COMMENTARY

Transgenerational Impact of Structural Violence:Epigenetics and the Legacy of Anthracite Coal

Paul A. Shackel1

# Springer Science+Business Media, LLC, part of Springer Nature 2017

Abstract This project connects past forms of structural violence to current healthconditions found in communities. Using historical and archaeological material fromdeindustrializing region in the United States, it appears that nutritional and livelihoodstress in the late nineteenth century may have resulted in the transgenerational inher-itance of negative human health outcomes experienced by descendants today. Whilemore in-depth genetic research is needed, it is clear that the study of health disparitiesfound today may be situated in the long-term stresses (environmental and nutritional)that communities faced generations ago. Historical archaeology is a way to develop alongitudinal study of health disparities.

Keywords Structural violence .Well-being . Epigenetics . Anthracite coal miningnortheastern Pennsylvania

Introduction

Since 2009, the Anthracite Heritage Project (University of Maryland) has conductedresearch in Northeastern Pennsylvania’s nineteenth and twentieth-century coalfieldtowns, performing oral histories, archaeological excavation of domestic structures,and textual analysis to document systematic processes of discrimination against animmigrant labor force and their lasting effects. The following discussion documents thelong-term structural violence in these communities, creating the foundation for thinkingabout how nutritional and livelihood stress in the late nineteenth century may haveresulted in the transgenerational inheritance of negative human health outcomes expe-rienced by descendants today. I am proposing that compromised nutrition and envi-ronmental conditions during fetal development expresses itself not only in the child

Int J Histor Archaeolhttps://doi.org/10.1007/s10761-017-0451-0

* Paul A. Shackelpshackel@umd.edu

1 Department of Anthropology, University of Maryland, College Park, MD 20912, USA

experiencing it, but also in successive generations. This work, I believe, will allow thediscipline of historical archaeology to position itself to make contributions to thetransgenerational impact of structural violence in the context of epigenetic studies.

This study begins in the early nineteenth century whereby the anthracite coalindustry began to dominate Northeastern Pennsylvania’s economy (Fig. 1). The firstcoal miners to this region came from England, Wales, and Germany, later followed bythe Irish in the mid-century. By the end of the nineteenth century the largest proportionof the population came from Southern and Eastern Europe. These new immigrants wereeasily enticed to the coalfields because of deteriorating economic and political condi-tions in their home countries (Greene 1968:25–26; Miller and Sharpless 1985:172–173;Stolarik 1980). Much like their predecessors, the majority of new immigrants intoNortheastern Pennsylvania faced ongoing stresses, such poor living and workingconditions, frequent encounters with underemployment, and periods of hunger andmalnutrition (Dublin 1998; Roller 2015b).

The anthracite coal industry peaked aroundWorldWar I with about 180,000 workersextracting over 100 million tons of coal per year. While mining had the highestmortality rate of any profession in the United States, the industry continually recruitedlabor from overseas, offsetting the high death rate and ensuring low wages and highprofits (Richards 2002:7; Smith 1886, 1887). The coal operators considered humanlabor as interchangeable and expendable. Stephen Crane visited mines in the Scranton

Fig. 1 Eastern Pennsylvania including the three major cities in Northeastern Pennsylvania, Scranton, Wilkes-Barre, and Hazleton with the anthracite coal fields in the shaded area

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area and described the living and work conditions in these coal communities: BMan isin the implacable grasp of nature. It has only to tighten slightly, and he is crushed like abug.^ He continued, BIf a man escapes the gas, the floods, the ‘squeezes’ of fallingrock, the cars shooting through the little tunnels, the precarious elevators, the hundredperils, there usually comes an attack of ‘miner’s asthma’ that slowly racks and shakeshim into the grave^ (Crane quoted in Dublin and Licht 2005:24).

The coal industry began its steady decline after World War I as other fossil fuelsbecame readily available to households and industries. The higher levels of unemploy-ment meant that an increasing number of families faced severe economic conditions(Dublin and Licht 2005).

The last immigration wave from Southern and Eastern Europe came to an abruptend with the anti-immigrations laws of 1921 and 1924. The coal industry continuedto decline and then deteriorated precipitously after World War II (Dublin and Licht2005; Tarone 2004; Turner 1977, 1984). During the post-World War II era theregion faced some of the highest unemployment rates in the United States. Womenwent to work in the many new knitting mills that migrated to the region from theNortheast and Mid-Atlantic states in an attempt to evade organized labor. Some mendeveloped boot-leg mining operations, while others commuted weekly to northernNew Jersey to work in the area’s light industry (Dublin 1998). Those in Northeast-ern Pennsylvania struggled to make ends meet, and this struggle and stress tosurvive continues today in many communities. Many of these long-term healthand well-being deprivations, as well as the trauma of underemployment and work-ing in dangerous conditions, have affected the general well-being of the region,making it an undesirable place to live and relocate.

