling
into an economic hole from which its notoriously hard to claw out.
Employed people might think of being out of work as being relaxing, but jobs provide identity and
purpose. Whatever the job, it can give a sense of belonging, of being a contributor; an important
part, however menial, of an organization with a bigger purpose, a valued part of society, wrote Tom
Fryers, a visiting professor of public health at the University of Leicester in the U.K., in a recent
paper. Work can provide a structure for the day, week, and year without which life just drifts by.
Idleness, meanwhile, further depletes
bodies and minds.The rate of depression
is 19 percent among people who have
been unemployed for a year, compared
to just 10 to 11 percent for people who
went without jobs for just a few weeks.
Even though they dont face the same
financial strains as the long-term
unemployed, people on disability still
suffer the negative health effects of
being jobless. Researchers have also
found high rates of depression among
recipients of welfare, for example.
Once you're on the couch, your muscles become weak, you're going to gain weight, you're not
physically capable of going back in the coal mine, Smiddy said. A lack of work has been shown to
increase the risk of premature death significantly, particularly for men.
The problem, as Smiddy sees it, isnt just that the economy is limited, or that the regions education
and medical systems could use an overhaul. The countys health has been so poor for so long, he
says, that locals have set their expectations too low. And once everyonethe people, their employers,
their doctors, the governmentaccepts that bleak vision, it hardens into reality. It makes it so theres
no life after coal.
Its Just pull my teeth, or Grandpa died when he was 50 or Momma's already on oxygen, Smiddy tells
me, his voice growing increasingly exasperated as he clicks through x-rays in his makeshift office.
Theres a negative fatalistic attitude. We have to have an expectation of health, and seek health.
*This story originally stated, based on the recollection of Wegbreit, that Buchanan county had seen
its first grocery store only recently. In fact, it has had a grocery store since 1955. We regret the
error.
Donald Rose has no teeth, but thats not his biggest problem. A camouflage hat droops over his
ancient, wire-framed glasses. Hes only 43, but he looks much older.
I met him one day in October as he sat on a tan metal folding chair in the hallway of Riverview
School, one of the few schoolsfew buildings, reallyin the coal-mining town of Grundy, Virginia. That
day it was the site of a free clinic, the Remote Area Medical. Rose was there to get new glasseshes
on Medicare, which doesnt cover most vision services.
Remote Area Medical was founded in 1985 by Stan Brock, a 79-year-old Brit who wears a tan AirForce-style uniform and formerly hosted a nature TV show called Wild Kingdom. Even after he spent
time in the wilds of Guyana, Brock came to the conclusion that poor Americans needed access to
medical care about as badly as the Guyanese did. Now Remote Area Medical holds 20 or so packed
clinics all over the country each year, providing free checkups and services to low-income families
who pour in from around the region.
When I pulled into the school parking lot, someone was sleeping in the small yellow car in the next
space, fast-food wrappers spread out on the dashboard. Inside, the clinics patrons looked more or
less able-bodied. Most of the women were overweight, and the majority of the people I talked to
were missing some of their teeth. But they were walking and talking, or shuffling patiently along the
beige halls as they waited for their names to be called. There werent a lot of crutches and
wheelchairs.
Yet many of the people in the surrounding county, Buchanan, derive their income from Social
Security Disability Insurance, the government program for people who are deemed unfit for work
because of permanent physical or mental wounds. Along with neighboring counties, Buchanan has
one of the highest percentages of adult disability recipients in the nation, according to a 2014
analysis by the Urban Institutes Stephan Lindner. Nearly 20 percent of the area's adult residents
received government SSDI benefits in 2011, the most recent year Lindner was able to analyze.
According to Lindners calculations, five of the 10 counties that have the most people on disability
are in Virginiaand so are four of the lowest, making the state an emblem of how wealth and work
determine health and well-being. Six hours to the north, in Arlington, Fairfax, and Loudoun
Counties, just one out of every hundred adults draws SSDI benefits. But Buchanan county is home to
a shadow economy of maimed workers, eking out a living the only way they canby joining the nations
increasingly sizable disability rolls. On certain days of the month you stay away from the post office,
says Priscilla Harris, a professor who teaches at the Appalachian School of Law in Grundy, because
that's when the disability checks are coming in.
