Good afternoon everybody and welcome. I'm Neil Romanosky and Dean of University Libraries welcome to our spring installment of our authors at Alden series on what is a beautiful day spring afternoon here in Athens. I hope it is as well wherever you happen to be joining from. Thank you again for being here today. I also want to thank doctors Michelle Morone and Tiffany Arnold for being part of our program today to libraries events coordinator Jen Harvey for organizing this event and to our good friends at the Ohio University Press for partnering with us so often in this series which when they do really enables us to showcase great works like we'll be talking about today that they that they publish. Before we begin the program I one housekeeping item have been asked to remind everyone how to turn on live captioning the live captioning option. So that's located in the upper right section of your screen you'll see three dots. If you click on them and select turn on live captions you should then see captioning. So without further ado it is now my pleasure to turn things over to Beth Pratt interim director of the Ohio University Press who will be introducing our guest today. Thank you Neil and thanks to Alden for hosting this today. I think it's going to be a fascinating conversation. Today's guest author is Dr Michelle Morone, who will be discussing ailing in place environmental inequities and health disparities and Appalachia, which is published by Ohio University Press. Dr Morone is a credentialed food safety professional and is the former chief of the Ohio Environmental Protection Agency's Office of Environmental Education. She's focused her career on examining the relationship between environmental contamination and human health outcomes, including exploring disproportionate exposures and low income areas. Along with ailing in place Dr Morone has published numerous articles on environmental health issues such as tracking and pollution and their relationship to health. And she also collaborated with Jeff Buckley to write mountains of injustice social and environmental equity and Appalachia also by Ohio University Press. Dr Morone will be joining us with Tiffany Arnold, who is an assistant professor of instruction in the College of Health Sciences and Professions. Dr Arnold's research and professional interests include Appalachian cultural competency development and healthcare professionals and the impact of culture on decision making for low income Appalachian youth. She has participated among other things in the 2019 Appalachian Teaching Project. So thank you for joining us and we'll turn it over to you. Okay, so thanks everyone for being here. I think what I'm going to do first is spend a little bit of time providing an orientation to the book Ailing in Place. Give you a few definitions I think that will be important to understand the context of the book and then share with you a few of the stories that are in the book as well. After I'm finished, Dr Arnold has some questions that we're going to have a short conversation and then we'll be opening it up to questions from anybody in the audience. Does that sound the way you understand it Tiffany? Yeah, that sounds great. Okay, so I'll go ahead and get started. So the first thing I have to do is on my title slide about environmental inequities and health disparities in Appalachia is I don't want to assume that everybody who's participating today knows where the Appalachian region is where it is located in the United States. So the Appalachian region has actually been politically defined by the federal government and it consists of 420 counties and it encompasses 13 states and the only state that is completely delineated as Appalachia is the state of West Virginia. And this map here shows you the sub regions in Appalachia that are the northern, which is the kind of the turquoise at the top and then the north central, the central Appalachian region, south central and southern. And when most people think about Appalachia, I think attention draws to those states that are in the central region, including eastern Kentucky, southwestern West Virginia, a little bit of Tennessee. And as we walk through some of the health conditions in the region that keep this map in mind because the central Appalachian region is a little bit different than the other other parts of Appalachian when it comes to health. So let's talk about health first. So health is really multifaceted. And the factors that influence it are complex and interrelated. Health is defined, most health professionals, public health professionals, and those who work in the healthcare field, define it as a complete state of well-being, not just the absence of infirmity, not just you're not sick, so you're healthy. It is a complete state of well-being and it includes mental health. And I hope that we get to a point sometime soon where we don't have to say, and it includes mental health, that everyone will understand that mental health is part of a complete state of well-being. Now, when we have a disparity in health, that's usually defined as a difference between groups or individuals, just a flat-out difference, a health disparity. Now, different than a disparity is an inequity. And then an equity is really an unfair difference. And I'm going to give you a definition of environmental health inequities to kind of frame, you know, that's really the foundation for the whole book, The Ailing in Place book, is these environmental health inequities or these unfair differences between groups. And these inequities highlight social justice. Resources needed to be healthy include not only quality medical care, but also education, health promoting physical and social conditions, the built environment neighborhoods, environmental conditions, among many others. So I became really interested in, well, I've been interested in Appalachia for a long time, but general or specifically, but health in underrepresented populations in general for a number of years. And in 2017, the Appalachian Regional Commission, which is a federal organization, put out a report that was focusing on health disparities in Appalachia. And what they