Structural Violence in the Anthracite Region

The unhappiness and substandard well-being found in contemporary NortheasternPennsylvania may be in part the transgenerational result of the structural violenceencountered by new immigrants from Southern and Eastern Europe a century ago asthey were racialized and exploited for many subsequent generations. Johan Galtung(1969, 1990) notes that structural violence is embedded in social structures of oppres-sion, such as racism, sexism, homophobia, and elitism that do harm by preventingpeople from meeting their basic needs. Structural violence is difficult to see. It refers toa form of violence wherein some social structure or social institution may harm peopleby preventing them from meeting their basic needs. Because of the existing structuralviolence there is a high rate of premature death and unnecessary illnesses and disability(Little and Shackel 2014).

Paul Farmer (1996, 2004), as well as Philippe Bourgois (2001), Seth Holmes(2013), Sandra Lane et al. (2008), James Quesada et al. (2011) have used theframework of structural violence (and the closely related notion of structuralvulnerability) to address the role of political and economic conditions in generatingor exacerbating specific health disparities. They examine the current social andeconomic structures that create health disparities and note that it is imperative toexamine the long-term history of structural violence and show how it manifests inparticular settings. This approach, Farmer (2004) notes, helps explain how these

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inequities developed and it helps explain why they persist today. BThose who lookonly to powerful present-day actors to explain misery will fail to see how inequalityis structured and legitimated over time. Which construction materials were used,and when, and why, and how?^ (Farmer 2004:309).

Different forms of structural violence were rampant during the coal mining era ofNorthern Appalachia from about the mid-nineteenth century with the in-migration ofthe Irish (Palladino 2006). Racialized inequalities were seen as part of the natural order,or a natural outcome of history, often reinforced through religion and ideology,language and art, empirical science and formal science. In the late nineteenth century,with the increased in-migration from Southern and Eastern Europe, social scientistdeveloped evolutionary hierarchies that placed these new immigrants, as well as others,in relationship to and below those of Western and Northern ancestry (Allan 1994;Dillingham Commission 1911; González-Tennant 2017; Omi and Winant 1983:51;Orser 2007: 9; Smedley 1998:694).

The new immigrant miners were paid about 20% less than the BEnglish speakers,^those with ancestral roots in Western and Northern Europe. The inequality of pay wasjustified because of their naturalized racialized status (Blatz 1994; Galtung 1990;Shackel 2018b; Wallace 1987). Language became a major barrier for advancement.In the late nineteenth century Pennsylvania laws required miners to take their mininglicense exam in the English language. This law prevented many foreign-born workersfrom advancing their skills, keeping their family income relatively lower than thosewho were able to take the exam in English (Aurand 2003; Novak 1978). The Report onImmigration (Dillingham Commission 1911), which was commissioned by the U.S.Senate to examine what they perceived as an immigration problem, has a section onimmigration and labor in the coal industry. The report places the Southern and EasternEuropeans at the bottom of the scale of preferred nationalities in mining (Roller 2015b).U.S. government documents reinforced theories of eugenics and stated that the sincesouthern Italians were geographically close to Africa, they shared significant biologicaland intellectual characteristics with Africans. The northern Italians were closely relatedto the Alpine race and were therefore similar to Anglo-Saxons (Luconi 2016; U.S.Senate 1911:2). (Table 1).

Because these new immigrants were not seen as equals, they more frequentlyfaced extreme physical, nutritional, and mental hardships as they dealt with sub-standard housing, dangerous living and working conditions, and frequent encoun-ters with undernourishment. They also faced harassment and verbal abuse from theestablished population, and their economic survival was tied to the company store.In One Kind of Freedom (1977), economist Roger Ransom and Richard Sutchdescribe a form of debt-peonage associated with sharecropping immediately afterthe American Civil War. Forms of debt-peonage flourish in places with highilliteracy rates in rural and isolated areas, an inviolate power structure, and a corruptor corruptible law enforcement (Daniels 1972). Miners were caught in an unendingcycle of being indebted to the company store, which kept them living in substan-dard conditions. Often, they were too poor to overcome their debt and move awayand find another occupation. Many miners saw this situation as a form of slavery,and some described their pay and indebtedness to the company as earning slavewages. These conditions associated with poverty most likely has had a long-termeffect on the general health and well-being of the population.