Just about everyone I spoke with at the Grundy clinic was a former manual worker, or married to
one, and most had a story of a bone-crushing accident that had left them (or their spouse) out of
work forever. For Rose, who came from the nearby town of Council, that day came in 1996, when he
was pinned between two pillars in his job at a sawmill. He suffered through work until 2001, he told
me, when he finally started collecting his check, as its often called. He had to go to a doctor to prove
that he was truly hurtinghe has deteriorating discs, he says, and chronic back pain. He was turned
down twice, he thinks because he was just 30 years old at the time. Now the government sends him
a monthly check for $956.
Each classroom at Riverview School had a different specialist tucked insidein one, an optometrist
measured eyes with her chart projected on the classroom wall. She showed me a picture she took in
a nearby town of a man who, unable to afford new glasses and rapidly losing eyesight, had taped a
stray plastic lens over his existing glasses. The clinic had brought along two glasses-manufacturing
RVs where technicians could make patients like Rose a fresh set of glasses, including frames, in just
a few hours.
As for his teeth? Roses diabetes loosened them. They went ahead and pulled them all, he said. He
assured me that being toothless was not as grave a life-change as the toothed might imagine it to be.
I can still eat a steak, trust me, he says. I use my tongue and my gums.
Grundy, which is located at the tip of Virginia that jabs into Kentucky, is sheltered by the steep,
wooded Appalachians and cut through by the mighty Levisa Fork River. (The river is so mighty that
the area has suffered nine major floods in the past century, and recently the entire town had to be
relocated to higher ground.)
In October, the sun-dappled mountains blazed with red and orange as the leaves turned. If you
wanted to send someone a postcard to convince them of the merits of Virginia, this would be it.
But if this place has the scenery of the Belgian Ardennes, it has the health statistics of Bangladesh.
People here die about five years earlier than they should. About a third of people smoke, and a third
are obese. A quarter of the people live in poverty, compared with about 11 percent in the rest of the
state.
These Appalachians, many of them former coal miners, are among the nearly nine million American
workers receiving disability payments today, compared with 1.4 million in 1970. Spending on the
program has risen nine-fold over the past four decades. Clusters of recipients can be found from
California to Maine, though as Lindner points out, the states with the highest numbers tend to be in
the South and Southeast.
Critics say the programs expansion is partly driven by Americans who are perfectly capable of
working but are unwilling to do so. Since the mid-1980s, government spending on the elderly and
disabled has ballooned, even as tightened eligibility rules have slashed welfare aid for needy
mothers and children. Even advocates of big-government-style welfare acknowledge that some
people use the program because its the only form of income available to them. At the clinic, people
who were themselves on disability complained about others who they saw as lazy fakers who milked
the system.
But visiting a place like Grundy reveals a more complicated picture. There are undoubtedly some
who exaggerate their ailments in order to collect their checks. But many of the coal workers here
have experienced horrific on-the-job accidents and cant go back to the mines. Other residents have
been battered by diabetes, obesity, and tobacco. Others still suffer from severe depression and
intellectual disabilities that would preclude most kinds of work. And most importantly, there are no
other options here: no orthodontists office where someone can work the front desk; no big firms
brimming with entry-level secretarial jobs. Its not even clear how a person would go about calling
around for a job here: My iPhone stopped working a few miles outside the county line.
Few white-collar people understand the degree to which manual labor chews up workers bodies.
And in Grundy, theres nowhere for them to go afterward.
Here you have a Pandora's box of every social issue that might contribute to disability, said Martin
Wegbreit, the director of litigation at the Central Virginia Legal Aid Society. Before coming to
Richmond in 2004, Wegbreit worked in southwest Virginia for nearly 20 years.
These are jobs that even if they don't injure people, they wear people down, he told me. It's hard on
the back, it's hard on the knees, it's hard on the entire body.
Residents of Grundy and surrounding areas wait to be seen at the Remote Area Medical free clinic.
(Olga Khazan)As I drove around Buchanan, trailer homes seemed to be the predominant form of
housing. I passed a Dairy Queen, a Long John Silvers, a Pizza Hut, and not much else. Locals blame
the towns economic slump on the decline of coal, which they in turn blame on the Environmental
Protection Agencys regulations. Several yards were dotted with campaign signs urging passers-by to
Stop Obama/Vote Gillespie. (Sixty percent of Buchanan county voted for Ed Gillespie, the Republican
candidate for Senate, though he lost in the state overall.)
