Over the course of the past year, funding from the Collaborative allowed for the development of a research project exploring the Miners’ Memorial Hospital Association (MMHA), a unique hospital system run by the United Mine Workers of America (UMWA) across Kentucky, Virginia, and West Virginia in the 1950s and 1960s. This investigation, in turn, also led me to broader questions of health activism and the provision of care across the region in the years leading up to the War on Poverty. The project traveled from archives in Connecticut across Tennessee and North Carolina, and culminated in presentations at the History of Science Society annual meeting and at Sewanee, all the while shifting as new and varied themes emerged in the archives. I began the project eager to dive into the policy implications of the MMHA, which seemed to represent a notably progressive moment in health care reform, not just for Appalachia, but for the nation at large. As I dug through boxes of UMWA promotional material and interviews with hospital staff, it became clear that the MMHA also presented an early example of efforts to deploy terms like “empowerment” and “community involvement,” even when such language was not backed up by action. Far from validating popular depictions of Appalachia as an isolated, neglected region, this history suggests that Appalachia served as a key site of modernity, originality, and creativity in the fight for more equitable health systems, even if the UMWA’s experiments struggled to take hold.

This research has helped me to better understand how the complicated history of healthcare access in Southern Appalachia sheds light on the region’s contested role in healthcare politics today. This past fall, I drew connections between this historical moment and our current one as I presented this research in Atlanta and at Sewanee. Conversations following both presentations were incredibly rich, but I particularly appreciated my time at Sewanee for the diversity of participants. There, the conversation included students in history and biology, as well as hospital executives and physicians. Our nuanced discussion pointed to the essentially interdisciplinary nature of this work, and of the importance of locating and mobilizing historical evidence as we try to make sense of seismic changes in our national debates around health policy. In keeping with the goals of the Collaborative, it became clear that discussion of health care reform cannot take a one-size-fits-all approach, and furthermore, cannot imagine urban sites to be the only natural spaces for progressive experimentation. This research demonstrates the necessity of treating rural spaces as sites of innovation, if we are to develop a flexible, adaptive healthcare system that truly meets the needs of its users. This historical research does not, of course, provide a straightforward roadmap away from our current crisis of care. It does, however, provide us with some valuable ways of imagining how it might be otherwise.