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Health Surveys and General Well-Being in Contemporary Northeastern,Pennsylvania

The long-term economic hardship found in Northeastern Pennsylvania has taken its tollon the region’s general outlook and prosperity. Economists Edward L. Glaeser, JoshuaD. Gottlieb, and Oren Ziv of the National Bureau of Economic Research usedinformation from the General Social Survey, with data from the 1970s, and Gallupsurveys with data from the 1940s, to provide a long-term history to gauge Bhappiness^in various regions of the United States. They use these studies along with the Behav-ioral Risk Factor Surveillance System (BRFSS) to create an index of happiness. TheBRFSS is a nationwide survey operated by the CDC (Centers for Disease Control andPrevention) conducted by individual state health departments, which measures behav-ioral risk factors. Since 2005, a CDC survey has asked individuals to report on theirown life satisfaction using a discrete response scale that includes very satisfied,satisfied, dissatisfied, and very dissatisfied. In each year about 300,000 people through-out the United States respond to this question. While the researchers recognize thatsatisfaction may differ from happiness, they used the terms interchangeably (Glaeseret al. 2014:1, 6, 7).

The BRFSS indicates that in the rust belt areas about one-third of the intervieweessaid that they were very satisfied with their lives compared to almost 50% across theUnited States. Self-reported unhappiness is higher in declining cites, and this tendencyremains constant even when controlling for income, race, and other variables (Glaeseret al. 2014:1). In the study of BUnhappy Cities,^ Northeastern Pennsylvania (Scranton,Wilkes-Barre, Hazleton Metropolitan Statistical Area (MSA)) is ranked 367 out of 367metropolitan areas (Glaeser et al. 2014:63).While many corporations have fled theseunhappy areas those employees and former employees who remain are being compen-sated for their unhappiness with lower costs in housing (Glaeser et al. 2001, 2014:33;Glaeser and Kohlhase 2006).

In 2014, Gallup and Healthways released the report State of American Well-Beingdescribing Americans’ sense of well-being with regard to their emotional health, work

Table 1 BRaces preferred by mining operators for specific occupations^ found in United States ImmigrationCommission Report, Immigrants in Industry, 1911

Pick miners. Fire bosses. Engineers. Foremen. Stablemen, Blacksmiths, etc.

American.English.Welsh.Irish.German.French.Lithuanian.Polish.Slovak.Ruthenian.Belgian.Italian, North.Italian, South.

American.English.Scotch.

German.American.English.Irish.

English.American.German.Irish.

German.American.English.Welsh.Irish.Slovak.

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environment, physical health, healthy behaviors and basic access to health care. TheCEO and President of Healthways and the Chairman and CEO of Gallup write in Stateof American Well-Being that well-being has a direct impact on worker productivity.Generally, high well-being means a healthier and content population that is moreproductive and helps create economically vibrant communities. The survey rankedNortheastern Pennsylvania 177th out of 189 metropolitan areas with regard to generalwell-being (Gallup-Healthways Well Being Index 2014).

One way to strengthen an economy according to the Economic Policy Institute is toattract well-paying employers. The only way they will consider coming to a region is ifthe area has a well-educated workforce. In states that have a lower rate of education, ora less-schooled workforce, the median wage is $15/h. In states that have a highercompletion rate of schooling, such as states with 40% of the workforce holding at leasta bachelor’s degree, the average hourly wage is about $20/h. The Scranton/Wilkes-Barre/Hazleton area ranks 126 out of 150 MSAs for populations that are educated, andit ranks 146 of 150 for quality of education (Bernardo 2016).

The Brookings Institute report, America’s Advanced Industries, rated the top 100metropolitan areas for advanced jobs, or STEM related jobs. The Scranton/Wilkes-Barre/Hazleton MSA ranked 92nd.These jobs are leaving the area at a rate of about 2%per year, and the area has about half the number of advanced industrial jobs it had in1980. Salaries lag significantly when compared to the other regions. The reportindicates that advanced industries are essential for economic renewal in the UnitedStates (Falchek 2015; Muro et al. 2015).

Migration to the area ceased with the early twentieth-century anti-immigration laws,which took aim at the Southern and Eastern European immigrants. According to the2010 U.S. federal census, Northeastern Pennsylvania has one of the highest percentageof non-Hispanic whites of any U.S. metropolitan area with a population over 500,000.It has 91.5% of the population claiming their race as white alone and not claimingHispanic ethnicity. About 5.8% self-identify as Hispanic. While there is a steady out-migration from the area, since 2000 there is a low level in-migration to the area ofHispanics (Metropolitan Area Situation and Outlook Report 2016; US Census Bureau2000). Therefore, many of the life conditions and life styles of the traditional population(descendants of Southern and Eastern Europeans) have connections to the area and tothe mining industry. It is a population that is majority white (according to ourcontemporary definition of whiteness) since the earliest European migration, andcontinues to remain majority white. It has one of the oldest population in the U.S.(median age 40.2 years) when compared to 356 metropolitan areas and one of thelowest ratios of males (88.2) to females (100), a long-term result of the high mortalityrate in the mining industry. In this region the death rate outnumbers birth rate. Almost30% of the population is living below the poverty level (Metropolitan Area Situationand Outlook Report 2016; US Census Bureau 2000).