The place had its boom years. Coal first came in the 1930s, displacing poor farmers who tilled the
tough mountain dirt. In the 1970s, United Coal expanded rapidly by snapping up cheap land all
across Buchanan county. A 1978 New York Times article describes a never-ending rush hour on
Grundys lone highway as convoys of coal trucks with names like The Lord Is My Leader roared
through town. The Island Creek Coal Company made plans for a development of 1,600 Swiss-chale-style houses on a nearby hilltop.
The population of the county has shrunk by about 15,000 people since that year. In May alone, 188
workers were laid off in a mine near Grundy. The industry has been slammed by the newfound
natural gas reserves and is expected to contract further by 2020. Still, coal remains the largest
private employer in Buchanan, and its heavy impact continues to be felt even by those who no longer
work in the mines.
Though we sometimes associate the dangers of coal with big, splashy incidents like 2010s Upper Big
Branch Mine Disaster in West Virginia, in which a violent explosion killed 29 men, most coal-induced
disabilities are banal, and some are hard to detect. Among the most dangerous types of coal
environments is low coalso called because the seams are just 36 inches high. Workers in these mines
spent their days crawling through the vast, dark caverns. For a miner who avoids being crippled,
burned or buried alive, wrote John C. Tucker of Buchanan county in May God Have Mercy, the usual
question is which will give out firsthis lungs, his back, or his knees.
All types of mines require incessant bending and lifting; a bag of rock dust can weigh up to 50
pounds. Many of the former miners I spoke with complained of back pain, a condition thats both
excruciating and difficult for doctors to diagnose. Theres also plenty of hearing loss, says John
Gifford, a local disability attorney. It's loud as hell down there.
Other injuries are even more gruesome. Ive had men who had their hand trapped, fingers crushed,
fingers amputated, Gifford adds. One man didn't duck in time, so a cable pulled him off the mining
car and he suffered paralysis in both legs. Harris, the law professor, says a former student of hers
worked as a coal miner until he was trapped in a collapse and had to have his foot amputated.
In the schools cafeteria, I met a middle-aged man named Robert who told me he began working in
the mines when he was 8 years old to help his family. (He asked me to use only his first name.) In
1999, he and some co-workers were repairing a piece of machinery and a metal chunk the size of a
small table swung off a hook and came crashing down onto him, taking the entire apparatus down
with it.
"My forehead hit the ground, and the metal hit the back of my head, he said. I had a hard hat on. The
first time it hit me, it knocked my hard hat off. The second time, it knocked my head into the ground
and landed on top of me and bent me over."
After the initial recovery came the bad headaches and the prescription painkillers that he couldn't
tolerate. An x-ray revealed a herniated disc. He tried to go back to work three times, he says, but
after four or five days back on the job, hed be puking from the pain. It took him five years to get his
disability check. He now says he and his wife make about $2,000 a month from disability.
We were within two, three days of losing our home, his wife, Vicki, said. If he hadnt got it when he
did, we would have.
Vicki was also applying for disability after quitting her job as a nursing assistant. Years of lifting
300-pound men, she said, inflamed the arthritis and bone spurs in her spine. She doesn't have health
insurance, which is why she comes to clinics like this. The couple had been there since 4 a.m.
Working in a mine has gotten safer over the years. But even if a coal worker manages to escape a
freak accident, standing in clouds of coal dust can be treacherous for the lungs over time. In a back
room of the elementary school, I met with Joe Smiddy, a retired pulmonologist who now volunteers
for Remote Area Medical doing chest x-rays.
He showed me an image of a pair of lungs mottled with tiny white speckseach of them a piece of coal
dust with a scar around it. This is coal workers' pneumoconiosis, or black lung disease. This
gentleman has a lung full of dust, he said.
Coal workers are supposed to be offered masks to wear, Smiddy said, but for a 12-hour shift in a
coal mine, there's almost nobody who can wear a mask. They say, It's heavy on my face, I can't
breathe with it on.
No matter how much gunk is clogging their airways, Smiddy said his patients often avoid
complaining to their bosses or letting on that theyre sick. Unless, that is, theyre ready to go on
disability.
Coal mining is the only job available to them, and they're feeding their family, he said. They're going
to not raise any sand.