discovered in their research is that people in that central Appalachian region, that yellow region on that map, feel physically unhealthy 42% more often than the average American. So this is based on survey research. So someone from Central Appalachia is more likely to say, almost twice as likely to say, I don't feel well, I feel physically unhealthy, more so than the average American. They also discovered that Central Appalachian, people who live in the Central Appalachian region also feel mentally unhealthy, about 25% more often than the average American. So your perception of your health is part of your complete state of well-being. And this is the first time we start to see some documented health disparities in the Appalachian region. The suicide rate is 17% higher in Appalachia and 31% higher in Central Appalachia. In the data that was used to put this report together, that was published in 2017. So it was data from 2013. They also note Appalachian Regional Commission also notes that 6% of Medicare prescription claims in Appalachia were for opioids. And the difference is not that great in the rest of the country, it was 5.3%. And then another indicator, another factor of these multifaceted health that feeds into health is your access to health care. And primary care physicians in Appalachia, the ratio between every physician to every person in Appalachian, Appalachia is really quite different in the region than it is in the rest of the country. It's 12% lower, there's 12% fewer primary care physicians in Appalachia in general, 22% lower in the Central Appalachian region, and 40% lower in counties that are the most economically distressed. So this is the first time that we start to see some actual data and some evidence that there really are published evidence in a major report like this that there really are differences, health disparities in Appalachia between people who live in this region and people who do not. So to bring this home to Ohio, one other indicator, there's lots of indicators, but one other indicator of health disparities is taking a look at the leading causes of death. So the graphs I'm going to show you right now are not indicative of higher incidences of these diseases, but they compare the death rates. So how likely you are based on where you live in Ohio to die from these conditions. And I'm going to run through five of the leading causes of death. And as the figures show, when you break down the causes of death by geography, you start to see that where you live in Ohio is related to how likely you are to die from these specific conditions. So the red bar shows you the Appalachian counties in Ohio. And let me back up and run through those again. So there are 32 Appalachian counties out of 88 in Ohio. And you can see if you have heart disease, the 210 people per 100,000 die from heart disease in 2019 data in Ohio. And follow the red bar because those are the Appalachian counties. Then you can see it's highest for cancer, highest for accidents, highest for chronic lower respiratory diseases, and highest for diabetes. So again, some differences just within our state, differences between the 32 Appalachian counties compared to the rest of the state. Another indicator of health disparities. So with this information and my background and really trying to understand why are there disparities and what disparities are actually inequities that make that contribute to these differences. And over and over, you hear health professionals and you see articles and politicians talking about lifestyle. Well, people just don't eat well. They smoke too much. They don't get enough exercise. That's true. That's true. There's data that shows that smoking rates are higher in the region. But my interest really is, is there something about this place? Is there something about just living in Appalachia that could be contributing to health disparities? So the book is really about health disparities that are based on where people live rather than how people live, where they live. And so what I did in the book was really look at are there differences specifically related to environmental health issues that are contributing to these disparities. And before I go any further, let me give you the World Health Organization's definition of an environmental health inequity. And the key word here is that an inequity is avoidable. It can be prevented. It can be prevented. They don't have to exist. It's a social justice issue. And we spend a lot of time talking about health inequities in other countries. And one of the other, one another reason for my interest in putting this, all of these ideas into one book is to draw attention to things that are happening within our own country. And really my purpose in writing the book was to draw attention to these environmental health inequities, those things that are controllable that could directly and indirectly be affecting the health of people in Appalachia. And this includes looking at some high level issues and then delving into specific issues in local communities. And the topics I cover in the book include the built environment, water pollution, food safety and security, toxic releases, resource extraction, facility siding and occupational health and disasters. And looking for some of these avoidable inequalities in Appalachia that might be affecting health. So what I'm going to do now is just take a few minutes and we're going to start with a high level issue, a built environment issue. And then I'm going to narrow it in and talk about a couple of other more localized stories that I highlight in the book. So first of all, let me just share with you a little bit about radon. So this is this is one environmental health issue that I think is very interesting. And that's the issue of radon. So what is radon? Let's take a, this is an example of a built environment issue specifically related to inside environments. It's a large scale place based place based issue rather than a localized story. So radon is probably the most significant and least understood environmental health problem. It's a naturally occurring radioactive gas that's emitted from uranium. It is place specific because