Evidence for the Long-Term History of Structural Violence

Many of the late nineteenth-century new immigrants from Eastern and SouthernEurope came to Northeastern Pennsylvania as laborers and occupied the lowest-skilled jobs, and therefore earned the lowest wages. Once settled in the coal patch

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town, every household established a garden, which was a strategy to protect familiesfrom lean times, and underemployment – during summers, recessions, and strikes.Long-term deprivations in living and working conditions and deficiencies in nutritionamong the region’s traditional population (considered here to be descendants of theoriginal Eastern and Southern Europeans) can be documented from the late nineteenthcentury. Several archaeological assemblages provide a historical context and explana-tion for the effects of inequality in the anthracite region. Archaeological signatureshinting at malnutrition may have led to the transgenerational effects of poor health andgeneral unhappiness that continues to affect the contemporary descendant communityof the Southern and Eastern Europeans.

As the anthracite coal industry expanded in mid-nineteenth century, thousands ofimmigrants streamed into the many coal patch towns in Northeastern Pennsylvania.Eckley, Pennsylvania was one of these towns. The village attracted immigrants fromdifferent nationalities and the town was segregated by occupation and ethnicity (Warfel1993:7). Many house lots measured 50 × 200 ft.(15.24 × 69.96 m) and containedoutbuildings, including summer kitchens, privies, coal sheds, and eventually garages.Much of the remaining back yard space was cultivated in fruit trees and vegetablegardens (Blatz 2003:27; Holt 2001).

The archaeology project focused on domestic structures found on Back Street, anarea that contained the smallest domestic structures in town that were inhabited by thenewest immigrants. These people were generally laborers and occupied the lowest endof the work hierarchy. A total of 13 excavation units were placed in the side and backyard areas of a double house. While 6487 artifacts were recovered, only 195 faunalspecimens were identified, which is relatively small in proportion to the entire assem-blage. The materials are highly fragmented and difficult to identify, although bird,mammals and mollusk are present. The mammals include cattle, sheep/goat, and white-tail deer. The cuts of beef are the most common identifiable portion of the assemblageand tend to be chuck primal cut, which is a low-quality cut and relatively inexpensive.It is usually ground for stews or dishes like holubky (see below). There are also severalcow cranial fragments in the assemblage, suggesting the consumption of cow’s headsoup. The cow’s skull is one of the cheapest meat products, yet when boiled overseveral hours its product is rich in protein, and it becomes the basis for a bonesoup/broth. The sheep/goat remains are predominantly from the animals’ hind foot.This shank cut is considered a lower quality and therefore cheaper to purchase. Chickenis the only identified bird bone. A tibia fragment from a white-tail deer indicates thathunting was necessary to supplement the family’s diet (Westmont 2017).

Lattimer No. 1 is another coal patch town that developed in 1869. By the 1880s thenew immigrants from Southern and Eastern Europe began arriving to work as laborers inthe Lattimer mines. They were provided a parcel of land, rather than housing, and thenewcomers constructed their own quarters. Italian and Slavic enclaves were establishedon the edge of the planned town and developed in a more organic form when comparedto the company planned town. The shanty enclaves eventually developed with morepermanent housing. Each home lot had a set of outbuildings including a summer kitchenand a privy (Roller 2015b; Shackel and Roller 2012, 2013; Shackel 2016, 2018a).

Excavations in an Italian home lot in the enclave uncovered an outbuilding to the rearof the main dwelling, which served as the summer kitchen. While excavating twelve testunits, many of them in the backyard with five test units were placed in and around the

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summer kitchen, no faunal remains were encountered, except for one pig’s tusk. The tuskis in the shape of a horn, and may have been used to ward off the evil eye (malocchio,maloik). Horns (usually pig’s tusks) to ward off evil spirits continues to be a commonpractice in the area among households of Italian descent. The Bhorn^ is usually placednear windows and doors, in order to keep evil spirits away. Shovel divots into the subsoilis a clear indication that gardening occurred in the back lot areas. Interviews with long-term residents confirm that the back areas were used primarily for gardening andhouseholds tended to grow potatoes, cabbage, onions, beans, tomatoes and squash(Roller 2015b; Shackel 2016). These gardens had to supplement butcher-purchasedmeats and help sustain the family during lean times, or when workers went on strike.

In general, the small and non-existent faunal assemblages from the laborers’ familiesliving in these two coal patch towns may be an indication that they probably struggledto maintain a high protein diet necessary for difficult working conditions. They werealways on the verge of starvation, because of unemployment, underemployment, orbecause they frequently participated in strikes protesting unfair labor conditions. A fewstrikes were as long as six months. If protein did exist, it tended to come from low cutsof meat, or preserved meats like ground beef and sausage. Corroborating evidence fromoral histories and other historical sources indicate that these communities mostly reliedon vegetables and starches for the everyday diet of laborers and their families. A reviewof contemporary cookbooks dating to the early twentieth century provides anotherglimpse into the diet of the new immigrant, in this case people from Eastern Europe,and in particular, the Slovak community.

