Medical Mistrust in Appalachia

Helping Patients and Providers Communicate with Cultural Humility

  • Author(s): Welch, Wendy and Beth O'Connor
  • Series:
  • Imprint: University of Tennessee Press
  • Publication Date: 2026-01-09
  • Status: Not Yet Published - Will Back Order
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Clinicians and academics on improving medical communications in Appalachia.

According to the National Institutes of Health, about 25 percent of the American population does not trust doctors and medical professionals. Focusing on rural Appalachia specifically, Wendy Welch, PhD, MPH, and Beth O’Connor, Med, discuss the region’s complex relationships with modern medicine and its institutions in this important collection. Offering multiple academic and clinical perspectives in thirteen unique essays, Medical Mistrust in Appalachia explores the history of this skepticism toward healthcare, analyzing the region’s relationship to medical infrastructure and the relationship between medicine and marginalized communities.

This volume fills a gap in scholarship by elevating the voices of practitioners and wrestling with the realities of medical mistrust as a cultural phenomenon—one born from a system that has historically struggled to center the safety and health of Appalachian communities. Presenting medical mistrust as a justifiable reaction in the interest of self-preservation, Welch and O’Connor address Appalachian stereotypes while confronting the ways medical institutions have fostered environments of mistrust and inequality. Importantly, Welch and O’Connor conclude with a discussion of how medical infrastructure and Appalachia can move forward together. Medical Mistrust in Appalachia is a must-read for rural healthcare professionals, medical students, and readers interested in Appalachian culture.

Wendy Welch is director of the Graduate Medical Education Consortium of Southwest Virginia and author of The Little Bookstore of Big Stone Gap and Fall or Fly: The Strangely Hopeful Story of Foster Care and Adoption in Appalachia. She is the editor of Public Health in Appalachia, From the Front Lines of the Appalachian Addiction Crisis, and Masks, Misinformation, and Making-Do: Appalachian Health-Care Workers and the COVID-19 Pandemic. Welch is a radio reporter for Inside Appalachia.

Beth O’Connor has been the executive director of the Virginia Rural Health Association since 2005 and was the 2022 President of the National Rural Health Association. She contributed chapters to Masks, Misinformation, and Making-Do: Appalachian Health-Care Workers and the COVID-19 Pandemic and Rural Education and Queer Identities: Rural and (Out)Rooted. O’Connor is the creator and host of the Rural Health Voice podcast.