it is so tied to geology. This map that you see on the screen right now is from the United States Environmental Protection Agency. And it identifies areas in the US that has the potential for elevated indoor radon levels. US EPA developed this map using some data that they gathered on indoor radon measurements. Geology maps, area radioactivity, soil parameters and foundation types. So these, this is a rough estimate map. It represents general estimates and US EPA said, you know, specifically recommends that local places should do more in depth analysis. But this map can be used to identify local places that should be looked at. And you can see in this map that high levels of radon are not unique in Appalachia. However, the 13 states in the region, which is roughly the area that is orange and red in this part of the country. The 13 states in the region, the highest levels of radon are estimated in the Appalachian components of those states. And this, it should be of no surprise is where the coal is. So this map is from the US Geological Survey and I've put it on the same slide with the US EPA radon map. So you can see and just kind of roughly see the relationship between coal and radon. You can see in the central Appalachian region, which is this region right here. We have some of the red areas, the zone one or the counties that are estimated to have the highest amounts of radon. So these are the types of, this type of issue is an issue that really started to make me really curious. When we can see our, we've got radon, we've got coal, I can look at maps and I can maybe see some associations, but there's really no data that has a cause and effect or has complete, a complete relationship between the two. But you know, is there something there, the relationship between coal and radon is compelling, especially when you take a look at cancer rates or cancer mortality. Lung cancer is significantly higher in Appalachia than the rest of the United States. Now it's true that smoking here in the Appalachian region, the rates are higher. But I just question, is it possible that there are place based factors that also contribute to these to lung cancer? Good studies indicate that just living near a coal field correlates with high levels of lung cancer. Radon levels in mines study also indicate that radon levels in mines could endanger minors health. And when you burn coal for electricity, you also release some radioactive particles. So proximity to coal could be seen as an indicator of exposure to radon. Then the risk of radon exposure is enhanced by housing conditions. Poor foundations, poor ventilation, as well as housing units that use well water can increase exposure to radon. US EPA says that radon is the second leading cause of lung cancer. Lung cancer rates and mortality from lung cancer are highest in Appalachia. Geology and housing conditions contribute to radon exposure. So we need to pay attention to these types of place based issues. And the inequitable part of this is, you know, we can't control the natural sources of radon, but we can prevent people from being exposed by paying attention to the built environment and improving housing conditions, for example. So that's one high level issue, and I delve into radon just a little bit in the book. I also talk about lead and secondhand smoke. Let me take you now to a more localized issue, and this is a story about drinking water. And it's from Wyoming County, West Virginia. Robert Wood Johnson Foundation produces what's known as the county health rankings on an annual basis, and it's a really excellent resource. And in the county health rankings, they actually rank every county in each state based on health outcomes and health factors. And the health factors include things like clinical care, the physical environment, demographic information. So factors that contribute to health. And you can see here, this is from Robert Wood Johnson's 2020 county health rankings. Wyoming County, down there in the southwest corner of Virginia, that's Central Appalachian region. Out of the 55 counties in West Virginia, it ranks 49 out of 55 when it comes to health outcomes, and 50 out of 55 when it comes to health factors. It is located in a place that is described as the hidden gem of southern West Virginia. Since 1912, when the first coal mine opened within its limits, Wyoming County has been a hotbed of coal production in West Virginia. In 2013, for example, more than 6 million tons of coal was mined in 15 underground and 10 surface mines in Wyoming County. And it was ranked as one of the top 10 coal producing counties in the state. The coal industry in the county employed about 1,300 people in 2013, a significant number considering the total population of the county was only about 22,000 people. As the total state employment and mining decreased, the overall state unemployment declined with it. And during the 1990s, the employment rate in West Virginia hit double digits, peaking at 11.6% in early 1992. And at this same time, the total coal production sunk to its lowest levels. The state as a whole, West Virginia was able to rebound in the 1990s and early 2000s, but the recovery was undone as the whole country went into recession. So this situation in West Virginia is a story of the legacy of coal mining. And that legacy takes us to a town called Bud in West Virginia. Now these are photographs that I took as I was touring around the region as I was exploring these stories. And I do have to say that the stories come from interviews that I had with environmental health professionals throughout Appalachia. When I talked to them and I was explaining my purpose of writing the book, can you tell me some stories about localized place-based environmental health issues? And Bud is like many small communities throughout Appalachia that are currently relying on ailing drinking water systems that were constructed by coal mine owners with little regard for the environmental health. So these were coal camp communities that coal miners lived in while they mined for the coal companies. In 2010, the census estimated that the population of Bud was about 500 people. And 40% of the 500 lived