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Although Appalachia has some of the worst health statistics in the United States, its residents’ strong sense of place and resilience provide reason to hope for its future. This chapter recaps the lessons from previous chapters. In doing so, it positions Appalachia as a complex (and often contradictory) region. While great strides have been made in reducing traditional health inequities among Appalachia’s people, more progress is needed. Further, new health challenges—such as the opioid epidemic and COVID-19—demand adaptability from a region that is still, in terms of health and economic infrastructure, overextended. Creating a culture of health in the mountains will take more than a public health response. It necessitates new ways of thinking about well-being and its intersections with society, the economy, and the environment. However, if policy-makers tailor evidence-based solutions to Appalachia, they will a path forward.

Though Appalachia has long been maligned by the rest of the United States and reduced to a litany of stereotypes, it is a region abounding with geographic, political, economic, and cultural complexity. This chapter explores the early history of the region (from early native American settlement, through the de Soto exploration to European settlement) and traces the origins of common misconceptions about Appalachia to illustrate its complexities. It then explains how Appalachia’s colorful history has complicated the study of its local cultures and, therefore, health outcomes. It argues that healthcare providers and scholars should approach the region with a focus on local culture, applying principles of intercultural competence to view Appalachia not as a singular place but, instead, as a vast collection of communities united by their strong sense of place.

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