The earliest printed cookbooks catering to Slovak cuisine in this region werepublished in the early twentieth century in Scranton and Wilkes-Barre, the two largestcities in the anthracite region. They were printed at least one generation after the initial,large-scale immigration from Southern and Eastern Europe. These books tend to gatherrecipes and their publication was sponsored by different social or church groups. Whileseveral cookbooks from the region survive they contain a wide variety of dishes, whichrange from meat preparation, and traditional foods, including breads and pastries. Inmost of the cookbooks the meat (beef, pork, and chicken) recipes consist on averageabout 5% of the entire cook book. The preponderance of recipes tend to favor highstarch dishes, and if there is protein, these cookbooks also feature the preparation oflower cuts of meat, like ground beef and pigs’ feet.

These regional cook books tend to have dozens of (Slovak) recipes for potatopancakes, potato cakes, and dumplings filled with potato or cabbage, the latter whichwe know as pierogis. In thirteenth century Poland, pierogis were associated with afamine food, and they once again became popular in the United States among those ofEastern European descent during the Great Depression. Even though the potato did notbecome a main staple in Eastern Europe until the nineteenth century, the Slovaks haveat least 31 different terms for potato, because of its importance to the culture’s everydaydiet (First Catholic Slovak Ladies Union 1952; Langer 1975; McHale 1913; Woman’sInstitute of Domestic Arts and Sciences 1923; Wyoming Valley Women’s Club 1925).

Holubky (also referred to as stuffed cabbage, and many may know it as pig stuffed ina blanket) is a dish consisting of cooked cabbage leaves wrapped around a meat filling(usually ground beef, and sometimes lamb or pork) and grains, such as rice or barley,and may include mushrooms and vegetables, and seasoned with onion and garlic.Another dish, halušky, consists of a soft noodle or dumpling. It can be served as is with

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a sauce or gravy, or cooked cabbage can be added. There are many recipes forcabbages, such as scalloped cabbage, creamed cabbage and sauerkraut (First CatholicSlovak Ladies Union 1952; McHale 1913; Woman’s Institute of Domestic Arts andSciences 1923; Wyoming Valley Women’s Club 1925). One informant noted that hisfamily grew so much cabbage in their garden that they had enough cabbage to eat allyear, sometimes as a main meal, and sometimes as an additive to make halušky.

Studenina, or jellied pig’s feet, is made by boiling pig’s feet in salted water. Once themeet separates from the bone, the bone is removed and soup greens, onion, and garliccloves are added. When the soup cools it becomes jellied. Beet soup recipes arepopular, as well as a variety of ways to pickle various types of vegetables (FirstCatholic Slovak Ladies Union 1952; McHale 1913; Woman’s Institute of DomesticArts and Sciences 1923; Wyoming Valley Women’s Club 1925).

Cookbooks provide an important source for understanding the general diet andnutrition in part of the Northeastern Pennsylvania community. While the diet may havechanged somewhat from the time of the initial immigration to the development of theserecipes found in the cook books, this source provides some insight into thecommunity’s access or lack of access to a high protein diet. They did rely extensivelyon vegetables and starch. While the faunal assemblage produces few remains, they didrely on processed meats for special occasions.

Epigenetics: the Contemporary Effects of Long-Term Structural Violence

In February 1938 the Lattimer Coal Company went bankrupt and began to sell offmuch of their property, including the houses and house lots in their communities, andmany of those renting were allowed to purchase the houses they occupied (Roller2018). A number of workers attained a livable wage as they fled the mines and foundwork in light industry in the area, or in the region (Dublin 1998; Dublin and Licht 2005;Roller 2015b).

The different coal patch towns initiated their own community improvements. In the1940s Lattimer No. 2 (renamed Pardeesville in 1938) developed a sewer system andprivies were replaced with indoor plumbing connected to cesspools. In some caseswildcat sewage systems ran waste directly into rivers, streams, and sometimes intoabandoned mines (Roller 2015a, 2015b:280, 2018). The county installed a municipalsewer system in the 1960s, and indoor plumbing soon became the norm throughout theregion’s coal patch towns.

After abandonment in the 1960s, the cesspools eventually drained and they becamereceptacles for household trash. In Lattimer No. 2 the Anthracite Heritage Projectexcavated one of these abandoned and filled cesspools that dates to at least the 1960s.Recovered artifacts included items like light bulbs, tableware, and nail polish containers,among many other familiar items. There are also large quantities of over-the-countermedicinal bottles/containers in the assemblage, such as BBayer Aspirin,^ BNoxzema^cream, a bottle fragment with the embossed: BHANDMEDCO.^/ BPHILADELPHIA.^There are several eye droppers, as well as many medicine vials and other unidentifiedmedicine containers. Also included in the assemblage were a dozen hypodermic needlesused for insulin shots to treat diabetes. According to a local interviewee, the resident thatoccupied the house who was of Slovak ancestry, struggled with diabetes and the disease

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was eventually the cause of death. While the standard of living in these coal patch townsimproved for some, poor health conditions are prevalent in this particular household andthey may be linked to the long term structural violence that perpetuated social, politicaland economic inequities and health disparities.