below the poverty level. The 2010 household income in Bud was about 18,570, which was less than one half of the median household income for the whole state of West Virginia. Most of the homes in Bud were built in the 1970s. And in 2010, the median housing value was $9,999, ranking it the lowest in the state. And you can see here the location of Bud in the winding gulf coal field. The story with Bud is that there's one public school in the community that serves kindergarten through eighth grades and feeds students into two high schools in the county. A little more than 200 kids attend the school, and for more than six months in late 2013 and early 2014, they could not drink the water in their school. At that same time, 2013 and 2014, much of the attention about water problems in West Virginia was focused on Charleston and the January 2014 spill of chemicals into the Elk River. That caused the Charleston water supply to shut down. This little community of Bud had been struggling for months without access to clean, safe water. Residents of Bud, they were getting their water from a system known as the Eastern Wyoming Community Water System. This was a privately owned land and family, it was on privately owned land and it was family run. And for many years, the water system was created for the coal camp. And for many years, the system was neglected that was serving the community of Bud. The system was neglected to the point that the Office of Environmental Health Services in the West Virginia Department of Health and Human Resources gave the letter to the property owner noting that the system was a serious health concern. That's what it said in the letter. And the letter also explained that the water system was most likely established decades ago by a coal company to serve the local coal camp community. The system was the only source of drinking water for the residents of Bud. Oil order was issued for Bud residents in September of 2013. And for the next several months, there were days where people in the community, including the school, could not use their water at all, even if it was boiled. The water system was seriously out of compliance for drinking water regulations. In January 2014, EPA issued a formal notice of violation for the system because there had been no monitoring to ensure the water was safe to drink. This was all going on at the same time that that major chemical spill affected the Charleston water situation. And this is a very telling quote from a state senator when he said, I know the Charleston water crisis made national headlines, but the scope and duration of this event affected the residents of Wyoming County as much or more than the Elk River situation. Finally, after almost six months, the boil order was lifted in April 2014 because the water system was sold to the local public service district. A new operator was hired and maintenance was completed and the water tested safe to drink. The example of Bud shows us health disparities related to environmental health inequities in one state in West Virginia. Resources were really siphoned to deal. And I'm not saying it was a wrong thing. I'm just saying that resources were siphoned to deal with the Charleston situation where this small rural community, Bud, in Appalachia, they're both in Appalachia. The small rural community was struggling to even have safe water, to even have access to water at all. So an example of a local, much more localized than the radon issue. And then the other story I'll share, I can share a lot of stories, but I picked two for today. I'll share a story of hydraulic fracturing, which I talk about in the book when it comes to resource extraction. So I'm going to talk about Carroll County, Ohio. And the interesting thing about Carroll County is in the Appalachian region of Ohio, it's one of the 32 counties that's considered Appalachia. Here are the 2020 figures from the county health rankings. Carroll County is pretty good when it comes to health outcomes and health factors in the state. Now this is 2020. This is not the case 10 years ago or even five years ago. Carroll County was ranked much lower. Conditions have changed in Carroll County, at least in part related to hydraulic fracturing. Now I'm not going to spend time explaining what hydraulic fracturing is. I'm going to assume that many people have at least some understanding that it is a technique to get gas from shale, natural gas from shale. But Ohio, Appalachian Ohio has really been a hotbed of activity. Now Carroll County, here is a picture driving in to Carroll County from the adjacent Monroe County. According to the U.S. Census, the population in Carroll County in 2012 was about 28,000 people. And there's 1,023 square kilometers in Carroll County, so about 28 people per square kilometer. As you all know, each county in the U.S. has what's known as the county seat, which is the town that houses most of the county government. And this is the county courthouse in Carrollton, which is the seat of Carroll County. On the outskirts of town five years ago or so, this would be a very common scene. This is a drilling rig for hydraulic fracturing. And I want you to note the soybeans in the foreground. These, by the way, I took all these photos as well. This is a well pad after the drilling rig has been removed. Each well pad occupies in the neighborhood of three to five acres. So this well would be producing natural gas. Here is a well that's producing natural gas. And I want you to note the proximity to the playground in this photograph. Interesting thing about Carroll County is there are no four lane roads or highways in Carroll County. And this is actually a typical township road that's gravel. And I was in a vehicle with the head of the Carroll County Chamber of Commerce. And she had a four wheel drive vehicle and she was very used to driving on this road, these types of road. These roads are generally are often washed out during heavy rains. But according to one local official that I spoke to when I was there years ago, Chesapeake, which was one of the major hydraulic fracturing corporations in the county, spent more than $40 million on road infrastructure. They