Declining Hometowns

The section self is about to quote follows many passages of analysis on the special case of West Virginia. There were a lot of things self wanted to quote, but she decided that felt a bit like cheap thrills. Instead, here are some conclusions the author draws from her close examination of the state:

There Are No Accidents, Chapter Seven

• If the economy declines in your hometown, you need to drive farther to find work, increasing your risk of accident by exposure at the same time that your hometown has less money to pave roads. You are also more likely to take more dangerous work in desperation. If you get into an accident, you are saddled with medical debt that directly affects your ability to pay state taxes so the state government can pave the roads. Even this example skips over many factors that can multiply risk: less-safe older cars, exhaustion and stress brought on by longer commutes and life in poverty, distance to medical care, and the fact that your income might be so low that you have to walk or bike to work, an especially dangerous condition. An accident can make you vulnerable to poverty, living in poverty makes you more likely to die by accident, and poor places do not have money to spend to prevent accidents.

Never mind states, let’s go down to the county-by-county level:

• Nationwide, the census area whose residents are most likely to die by accident is rural Lake and Peninsula Borough, Alaska, which is 76 percent Indigenous.
• The first sizably populated runner-up is Oglala Lakota County, with a population of more than three-quarters of a million people. It is entirely inside the Pine Ridge Reservation. It is one of America’s biggest and poorest reservations, a place of devastating superlatives: lowest life expectancy, lowest per capita income . . . a majority of homes lack water, electricity, insulation, and sewage.

This is heartbreaking.