“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. They’re probably faith-based people, family people. Most are just trying to function.””