spent more than $40 million on road infrastructure in Carroll County. The annual budget for county roads, $600,000 county government budget. But Chesapeake spent more than $40 million so that they could get their rigs, you know, move their rigs around the county. This I was in my little Nissan Versa cruising down one of the two lane highways in Carroll County when I was approaching a stop sign and had to back up so I could let these brine trucks make this turn in Carroll County. And then you can see them heading up the road. And some people who live in Carroll County were upset by the amount of truck traffic that was going on during the peak hydraulic fracturing drilling. So they worked with Chesapeake and they would post these signs that they didn't want trucks to be on specific roads. So this is a pretty recent. This is the most recent map I could find of the horizontal well drilling. It's Utica Shale. We've got Marcellus and Utica Shale in Ohio. I've shown you where Carroll County is on the map, the box here that I've outlined and where it is in locate, you know, in proximity, the Appalachian region, the Appalachian counties are the northeast and then come down to the southeastern part. And as of March 2021, the records had 531 wells of 2,882 permitted. So 19% of all of the wells that were permitted in Ohio are located in Carroll County. Belmont County is actually the highest. They have 25%. Belmont County is next to Carroll County. So if we take a look and we do the breakdown, this is well activity in Ohio. It's 17% permitted, drilled and producing as of last week. You can see that Carroll County has 17%, Harrison County 18%, Belmont County 23%. If you use Carroll County as a case study, there are 533 wells in the county with an area of 399 square miles. So there is more than one well per square mile in Carroll County. All of the land that is going to be leased in the county is already leased largely to the benefit of private landowners who are mostly farmers. However, if you look closely at how individuals have spent their money, you won't find people moving out of the county. You will not find people moving or making excessive purchases. When I was speaking to the head of the Chamber of Commerce, what she was saying is that you see at that time this was going on five or so years ago, you see farmers paying off their debt, reinvesting in their farms. Local sales taxes increased from truck sales, hotel reservations, and there definitely were indirect benefits to businesses from things like home improvements being made by the locals. On the other hand, people are not benefiting from the jobs associated with drilling activity unless they're truck drivers at this time. People who work on the drilling rigs are also known as roughnecks. They're mostly transient and they move from place to place with the drilling companies. And this has created, according to people I interviewed in the county, this created some friction between roughnecks and locals. At the height of the drilling activity, there were calls to the local sheriff and those calls doubled during that time. In addition, one problem with the pace of the drilling in the county was that these rigs don't have specific addresses, so it makes it really difficult for emergency personnel to respond when there's an accident. All in all, the local government services such as the health department, the local law enforcement and utilities face significant challenges dealing with the new demands from drilling activities. So what does this all mean for health? Well, actually, we don't know. We don't know what fracking means for health. This is a billboard that was in Carroll County and it's hard to read it, I know because of the colors, but it says the answer to foreign oil. What are the health effects of fracking? We don't know yet. Summary emerging, but linking health outcomes specifically to fracking will take time. In 2016, US EPA published a study and they suggest they identified groundwater contamination, but they made this statement. It was not possible to fully characterize the severity of impacts, nor was it possible to calculate or estimate national frequency of impacts on drinking water resources from activities related to the hydraulic fracturing water cycle. In the meantime, as the empirical research struggles to catch up with the practice of fracking, we have anecdotal evidence. It's abundant and it serves as the foundation of messages that are both in favor of and opposed to hydraulic fracturing. A few decades from now, Appalachian places may once again be faced with the health threatening environmental conditions resulting from the rush by outsiders to extract the region's natural resources. A situation that we saw play out with coal over the past 50 or 60 years. So I'm going to stop there with my stories and see if we want to move to questions. The rest of the book does include numerous stories, some in Ohio, some in other states in the region as well. And I feel like that was a way to try to tie in environmental health with environmental inequities with health. Thanks, Michelle. Just a few questions I wanted to start with before we open it up to the audience and hear what they have to say is, I wondered if you would talk a bit in the book. You know, I use this book in a couple of different classes and we've gotten overwhelmingly very positive responses from students. But you make a big point of connecting environmental health and social justice in almost every story that you tell. So would you mind talking a little bit about that connection and how that kind of all fits together? Right. And thank you for that question because it really gives me an opportunity to talk about what environmental health is. And I do spend a chapter explaining environmental health. So by now, at this point in the COVID pandemic, public health is probably the words public health are probably rolling off your tongue. You're probably talking about it every day, whether you say public health or not. So environmental health is a component of public health. And it really focuses on understanding the relationship between the environment and human health. And then as a