The biggest issue, experts said, is lack of access to care — whether it’s preventive screenings or cancer treatment. If one of Owsley County’s 4,600 residents needs to visit the doctor, they have three choices: the health department or two clinics. But doctors are not always available or working, and opportunities for screening vary. For instance, mammograms are only offered once a month at the clinics, and colon cancer screenings are referred out of the county, and cervical cancer screenings are done weekly at the health department and daily at the clinic, Lucas said. The three regional hospitals are at least a 30-minute drive away on narrow, curvy mountain roads. The Markey Cancer Center in Lexington is a far drive for people in rural Appalachia.

https://fivethirtyeight.com/features/cancer-rates-are-dropping-but-not-in-rural-appalachia/

Two problems in coal country. After coal, the main legal crop there is tobacco. Every one smokes there and there are no efforts to educate them against the health risks involved, as their little gov't subsidized tobacco plots are what they have to live on (legally of course).

As for the miners, the coal companies will not spend extra money on their health and safety if they can get away with not doing so. Black lung and cancer from coal dust and polluted waters thus are their only way of life so far.

It all must start with education and access to services, which they have to be able to afford. When you are on permanent welfare it's hard to afford health care. So the result is now everyone either pushing illegal drugs or hooked on them in those regions.