There is other environmental stress that impacts the general health in communitieswhere coal extraction predominates. For instance, the research by Hendryx and others(Hendryx 2009; Hendryx and Ahern 2008; Hendryx and Zullig 2009) note the envi-ronmental stresses when studying health conditions in the West Virginia coal miningregion. Many of the results would be similar to other coal communities. They noted thatchronic illness might be prevalent because people in this region have less access tohealth care, have higher smoking rates, and are living in poorer economic conditions.Their study adjusted to the data to include those factors, and still found disease rateshigher in coal-mining communities. As coal production increases, so does the incidenceof chronic illness. Coal-processing chemicals, equipment powered by diesel engines,explosives, toxic impurities in coals, and even dust from can cause environmentalpollution that could have a negative effect on public health. The people in coal miningcommunities; 1) have a 70% increased risk for developing kidney disease, 2) have a64% increased risk for developing chronic obstructive pulmonary disease (COPD) suchas emphysema, 3) are 30% more likely to have high blood pressure (hypertension).

In general, the hospitalization rate for COPD and hypertension increases as the amountof coal extraction increases. The mortality rate is also higher in coal mining regions.People living near open air mining (strip mining and mountain top removal) who rely onwells systems, are likely drinking water drained from the mines (Acid Mine Drainage -AMD, or Acid Rock Drainage - ARD) and are consuming an abnormally high rate ofmetals that are being washed out of the coal beds. These communities have cancer ratesof 14.4% compared to 9.4% for people elsewhere in Appalachia. The rate of childrenborn with birth defects is 42% higher in mountaintop removal mining areas. (Ahern et al.2011; Hendryx et al. 2012; Hitt and Hendryx 2010). While we do not have comparablehistorical data for the general health conditions of coal communities a century ago, it iseasy to assume that many of the chronic diseases would have existed and were probablyworse, since we now have some environmental laws regulating dust and particle con-taminants in mining towns. Strict water regulations existed until February 16, 2017, whenPresident Trump signed legislation ending the Office of Surface Mining’s StreamProtection Rule, which protected waterways from coal mining waste (Henry 2017).

A recent CDC study indicating death rates related to cardiovascular disease illustrateshighermortality rates in the American South and confirms that this non-infectious diseaseis also prevalent through Appalachia, extending into the far reaches of NortheasternPennsylvania and into the southern tier of New York (Fig. 2). Many argue that the poorhealth conditions found in contemporary populations are related to low education, lack ofexercise, a poor diet and poor access to medical care (De Backer 2008; Graham 2014;Watson and Preedy 2013). However, when examining variables related to cardiovasculardisease (CVD) about one-half of those with CVD lack any of the conventional riskfactors (Futterman and Lemberg 1998), and therefore much remains to be explainedconcerning the origins of this disease, and probably many other diseases.

The field of epigenetics may be one way of explaining the 50% rate that cannot beexplained by conventional risk factors. Epigenetics is the study of the change in geneticexpression that does not involve the underlying DNA sequence. It is the change in

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phenotype without changing the genotype, which affects how cells read genes. Epige-netic marks serve as on/off switches for genes. The cells that make up different parts ofyour body - brain, heart, muscles - all have the same DNA. However, these cells takeon different functions depending on how epigenetic marks turn on or off particulargenes. Therefore, the study of epigenetics is about examining how the epigenetic marksmay switch on or off and have a role in sustained generational changes. In this case,changes that may impact health and well-being.

One of the first studies of transgenerational outcomes was an examination of babiesborn to mothers whowere exposed to acute food shortages at the end ofWWII, known asthe HungerWinter (1944–45). Using a sample of 1808 first born children to mothers whoexperienced famine conditions in utero from cities in Holland, the study indicates that thebirth weights of babies to mothers who were exposed to famine conditions in utero hadoffspring with lower weights when compared to babies of non-exposed women (Lumey1992). Subsequently, there has been a growing literature that shows that information thatis not contained in the DNA sequence - epigenetic information - can be inherited from theparent to the offspring and succeeding generations (Heron 2010; Kuzawa and Sweet2009; Susser et al. 2012; Thayer and Kuzawa 2011).