practice, taking preventive measures so that we break the chain between environmental conditions and human health outcomes. And the thing about it is environmental justice is such an important component of environmental health practice. And we see this not just in Appalachia, but think about some of the leading environmental stories, contemporary leading environmental stories. And probably the best one that most people have heard at least something about is the conditions in Flint, Michigan with the drinking water. And that being an environmental health issue that specifically affected underrepresented and minority communities. So it's the inequities that lead to the injustice. And for many reasons, environmental conditions seem to be conditions that are inequitable in many places. So there definitely are social justice issues that are just woven throughout the field. Well, along with that, in the book you talk about Appalachia being a pollution even, which I end up using that term a lot when I talk about the region. Can you kind of explain what that is and why this region is so known for that? Yeah, so a number of years ago I did some research on some empirical research looking at conditions in Appalachia related to specific environmental circumstances like toxic releases or facility siting. And the supporting research that was kind of underlying all that work was some work that took a look at the relationship between the economy and the environment. And this pollution havens hypothesis is one that says, look, if you live in a place that has a really good economy and low unemployment and a bad environment, then it's different than living in a place that has high unemployment, a poor economy and a bad environment. And those areas that have a poor economy and contaminated environment are thought of as havens for pollution. And another way to put it is when a organization or company or a polluting facility is looking for a place to site their facility, whether it's a landfill or a smokestack or a prison, which I talk about a prison in the book. They'll often, not always, but often they'll look for the place that is most or least empowered and is most in need of whatever economic growth they will tout, you know, to get their facility built. And a lot of times in some of the stories I tell in the book, these places are in Appalachia. There's two glaring examples. One I talk about in the book is in Forest County, Pennsylvania, which is with a state correctional facility. But another that's more related to a pollution haven is the uranium enrichment facilities that were located, three of them were located. Two within the boundaries of Appalachia and one in Paducah, Kentucky, which is Western Kentucky, but still in the region. So those Appalachias became like a haven for the pollution associated with uranium enrichment facilities and I do go into that someone in the book. So I hope that's kind of a circuitous answer. But yeah, it's just really unfortunate that it seems that because the economy is so poor in so many places in this region, we're almost willing to overlook, you know, these injustices and these these companies coming in, you know, we're slacking off a little bit, I think, on on what we're allowing to happen and what we're willing to, you know, fight back against because we are so in so much in desperate need of economic help. Yeah, it's interesting because, you know, I worked for the EPA before I came to Ohio University and I was always you can have both you can have a clean economy and a good economy and a clean environment and I think the more I get into, you know, and I'm reaching the end of my career, I think at this point, the more cynical I'm becoming about that really being possible in many places. And I think fracking is a is a really compelling example in Ohio because you know I looked back at the the news accounts and the statements that were coming from the politicians about, you know fracking in Ohio and they're talking about 200,000 jobs that are going to come with fracking. If we just, you know, we just let people frack without any regulations or oversight. And I think ultimately, when people looked back and they saw well how many jobs were actually created. It was like less than 20,000. And they were mostly truck drivers, because people who work on the drilling rigs are highly skilled in that specific field and we didn't have that kind of workforce in Ohio. So they're coming up from Arkansas, they're coming up from Texas. Sure, they're filling the hotels temporarily, but you hear 200,000 jobs and you're living in a in a place where, you know, the biggest, the largest business just closed, and you might be more likely to support something. Another case that I talk about is the Gavin power plant, which is down in Cheshire, Ohio, and that's a facility that, you know, it's a it's a polluting facility, but it also is the largest taxpayer in the county county. So, you know, this friction between pollution and the economy just plays out over and over again. And I think it's very pronounced in Appalachia. I'm not saying it's not other places, but I'm saying it's very pronounced in this region. Right. Well, what made you become I mean I know you've been interested in environmental health for your entire career, but why specifically here I've heard you talk before about, you know, not necessarily being a longtime resident of the region. What made you want to focus on this region. So I think it starts in late 1991 and 92. I went to Ohio State and then in 91 in 92 early 92 or late 91 I took a job at Ohio EPA. And really my first week on the job I was doing I was in a unit that was working with communities to help with their wastewater treatment problems. And my first week on the job, I came to Southeast Ohio, and the project one of the first projects I worked on was a sewer line install in Chansey, Trimble and Jackson. And that I just remember I can remember that day it's been 2030 years 30 years been 30 years I can remember that day driving around the area and seeing raw sewage straight piped to ditches in front of people's homes. And, you know, it was just like I, it was a it was an epiphany that