Study focuses on health care in Appalachian areas recovering from Hurricane Helene

Julie Gohlke is leading a multi-university research effort to understand how the catastrophic inland impacts of Hurricane Helene will continue to shape the health of Appalachian communities for years — perhaps decades — to come. 

The research is backed by a National Institutes of Health grant that will grow over five years pending the accomplishment of first-year milestones. 

"We're really just trying to learn from this experience so that we can support better mechanisms for future preparedness," Gohlke said.

Gohlke, professor of environmental health within the Department of Population Health Sciences in the Virginia-Maryland College of Veterinary Medicine, has spent her career studying the health effects of environmental disasters, from the Deepwater Horizon oil spill to extreme weather.  

But Appalachian flooding is more personal. She recalls once watching her father as he was unable to reach her grandmother’s flooded home in West Virginia. 

Her grandmother was not harmed, but Appalachian flooding has been deadly and destructive for many thousands, particularly after Helene in September 2024, which also caused landslides and wind damage in the region. 

"I've always wanted to look closer at long-term impacts from flooding in Central Appalachia," she said. "You've got a lot of unique topography and resource extraction processes in Appalachia that can influence flooding."

A region already under strain 

Before Helene, rural health care shortages, limited mental health services, and aging infrastructure already strained communities across the region. 

“Health services in rural locations are suffering anyway,” Gohlke said. “Then you put a large flooding event on top of it, and it becomes a real disaster. How can you build resilience into the system so that when you have the next major disaster, things aren't as bad as they were?” 

The primary grant — $791,037 awarded through the National Institutes of Health's National Institute of Nursing Research — will fund the first year of a five-year study spanning 20 counties across western North Carolina, eastern Tennessee, and southwestern Virginia. The grant could grow to $3.7 million over five years following the first-year research results.

Collaborators include faculty from Virginia Tech, Appalachian State, the University of Tennessee at Knoxville, Johns Hopkins, and North Carolina State, along with a network of Cooperative Extension agents in North Carolina, Tennessee, and Virginia, who will serve as both community liaisons and interviewers. 

“Extension agents in all three states were heavily involved in the initial response and recovery for Helene,” said Kathy Hosig, director for the Virginia Tech Center for Public Health Practice and Research in the Department of Population Health Sciences and initiative leader for health and well-being with Virginia Cooperative Extension. “This project really strikes a chord with them as both residents and service providers in the affected localities. Their deep community connections are key to the success of this project.” 

A parallel thread of the project involves knowledge exchange — bringing lessons from earlier Appalachian flood disasters in West Virginia and eastern Kentucky to communities still reeling from Helene. In those earlier cases, researchers found that recovery takes far longer than most people expect, and that a true "new normal" may not emerge for half a decade or more. 

In the initial year, the study will focus on interviews with administrators and staff at health care facilities and schools in the affected counties and learning from past floods in Central Appalachia.

Reading the data behind the visits 

A central component of the research in years two to five involves analyzing electronic records generated when a patient walks into an urgent care clinic or emergency department. That data, collected at the zip code level on a daily basis, is shared with state health departments and provides a granular picture of community health needs without identifying individual patients.

Satellite imagery and field verification of high-water marks will round out the data picture, though Gohlke acknowledged that cloud cover and the speed with which mountain floodwaters recede make satellite data imperfect for capturing peak inundation. 

By comparing health care visit patterns before and after Helene in flooded versus non-flooded areas, the team hopes to detect long-term health consequences.

"There have been several studies that have come out in the past five years suggesting that even 15 years after large flooding events, you see differences in life expectancy and health outcomes," Gohlke said.  

Among the consequences researchers have linked to prolonged displacement: mold exposure in damaged homes or substandard temporary housing driving respiratory illness, mental health deterioration, and the slow grind of navigating bureaucracy for relief aid.

The study will give particular attention to pregnant women and mental health outcomes, areas where prior disaster research has shown elevated vulnerability. 

A second, smaller grant from the Appalachian Regional Commission through a subaward via East Tennessee State funds a complementary student-led project, co-led by Emily Satterwhite, professor and director of Appalachian studies in Virginia Tech’s College of Liberal Arts and Sciences.

Through Gohlke's Appalachian community research course this past fall, Virginia Tech students partnered with the New River Conservancy to document bright spots and barriers to recovery in the New River Valley of Virginia. 

Gohlke believes the data generated by the studies could ultimately inform national conversations about flood insurance, federal aid funding structures, and floodplain mapping, much of which she said is already out of date.

"It could be that the research we are generating could support or refute some changes in those policies,” Gohlke said.