Fahe ﬁghts back against the Opioid epidemic by utilizing their deep roots in the region and their ability to connect outside investment to boots-on-ground leaders across Appalachia.
Almost three years of playing with their grandchildren—lost. By 2013, Appalachians were more likely to die early and experience chronic health conditions during their lifetime, a life expectancy gap with the rest of the country that had widened since 1990.12 The headlines have been coming, hospital closures, cancer, resurgence of meth, and then the greatest of them all: opioid overdose deaths, which nationwide in 2016 killed 42,249 people, more people annually than HIV/AIDs (6,721 people), car crashes (37,461 people), or gun violence (~38,000 people).13,14,15,16 Appalachian men ages 25 to 44 experience a 72 percent higher overdose mortality rate versus men in other parts of the country. For Appalachian women ages 25 to 34, the rate is 92 percent higher. West Virginia and Kentucky were rated 1st and 3rd respectively in the nation for overdose deaths.
Fahe is a regional Network of 50+ organizations throughout Appalachia making our communities and economies work, and pushing back against the economic stagnation and accompanying reduction in health outcomes in our region. Although decades of systemic poverty has taken a toll on Appalachia—19.7% rate in Central Appalachia with areas of eastern Kentucky as high as 25.7%, versus 12.3% for the nation—the Fahe Network has shown how local leaders and the right investments can and do turn the tide.
Fahe believes that in order for all Americans to have a good life, with a stable job, in a healthy community, investments in public health must focus directly on health investment and also on socio-environmental determinants, which account for half of key indicators, length, and quality of life. Fahe works both of these ways in the beautiful mountains we call home. In direct health investment, Fahe collaborates to develop residential treatment facilities that result in recovery opportunities unavailable but for Fahe’s leadership. By connecting local leaders in the mental health ﬁeld with real estate developers and the capital needed to construct and ﬁnance the residential facility combined with the operating models that connect subsidy resources recovery services are made available to people who most desperately need them and who don’t have the resources for private pay treatment. Speciﬁcally, Fahe has facilitated the collaborations that resulted in the creation of 1800 units of residential treatment facilities by bringing $50M in loans, equity investments, and subsidy to the operations and development that together demonstrate annual savings to the states in excess of $20M annually and a reduction in recidivism rates.
Eﬀectively engaging socio-environmental determinants of health requires broad, public-private partnerships in housing and employment: Whitesburg, KY, a persistent poverty town of 2,200 in the mountains of far eastern Kentucky is home to a prime example, one of three Appalachia Heat Squad pilots. This outreach program assesses and improves homes through energy audits and repairs, reducing energy costs in a region with an abundance of substandard and unhealthy housing that makes utility bills an increasing part of housing cost burden in Appalachia. Reducing high utility costs frees up money to support other needs, like health insurance or even healthy food. At the same time, Appalachia Heat Squad provides local jobs, a key need and an important social determinant of health.
In addition, the local leader of Fahe Network Member H.O.M.E.S. in Whitesburg, Seth Long, is deeply embedded in his community as a leader and participant in the activities of other community health and economic development organizations, including a local famer’s market, where H.O.M.E.S. has helped construct facilities for the market and for residents to enjoy music in an outdoor setting. Through this farmer’s market, local famers have additional customers for their produce, and residents in an area where fresh food is less available in dollar stores are able to buy local food that is fresh and nutritious. This eﬀort targets both patient health and the local economy, and exists because of a structured collaboration among community leaders including housing, health and economic development. In the future, because of these relationships, H.O.M.E.S. may be providing construction expertise to support the adaptive reuse of a school to expand a community health center.
Seeing the intersection of the need for good jobs, the opioid crisis, and the success that was being shown in Whitesburg, Fahe worked to create a program of transformational employment for recovering addicts in Eastern Kentucky, one of the innovative programs of its kind in the country. The Network is expanding a successful worker reintegration model piloted by DV8 Kitchens in Lexington, Kentucky into six coal-impacted counties in eastern KY over the next three years, providing paid internships for 30 people in addiction recovery, placing them with 30 unique employers, and providing informational training sessions designed to liﬅ the stigma many employers have about people going through recovery. Fahe was able to depend upon Appalachian Regional Commission funds through a POWER grant to do this, showing the importance of investment to making a diﬀerence in lives on the ground.
Building on the transformational employment strategies, the Fahe Network is leading the provision of access to wraparound recovery services such as transportation and housing with an Eastern Kentucky base in Whitesburg. The program received federal funding of $3.7M from the Substance Abuse and Mental Health Services Administration (SAMHSA). But for Fahe’s advocacy, that investment may not have made it to Appalachia, as service provision is typically deployed to a state’s major metro areas. This federal investment is now creating jobs, serving people, and turning people’s lives around who need it in persistent poverty Appalachia.
These vignettes of the Fahe Network in Whitesburg are just examples of a Network carrying out a broad suite of activities to make people’s lives healthier and more prosperous in persistent poverty areas and throughout Appalachia. They are small windows of how federal and private investment come together to build a vibrant region of more families that can enjoy living and playing together for years to come.