I'm not going to dispute your over-arching point (because I know the data very well), but as a lifelong resident of Appalachia, I can assure you there has been some real and significant reduction in the negative environmental impact of fossil fuels. It's a small comfort and mostly just for those of us who live here, but it's real and visible.
What kind of changes happened there ? just curious
~25 years ago I could have taken you to multiple entirely dead streams within a 20 minute drive of where I grew up - and you don't get very far in 20 minutes on Appalachian roads. Over large swaths of my home state, in fact, I could have done that from most people's homes. This is no longer the case, and a huge number of streams are now recovered or recovering. The surface water problems are by no means gone, but some of the recoveries that I've witnessed - the North Branch of the Potomac River is a good example - are breathtaking. That river was as dead as a doornail in the 90s and is now a vibrant, healthy wild trout fishery. It is still a post-industrial river, it still has dams, run-off issues, wastewater inputs, etc, but it is a far cry from what it was.