Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Richard Ingram

Committee Member

Dr. Julia Costich

Committee Member

Dr. Rachel Graham


In the Appalachian region, the need for primary care services has increased due to an increase in morbidity rates from coal mining, obesity, drugs, and poor health care. The Affordable Care Act (ACA) was enacted in part to expand access to patient care. The ACA aimed to help solve these problems and help underdeveloped communities such as the ones in the Appalachian region that do not have access to affordable and quality health care. This project examines differences before and after the ACA was passed on the delivery of primary care services by local health departments within the Appalachian region. Data on the local health departments within the Appalachian region was obtained from the National Profile of Local Health Departments census, which was taken by the National Association of County and City Health Officials (NACCHO). The data showed that after the implementation of the ACA in 2010 there was a clear decrease in the primary care services offered by LHDs within the Appalachian region.

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