A street scene in Arlington County, Virginia, one of the wealthiestand healthiestcounties in the
United States (hrvargas/Flickr)Compare all of this with Arlington County, 400 miles away in the
northern part of the state, which has one of the nations lowest rates of disability. Only 1 percent of
people in Arlington are on disability, and its regularly ranked one of the overall healthiest (and
richest) counties in the nation. Here, there are well-paved bike routes and a Metro-accessible Whole
Foods. People complain when they cant take their tiny dogs into Starbucks.
Virginia, in other words, is a state divided not only by politics, professions, and mountains, but also
by how run-down its citizens are. While Buchanan countys fortunes have been inextricably tied to
coal, those of Northern Virginia are hitched to the government. A large portion of its residents
belong to the vast army of contractors, lobbyists, lawyers, PR people, and other auxiliary workers
who orbit the federal government and rake in generous salaries for their efforts. As Dylan Matthews
pointed out in the Washington Post, theres been a $1.7 billion increase in lobbying spending
between 1998 and 2010 alone, which correlates neatly with the rise in incomes of Washington-area
residents.
Whats more, the eye-popping growth of contracting in the 90s that was intended to downsize the
government resulted in private workers doing the same work for exponentially more money.
Northern Virginia counties are now home to these wealthiest Washingtonians.
One day recently I visited an Arlington lululemon. Inside, a man gazed at a wall of performance tank
tops selling for $58. He hailed a beanie-clad associate and said he needed help finding a gift for his
girlfriend.
She does something with a machine, the boyfriend said.
Pilates? he associate offered.
Yeah.
Do you know which size she is?
Im going to guess, the boyfriend said confidently.
Sounds good. If you see a girl behind the counter who you think might be the same size as her, the
associate offered, they have no problem with you asking.
Unsurprisingly, Buchanan county has no similar high-end shops. In 2011, it got a Wal-Mart that
employs 230 people. At minimum wage, an entry-level job there pays as much as disability would,
but even retail jobs require standing for long hours. I searched Monster.com for jobs nearby, and
most of the 78 listings were in retail or home healthcare. Only two of the positions were actually in
Grundy.
We have no factories, we have nothing here, said Celeste Barrett, a social worker in Grundy. Coal
mining is all we have. Barrett was one of two women from the local department of social services
sitting in front of tables bearing heaps of donated clothes. The goods were destined for the families
of out-of-work miners, they said.
If you make any money in Buchanan county, you're a coal miner, said the other woman, Amanda
Coleman. These coal miners who were making $80,000 to $90,000 and they go down on disability,
where a household of one gets $1,200 [per month].
It's just such a hard job, Barrett added. By the time they get a certain age, most of them are humped
over.
An outmigration of the young and talented has left behind an aging population that is ill-equipped to
deal with a changing economy. Thirty-two percent of Buchanan's residents never graduated from
high school, compared with 15 percent nationwide.
What's more, the same landscape that makes the area so gorgeous can also, perversely, make it
harder to stay healthy. Compared with large Virginia cities, Buchanan has fewer roads, sidewalks,
and modes of public transportation, health workers said.*
The health problems cascade from there. The economy is built on physically grueling jobs. An injury
causes pain, which causes depression. Depression makes it harder to work. People gain weight. The
weight gain leads to sleep apnea and sometimes to diabetes. Diabetes can exacerbate vision
problems.
To top it all off, there are few doctors in the region, and Virginia rejected the Obamacare Medicaid
expansion, which would have insured an additional 170,000 people. Because getting to a doctor is
hard and expensive, people self-medicate with prescription painkillers, alcohol, and tobacco.
Eventually, said Smiddy, the pulmonologist, they become dysfunctional. They're weaving behind the
car. They're setting the stove on fire. It's not that they're bad people. Theyre probably faith-based
people, family people. Most are just trying to function.
Those who argue that the disability system has become choked with exaggerated claims are not
entirely wrong. In 2011, the Wall Street Journal reported on David Daugherty, a West Virginia judge
who had seemingly rubber-stamped approval for all but four of the 1,284 disability appeals that
came before him. He appeared to be colluding with a lawyer named Eric Conn, who had advertised
his services on billboards as Mr. Socialsecurity and sometimes brought an inflatable replica of
himself to events. Its faster for disability judges to approve a disability claim than to reject one, so its
easy to see how less-than-deserving cases would sneak through.