The Överkalix study, considered to be foundational research in exploring epige-netics, examined a group of males born in 1905. They were grandsons of boys who intheir pre-puberty years, a time when sperm cells are maturing, were exposed to differentnutritional episodes. One group was exposed to a Bfeast^ season and the other set wasexposed to a famine season. The Bfeast season^ group died on the average six years

Fig. 2 Heart Disease Death Rate, 2011–2013, for the white population, Ages 35+, by county. The circled areindicates the anthracite region in northeastern Pennsylvania. https://www.cdc.gov/dhdsp/maps/national_maps/hd_white.htm

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earlier than the grandsons of Överkalix boys who had been exposed to a Bfamineseason^ during the same pre-puberty window. In many cases the cause of death of thosein the Bfamine season^ group was diabetes. The Överkalix grandfathers were transmit-ting a brief, however, important childhood experience to their grandsons showing thatsome epigenetic marks may persist and be passed down for multiple generations alongwith genes (Pembrey et al. 2014).

The Cebu Longitudinal Health and Nutrition Survey (Cebu Study Team 1991) canserve as an example in maternal and child health for residents of the coal towns understudy. This ongoing study focuses on a cohort of Filipino women who gave birthbetween May 1, 1983, and April 30, 1984. The cohort of children born during thatperiod, their mothers, other caretakers, and selected siblings have been followed throughsubsequent surveys conducted in 1991–92, 1994, 1999, 2002, and 2005. Research isnow focused on the long-term effects of prenatal and early childhood nutrition andhealth on later adult outcomes, including education and work outcomes and develop-ment of chronic disease risk factors (Workman et al. 2015; Wright et al. 2016).

Regarding chronic diseases, about one-quarter of all deaths in the US are related toCVD in 2010 (Heron 2010). In addition, people with diabetes also tend to develop heartdisease or are victims of strokes. The chances of a heart attack for a middle-aged individualwith type 2 diabetes are high (Steckel and Senney 2015:3; NIH 2016). Economists Steckeland Senney (2015) use state level data to explain the high rates of cardiovascular disease(CVD) found mostly in southern states. They reference other health studies (Barker 2002;Barker and Thornburg 2013; Hanson and Gluckman 2008) and explain that a poorlynourished fetusmay bemaladapted to a rich nutritional diet. They explain that after severalgenerations of malnourishment in the American south, the climb out of poverty has led toa richer diet, and therefore a higher rate of CVD. They hypothesize that if the fetus ispoorly nourished its body is maladapted to a lush environment.

Steckel and Senney’s (2015) research supports an interesting and provocativehypothesis. They recognize the transgenerational effects of diet. However, their state-wide data analysis considers political boundaries and does not necessarily take intoaccount more local geographic and cultural differences that can be defined on thecounty level data. For instance, when looking at the CDC map (Fig. 3) there is a distinctred district (indicating high rates of heart disease), which follows the Appalachia regioninto its northern reaches, which includes the anthracite region in Northeastern Penn-sylvania and parts of the southern tier in New York. While Steckel and Senney’s (2015)hypothesis has validity as they show the relationship between growing income andCVD in the south, in regions like Northeastern Pennsylvania, which has not seeneconomic growth or recovery, it may be long-term poverty, toxic environment, andmalnutrition that that plays an influential role in creating the higher CVD rate in thisregion. Being exposed to the deprived conditions for several generations may leave thepopulation predisposed to chronic diseases and poor health.

Studies confirm the epigenetic transgenerational impact of nutrition and the outcomeof high rates of CVD. Some evidence shows that individuals can be predisposed tocardiovascular disease if the heart, vascular tree, kidneys and pancreas are modified inthe womb in response to maternal social stress and poor nutrition (Barker andThornburg 2013; Gluckman et al. 2008). One study (McEniry and Palloni 2010)examined a representative sample of Puerto Ricans within the age group 60–74. BThisstudy found that after controlling for standard risk factors the probability of heart

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disease was 65% higher among individuals who were born during seasons in which theincidence of disease and poor nutrition were higher^ (Steckel and Senney 2015:5).Subsequent studies on the Överkalix work indicate that children of mothers who sufferthrough famine during early pregnancy have a heightened risk of diabetes, obesity, andschizophrenia later in life (Bygren et al. 2014). Other studies show similar results(Daxinger and Whitelaw 2012; Pembrey et al. 2014).

Most of Northeastern Pennsylvania is not considered to be a medically underservedpopulation, although residents tend to go out of the area for treatment of any majormedical complications (General Assembly of the Commonwealth of Pennsylvania2015). The existing population mostly consists of descendants of the late nineteenthand early twentieth centuries Southern and Eastern European immigrants. Whenexamining CDC data for coronary heart disease death rates and controlling for whites,35 years and older, the data indicate an extremely high death rate in the anthraciteregion and compares to some of the highest rates found in the United States (Fig. 3).This high mortality rate related to CVD in Northeastern Pennsylvania, I believe, may bein part explained by the long-term structural violence that prevailed in this coal miningregion. The deprivation of health care access and chronic stress related to poornutrition, poor environmental conditions, and underemployment may havetransgenerational effects and therefore impact the general health and well-being ofthe contemporary community.

