Four U.S. senators and the nonprofit Bipartisan Policy Center on Wednesday proposed 19 measures to boost the economy in Appalachia, including expanded broadband and telemedicine, and tapping the region’s “vast” natural gas reserves for chemical and advanced manufacturing facilities.

The initiative is intended to help reverse struggles with poverty and isolation in the region where more than 25 million people live.

Other proposals include investments in highways and community water systems and education options like Pell Grants for older students.

Appalachia has been disproportionately hurt by economic shifts and declines in manufacturing and minings.

“With the right investments and smart policy, we can benefit from the energy transition now underway, as well as build and modernize transportation, water and sewer, and broadband infrastructure for the next century,” Manchin said.

Access to skilled workers is one barrier to more job creation in Appalachia, according to the report. It called for expanding programs that will create business partnerships to train workers and make it easier for them to get good jobs.

National data show 65-70% of Amrican jobs require some education beyond high school, while 35% require a college degree at least. Only about 23% of Appalachian working-age people have those degrees, while 30% is the national average.

The report called for quicker pathways from public schools to community, technical colleges, and universities that align with the economy’s skill demands. Each sub-region of Appalachia should make its own plan, according to the report.

The three drivers of poor health in Appalachia are chronic diseases, opioid addiction, and shortages of health care professionals, the report said. It cited federal Appalachian Regional Commission support for health projects, called for better data and analysis on the effectiveness of treatments and interventions and “creative partnerships” among governments, nonprofits and private entities.

The Appalachian Regional Commission has funded several projects in Chattooga County, especially in recent years. For instance, last year, the commission helped subsidize the retooling of the Tooga Theatre.