day was an epiphany and I think that kind of that started it all. And I've just been really lucky to have ended up in this in the Department of Social and Public Health and then to have the support and and to work in communities work with communities. Because my curiosity has led me to to researching answers to questions and to delving more into this the environmental inequity so a lot of some of it is luck but really that day that first week on the job at EPA was when I started to ask questions. Thank goodness for a chancey sewer line I guess. Yeah, I guess so. Well, one reason that I think that students have really responded positively to the book is because of the way that you are, you know, focusing on these specific communities and the stories that happen there. Instead of just, you know, applying everybody with all these facts and figures you're really telling the story of a community and so why did you choose to do it that way and and are there any of these stories that that you know you touched on a couple of them but are there any that are your favorites. So this was difficult for me because you know I am. I consider myself more of a science type writer. And I really want to thank oh you press and the people who edited the book at oh you press because one thing that they taught me was how to not write so much in passive voice. So instead of saying the the research was conducted to find if there was pollution in the water, you say, we took a look at whether there was pollution in the water. So that having the freedom to to write in active voice really contributes to the ability to tell some stories right. And then I also, I started the whole process by interviewing as many environmental health professionals in all 13 states that were willing to talk to me. And one of the things I wanted to do was to hear their stories and once I started to hear their stories I was like, you know, I think I would include I'd like to include some of these stories in the in the book, gave me the opportunity to get in the car and drive around the region and go to places I haven't been before as well. But I also wanted I was hoping that it would be, you know, a broader audience than just more of a science based textbook type thing. Well, I think that goes along with a long tradition of storytelling in this region. So, you know, when you're writing, hopefully for people in this region to read, I think that will, you know, connect with them, you know, on a different level. Were there any of those that you that you liked studying more or you'd like talking to the people more or any of the communities that well I tell you. Yeah, thanks for that question that I like the Bud's story. But the one story that I didn't tell today was a story of another cold camp kind of in the Bud area but in Virginia not West Virginia. And that was the case of in Bowdoin. And so this was a cold camp that is near Big Stone Gap. And I didn't know it at the time but I guess there was a movie called Big Stone Gap and a book I didn't know all that. So I drove down there when I was, you know, looking for pictures and to talk to people and and I went into Big Stone Gap and they had a, there was an old gas station that was converted to a visitor center. And I think it was a, I don't know, weekday afternoon I popped into the visitor center and they had like a life size cut out of Ashley Judd and was whoopie whoopie Goldberg in that movie too. I don't know. So, so I was like, Oh, this is this is cool. So I started asking questions and in Bowdoin was actually brought to my attention by an environmental health professional in Virginia. So I was asking the people in the visitor center about, you know, what about this in Bowdoin and their wastewater treatment? Like, Oh, I had no idea. So I drove over to in Bowdoin, which was like 10 minutes from Big Stone Gap.  And they were straight piping their wastewater right from their homes into a creek right in front of them. But they got together the little, the 20 homes or whatever got together and was able to get a grant and some other funding. And they built a small wastewater treatment. I don't want to even say facility, but wastewater treatment operation for those 20 homes. So when I looked at those homes, and I do have some pictures of it, those homes in that cold camp. They were just so different than the homes in the next cold camp over. And it was just kind of a success story. It brought it brought attention to the fact that there's still like 20,000 straight pipe communities in Virginia. But this was one example of a positive outcome. And at that point they were talking about getting in Bowdoin. It was named after a general general John and Bowdoin, but getting in Bowdoin on the National Register of Historic Places. I just looked the other day to see if they'd been successful and that I couldn't find any information. But I loved that story and I loved going to that little community and looking at their church and it was it was great. Yeah, that's it. That was a one that said that to me because it's so easy. I think for people to focus on the struggles and that's one where you know it really shows community resilience and in a lot of the positive attributes that we have in this region. So I'm glad that you included that. Just a couple more questions to wrap up before we get to the audience questions, but I wanted to ask you for college students who are hoping to enter the field of environmental health. You know, they may not know how to get started or what options they have. What would you say to them at this point? So I would say, first of all, come talk to me because we have a nationally accredited environmental health program here at OU, one of only about 30 in the country. And it is a great field with a wide variety of professional opportunities, everything from groundwater monitoring to inspecting restaurants to taking samples out of air pollution facilities to doing occupational health and safety. If you're interested in public health in general, and that means you're interested in preventing the spread of disease and illness and injury. And if you're interested in the environment specifically, environmental