Conclusion

Paul Farmer (2004:307) explains that Bthe impact of extreme poverty and socialmarginalization is profound in many of the settings in which anthropologists work.^

Fig. 3 Coronary Heart Disease Death Rates for Whites, 35 yrs. and older, 2012–14 in the Anthracite CoalRegion (encircled) of Pennsylvania. Starred Counties Belong to the Scranton- Wilkes-Barre – Hazleton MSA.From - Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention andHealth Prevention, Division for Heart Disease and Stroke Prevention. https://nccd.cdc.gov/DHDSPAtlas/default.aspx?state=County&ol=%5b10

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This impact often has deep social, political, and economic roots and is found indeveloping countries as well as throughout regions of the United States. The new-comers to Northeastern Pennsylvania escaped social and political traumas in their homecountries such as under nutritional and discriminatory stress. Then they faced the stressof migration and disruption to their social networks. In Northeastern Pennsylvania, thecoal baron’s poor treatment of their new workforce was legitimized by the racializationof new immigrants. They were placed in jobs based on their ethnic background. As aresult, the new immigrants were underemployed, provided lower wages than theirpeers, and lived in substandard housing. They tended to be in perpetual debt, andhad a limited supply and limited diversity of foodstuffs. Communities also facedenvironmental stresses, with the air filled with coal dust and the drinking of toxic waterleading to the early onset of several chronic diseases. The community faced additionalstress with the loss of the coal industry, resulting in emotional trauma and continuednutritional stress. Racial hierarchies that were naturalized in the mid- to late-nineteenthcentury legitimized the foundation of what became a long-term history of structuralviolence and the legacy of poverty and health disparities in the area, past and present.

In order to develop a more concrete case for transgenerational epigenetic outcomesfrom structural violence, there is a need for additional longitudinal evidence of specificfetal exposures and the attendant consequences for health, as demonstrated in thestudies of the Hunger Winter (1944–45) in Holland (Heron 2010; Kuzawa and Sweet2009; Susser et al. 2012; Thayer and Kuzawa 2011), the Överkalix study in Sweden(Pembrey et al. 2014) and the Cebu Study in the Philippines (Workman et al. 2015;Wright et al. 2016). Margaret Lock (2015: 162) argues that Beffects of apparenttransgenerational inheritance of epigenetic change are not highly uniform, and not alloffspring are inevitably affected. Scheper-Hughes and Bourgois (2004:318) also cau-tion that when undertaking these longitudinal studies there also needs to be someattentiveness to daily life and contemporary social and cultural processes.

The health concerns identified in this project are the low rates of satisfaction or well-being reported by residents (Centers for Disease Control and Prevention/CDC 2015,Gallup and Healthways 2014) and the relatively high coronary heart disease death rates(2011–2013, 2012–2014) reported by the CDC for counties in the study region. I amarguing that while most of Northeastern Pennsylvania is not a medically underservedpopulation, there are real medical needs in the region for better health care. Some of thehealthcare issues are attributed to the general poor diet and poor medical treatment in thearea. However, the scenario may be much more complicated. The historical and archae-ological data from about a century ago indicates that the new immigrants had low proteinand high starch diets. If they had the opportunity to consume meat it was often from theless preferred cuts. Contemporary cookbooks also have a plethora of recipes that tend tobe high in starch. While the coal industry declined dramatically after WWII, the livingconditions improved for some after some households escaped the oppressive conditionsof the coal companies. However, the archaeology from a 1960s context indicates that onefamily had to deal with poor health conditions and was part of the growing epidemic ofdiabetes and heart disease in this region, which may have been a result of thetransgenerational impact of malnutrition and other stresses on this population.

These results provide an interesting correlation using archaeology and other histor-ical materials that creates the foundation for further inquiry into understanding the long-term effect of structural violence on a community. The impact of structural violence on

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the new immigrant communities left the region an undesirable place to live. The higherthan average CVD death rate among the white population probably stems in part fromthe legacy of the coal barons who once controlled the everyday lives of workers andtheir families. Historic forms of structural violence have left Northeastern Pennsylvaniawithout an optimistic future.

Acknowledgements Much of the archaeology discussed in this paper has been a product of severalarchaeology field schools operated through the University of Maryland. Michael Roller oversaw the excava-tions at Lattimer 1 and one of the sites at Lattimer 2. V. Camille Westmont and Justin Uehlein supervised thework at the second site at Lattimer 2. V. Camille Westmont also supervised the archaeology work at Eckley. Iappreciate the invitation of Bode Morin, Site Manager of Eckley Miners’ Village, as well as the support of thePennsylvania Historical Commission, to explore the lifeways of the new immigrants to this historic commu-nity. He also made me aware of the Bhappiness studies^ related to Northeastern pennsylvania I appreciate thecomments by Barnet Pavao-Zuckerman, Christina Getrich, and Megan Bailey, as well as any annonymousreviewers on an earlier draft of this manuscript.

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