This book provides an overview of economic trends and social issues in the 13 states and 399 counties of Appalachia, with emphasis on implications for families, children, and communities. It places the trends and issues of the Appalachian region within a national context. These trends include declining employment opportunities and wages, increased poverty and concentrations of poverty, and inadequate public investments in people within their families and communities. The transition to a global economy is accompanied by conflict, not only about the workplace and terms of labor, but also about living space and the terms of creating and sustaining people in communities. Separation of work from community invites further tragedies for families and communities in terms of community demise and environmental degradation. The book's first three chapters describe national economic changes since 1970 impacting Appalachia. Chapters 4-7 discuss changes in Appalachia's social and human capital since 1970, including employment and income patterns; demographic changes; poverty of individuals, families, and children; and specific measures of health, education, and environmental protection. This section includes extensive data tables, figures, and maps providing regional and state information on child and family poverty; infant, child, and teen mortality; public health conditions; access to health care; welfare policies; high school and college graduates among adults; high school graduation rates; and out-of-school youth. Pages 172-184 are entirely devoted to the topic of education in Appalachia. The final section reviews proposed policies to meet the human needs of income, work, and family maintenance evident in Appalachia, and calls for a "theology of economic development" based on values of stewardship and economic justice. Appendices include economic rankings of Appalachian counties, 1988-92; methodology; and discussion of poverty definitions and of counties that have sunk below "severe economic distress" to a new lower rung of poverty. Contains 191 references and an index. (SV)