health is really the only career that you can you should consider. Is that strong enough? Okay, great. And then the last question that I had was, you know, you've written a couple of books now about environmental health in Appalachia. And I just wondered what's next on the horizon? Do you have plans for another or are you going in a different direction? Or what are you thinking now? I don't know if I have another book in me, Tiffany. I just don't know. I've been thinking a little bit about it, but yeah, I don't have any specific plans. I have a lot of data that is deferred data. So I have some, I've been working a lot on rural health care and access to care in Appalachia. So that's my focus right this minute. But we'll see. We'll see. Thanks for that question. It's a cliffhanger, I guess. It makes me think. It gets a cliffhanger. Stay tuned for part two. Well, Jen, do we have questions from from people in the audience that we wanted to talk about? Actually, yeah, we actually already have one in the chat. I just want to let everyone know if you have questions for either Dr. Moreno or Dr. Arnold. You can go ahead and either raise your hand or type it in the chat. And then I will call on you or read the question out. So the question we have in chat came in a little earlier from Jeff Callet. And Jeff is wondering what else is Radon associated with besides coal? Your map showed high Radon levels in non-coal rich areas like the Upper Midwest, Wisconsin and Minnesota. Okay, so first of all, Jeff, hi. And the second, that wasn't my map. That was US EPA's map, so I just want to let you know. So Radon comes from uranium rich geology. So any kind of geological formation that has uranium is going to be potentially, you're going to have potentially high levels of Radon. It's not just coal. That's probably the best I can do in terms of that answer in that question. All right, thank you. And it looks like we have someone with their hand up. Helen, would you like to unmute yourself and ask your question? Hello, can you hear me okay? Yes. Hi, mom. So I have a question for you, which is, you know, obviously I've been witness to a lot of your researcher for the years.   Thank you for that question. And Helen actually came on an excursion with me to Western Pennsylvania. And I have to say that I first see the environment. I first see what's around before I even see the people. And I'm just really, I guess, hypersensitized to environmental conditions. And some things you can see, like you can see straight pipe wastewater, you can see air pollution coming out of a stack. Other things you can't see, like you can't, you can drive around communities and see homes and they may look, you know, one way, but they may not be as habitable as they look. So I'm just very, very sensitized to environmental conditions. And I really believe and really the, I hope that the book and, you know, sparked some conversation about these unfair conditions that contribute to health. And instead of just saying, oh, it's lifestyle. Oh, it's too much fast food. So that's a really good question and one that I'll keep thinking about, but I do see the environment first. All right, we've got a couple more questions in the chat. The first is, I'm not sure if this was discussed earlier, but what was your inspiration for writing this book? Yeah, so it, like I said, it comes down, it comes back to that first week on my job at EPA and being down here in Southeast Ohio and seeing waste, untreated wastewater being, you know, discharged into ditches. But I guess you could go back further. I mean, even though I did not grow up in Appalachia, both my mother and my father's family were from Western Pennsylvania. That's really where their roots were. My mother and father grew up in Western Pennsylvania and Altoona and Johnstown. And I spent a lot of my childhood in both Altoona and Johnstown. And I didn't, I mean, I guess 1960, 1965 was when the region was actually delineated. And I moved away to the east coast and I never really thought about roots in Appalachia until I came back to Ohio and then came to Ohio University. And so I still have family, you know, in Washington, Pennsylvania where there's a lot of fracking. So I guess that's part of the inspiration too. All right, we've got one more question in the chat. And Grace is wondering if your book touches on the uranium facility in Pike County, Ohio. Hi, Grace. Good to see you. I'm glad you're here today. Yeah, I do mention that facility in the book and I actually have even a broader case study of that facility because I actually have done quite a bit of community engaged research with the Portsmouth gas gas diffusion plant or Piked in as it's commonly referred to or the A plant for the atomic plant. And that book is or that that research is really been focused a lot in recent years on occupational health and safety, specifically with police officers that were at the facility when I was enriching uranium in the 60s and 70s. So I have a whole another set of slides but I do talk about that in the book a little bit. All right, thanks Michelle. It looks like we're maybe you're out of audience questions but I'm going to give our audience just a minute to think about if they have any other questions while I put a couple links in the chat. The first one is a survey that I would appreciate everyone taking a moment to click on the link and complete. And then our second link, where did it go is to the Ohio University Presses page that has both of Michelle's books on it that are available for purchase and I believe Beth, please correct me if I'm speaking out of turn that these are currently on sale for 40% off because they are part of the Appalachian studies. Oh, they are. They are until tomorrow. Okay, so today. Definitely take advantage of that. So it looks like maybe we don't have any other audience questions. I want to thank you both so very, very much for your time today. It was a wonderful conversation. I really appreciate it. Thank you to our audience for taking the time out of your afternoon. And I hope everyone has a lovely afternoon. Get outside and enjoy the sunshine. Thank you so much. Thanks everyone. Thank you.