Central Appalachia Through the Eyes of a DrPH

Posted on October 28, 2026 by Jen Hammons Leave a comment

I have lived all of my life in Central Appalachia.

Long before I had a Doctor of Public Health degree, I knew what health disparities looked like.

I just didn’t call them health disparities.

I knew what it looked like when someone waited too long to see a doctor because there wasn’t one nearby. I knew people who stretched medications, skipped appointments, drove ridiculous distances for healthcare, or simply went without. I knew families who had to decide which bill got paid that month. I knew communities where everybody could tell you who was on dialysis, who had cancer, who had lost someone to an overdose, and who was struggling to breathe after a lifetime underground.

Later, public health gave me words for all of it.

Social determinants of health. Health professional shortage areas. Transportation barriers. Chronic disease burden. Economic instability. Geographic disparities. Structural inequity.

Useful words. Important words.

But they sound different when you have lived them.

My DrPH did not teach me that Central Appalachia had health disparities. I already knew that.

It taught me how to study them, how to understand the systems behind them, and, most importantly, how to think about building something better alongside the people who live here.

The Data Has a Face Here

When I look at a map of Central Appalachia showing diabetes, cardiovascular disease, cancer, substance use, poverty, or premature mortality, I don’t just see counties shaded darker than the rest of the country.

I see home.

And I think that changes the way you practice public health.

A statistic might tell me that a county has poor access to primary care.

Living here tells me what that actually means.

It means calling around trying to find someone accepting new patients.

It means waiting six weeks for an appointment.

It means driving across a mountain to get there.

It means missing work.

It means worrying whether the car will make the trip.

It means getting a prescription and then finding out you can’t afford it.

It means doing the math over and over again until healthcare becomes the thing that gets pushed to next week, next month, or next year.

The data matters. We need it.

But there is always a person behind it.

A DrPH has made me much more interested in what happens between the statistic and the person.

Distance Is More Than Miles

One of the biggest mistakes we make when talking about rural healthcare is reducing access to geography.

We measure miles.

Rural people experience burden.

Twenty miles on an interstate is not twenty miles across a mountain.

A telehealth appointment is not access if broadband is unreliable, the patient doesn’t have a compatible device, or the next step still requires traveling somewhere else.

A referral is not access if the specialist is two hours away.

A medication is not accessible simply because someone prescribed it.

An ambulance technically being “available” means something very different when help can take 45 minutes or longer to arrive.

This is where the DrPH lens has changed the questions I ask.

Instead of only asking, “Does this service exist?”

I ask, “Can people actually use it?”

How much time does it require? How much money? How many miles? How many missed hours of work? How many phone calls? How much internet access? How many other systems does someone have to navigate before they finally receive care?

Access is not binary.

And rural health cannot be understood by counting buildings on a map.

The Space Between Healthcare and Health

I came to public health as a pharmacist, and that experience still shapes the way I see systems.

Pharmacy taught me early that there can be a tremendous distance between developing the right healthcare plan and a patient actually being able to carry it out.

A diagnosis can be correct.

A prescription can be appropriate.

A discharge plan can be perfect.

And the patient can still go home without what they need.

Before my DrPH, I often saw those problems one patient at a time.

Now I see the patterns behind them.

Transportation. Affordability. Workforce shortages. Geography. Broadband. Food access. Health literacy. Policy. Trust. Infrastructure.

That is one of the things I love most about public health.

It forces us to zoom out.

Not so far that we stop seeing the individual, but far enough that we begin to see why the same problems keep happening to individual after individual.

Sometimes what looks like a patient problem is actually a systems problem.

And sometimes what we call nonadherence, poor follow-up, or failure to engage is a person doing the best they can inside a system that was never designed around the realities of their life.

Central Appalachia Is Not a Deficit

There is another part of rural public health that I have become increasingly protective of.

I am tired of seeing Appalachia described almost entirely by what is wrong with us.

Poor.

Sick.

Addicted.

Uneducated.

Underserved.

Those words appear over and over in research proposals, needs assessments, government reports, and grant applications.

Some of the underlying statistics are real. We should not minimize them.

But a community is not its disparities.

Central Appalachia is also resourceful. Loyal. Innovative. Stubborn in the best possible way.

People take care of each other here in ways that are difficult to capture in a dataset.

Churches become distribution centers. Fire departments become community hubs. Schools become food access points. Somebody always knows somebody with a truck. People build solutions with almost no money because waiting for someone else to fix the problem was never really an option.