Because of rising income inequality, poor people can now earn almost as much on disability as they
can at minimum-wage jobsas long as they can prove theyre sick enough. In a 2006 analysis, the
economists David Autor and Mark Duggan found that the main reason disability rolls have swollen is
that the programs rules were liberalized in 1984. The Social Security administration was directed to
weigh applicants pain and discomfort more heavily and to relax its mental illness screening. (The
government has four different sets of standards: one for people under the age of 50, another for
those between 50 and 54, another for 55-59-year-olds, and a final one for those 60 and older.)
To sign up, applicants first state their disabilities and the names of their doctors. Each application is
reviewed by state officials and sometimes by an independent doctor. Two-thirds of applicants are
rejected after this step because they lack medical documentation that their ailments will keep them
out of work for at least a year. From there, an applicant can appeal, and a different official will
review his or her paperwork. After that, another 11 percent of applications are approved.
The rejected cases are seen by administrative judges in courtrooms across the country. According to
a recent Washington Post investigation, the entire process can take years. If they make it through,
beneficiaries will receive $13,740 annually, on average.
The problem is, even if society were to decide that there should be fewer people on disability, that
the system has become too bloated with sneaky pretenders, it isnt clear what a fifth of the
population of Grundy would do to survive. Its entirely possible that some of the towns residents are
faking their disability claims, but its hard to imagine that most of them are. People who are rolling in
undeserved government dough generally dont line up at the crack of dawn to get their teeth fixed in
an elementary school cafeteria.
Residents of Grundy sometimes run into problems during their legal proceedings, which take place
via video chat from a courthouse over the mountains in Bluefield. The judge, who is listening to the
arguments remotely, must consider age, education, and whether the applicants skills can be
transferred to another line of work. If you are physically or mentally able to do a job, you don't meet
the test for disability, Wegbreit says. It doesn't matter if that job does or doesn't exist in your region
of the country. And that job doesn't exist in Buchanan county.
Enough applications get through that disability benefits provide an economic safety net to Buchanan
county residents. But the high number of recipients also depresses the area further by keeping new
businesses away. Companies arent eager to hire sick, worn-out miners.
This area is a nightmare of disability, Smiddy says. Any company starting a business here knows that
a substantial percentage of workers are going to have dust on their lungs, they're going to be obese,
they've already smoked a pack a day.
Once people get on disability, they usually dont go back to gainful employment. Though theyre not
counted in unemployment statistics, functionally, they become like the long-term unemployedfalling
into an economic hole from which its notoriously hard to claw out.
Employed people might think of being out of work as being relaxing, but jobs provide identity and
purpose. Whatever the job, it can give a sense of belonging, of being a contributor; an important
part, however menial, of an organization with a bigger purpose, a valued part of society, wrote Tom
Fryers, a visiting professor of public health at the University of Leicester in the U.K., in a recent
paper. Work can provide a structure for the day, week, and year without which life just drifts by.
Idleness, meanwhile, further depletes
bodies and minds.The rate of depression
is 19 percent among people who have
been unemployed for a year, compared
to just 10 to 11 percent for people who
went without jobs for just a few weeks.
Even though they dont face the same
financial strains as the long-term
unemployed, people on disability still
suffer the negative health effects of
being jobless. Researchers have also
found high rates of depression among
recipients of welfare, for example.
Once you're on the couch, your muscles become weak, you're going to gain weight, you're not
physically capable of going back in the coal mine, Smiddy said. A lack of work has been shown to
increase the risk of premature death significantly, particularly for men.
The problem, as Smiddy sees it, isnt just that the economy is limited, or that the regions education
and medical systems could use an overhaul. The countys health has been so poor for so long, he
says, that locals have set their expectations too low. And once everyonethe people, their employers,
their doctors, the governmentaccepts that bleak vision, it hardens into reality. It makes it so theres
no life after coal.
Its Just pull my teeth, or Grandpa died when he was 50 or Momma's already on oxygen, Smiddy tells
me, his voice growing increasingly exasperated as he clicks through x-rays in his makeshift office.
Theres a negative fatalistic attitude. We have to have an expectation of health, and seek health.
*This story originally stated, based on the recollection of Wegbreit, that Buchanan county had seen
its first grocery store only recently. In fact, it has had a grocery store since 1955. We regret the
error.