Those are not cute stories about rural resilience.

They are community assets.

And they matter when we design public health interventions.

The question should not always be, “What does this community lack?”

Sometimes the better question is, “What already exists here that we should be investing in?”

Research With Us, Not Just About Us

Central Appalachia has been studied plenty.

We have the reports.

We know where we rank.

We know our rates of diabetes, heart disease, cancer, substance use disorder, poverty, and premature mortality.

We need research, and we need good data.

But we also need something beyond another description of what is wrong.

We need implementation.

We need translation.

We need community-engaged research that starts with the people who actually live here.

I believe some of the best rural public health work will happen when we stop arriving in communities with a solution already built and start asking better questions.

What matters to you?

What is already working?

Who does this community trust?

What would make this intervention impossible to use?

What burden are we unintentionally creating?

What would success look like here?

And did anyone who actually lives here help decide what we were studying in the first place?

Community engagement cannot be the box we check after the research question has already been written.

Rural people should be sitting at the table when the question itself is decided.

Lived experience is expertise, too.

A DrPH Changed the Way I See Home

Earning a DrPH didn’t introduce me to rural health.

It gave me another way to understand the place I already knew.

I still see the patient.

Now I also see the population.

I see the policy.

I see the infrastructure.

I see the implementation gap.

I see the historical context.

I see the systems that make the healthy choice easier for some people and nearly impossible for others.

I can look at uncontrolled diabetes and ask what happened long before the A1c reached 10%.

I can look at a healthcare closure and understand that we aren’t simply losing a building. We are losing infrastructure.

I can look at an overdose death and understand that the story didn’t begin with the substance.

I can look at a transportation problem and understand that adding another appointment may technically increase healthcare while actually making access worse.

And increasingly, I find myself asking a very DrPH question:

What are we going to do about it?

Because describing a disparity is not the same thing as changing it.

Appalachia Isn’t the Exception. It’s the Warning.

The problems we are experiencing in Central Appalachia – healthcare workforce shortages, pharmacy and hospital instability, chronic disease, medication affordability, transportation barriers, aging populations, economic transition, and disappearing healthcare infrastructure—are not going to remain confined to rural mountain communities.

We are simply experiencing many of them earlier and more intensely.

That means Central Appalachia should not only be studied because of its disparities.

It should be listened to because there is something to learn here.

About resilience.

About community.

About trust.

About what happens when infrastructure disappears.

About what people build in its absence.

And about what healthcare and public health could look like if we designed systems around the realities of people’s lives instead of expecting people’s lives to fit the systems we created.

I am a pharmacist. I am a researcher. I am an educator. I am a public health practitioner.

And I am unapologetically Appalachian.

My DrPH didn’t separate those identities.

It taught me how much they belong together.

Because the goal isn’t simply to document what is happening in places like mine.

It is to use what we know, listen to the people who know their communities best, and do something that changes what happens next.

That, to me, is what it means to see Central Appalachia through the eyes of a DrPH.

About the Author

Jen Hammons: Jen Hammons, PharmD, DrPH, serves as the Director of Rural Health Advancement at Appalachian College of Pharmacy (ACP) in Oakwood, Virginia. A proud two-time graduate of ACP, she earned her Doctor of Pharmacy in 2018 and her Doctor of Public Health in 2025, becoming the institution’s first DrPH graduate.

Rooted in Central Appalachia, Dr. Hammons brings a personal understanding of the barriers rural communities face in accessing healthcare. Her work focuses on advancing rural health equity, expanding medication access, strengthening pharmacist-led services, and building partnerships that address the needs of underserved communities.

Before joining ACP, Dr. Hammons helped establish a free pharmacy to expand medication access for uninsured and underserved patients. Her background in community pharmacy and public health continues to inform her work advancing rural health equity and improving access to care across Appalachia.

Her work bridges clinical pharmacy, public health, research, education, and community engagement. She is particularly passionate about addressing chronic disease, improving access to care in medically underserved areas, and preparing the next generation of pharmacists to recognize their role in public health.

For Dr. Hammons, rural health is more than a professional focus. It is personal. Growing up in Southwest Virginia and witnessing the challenges families face in accessing care continue to shape her commitment to the region and the people who call Appalachia home.

She believes that clinical care can change a life, but public health can change a generation. Through her work at ACP, she is committed to building sustainable solutions that improve access, advance health equity, and ensure Appalachia remains part of the conversation shaping the future of healthcare.

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