10. Harlan County, Kentucky
> 5-yr. pop. change: -5.7%
> Poverty rate: 35.6%
> Bachelor’s degree attainment: 11.4%
> Life expectancy: 71.5 years
Harlan is one of many coal mining counties in Kentucky to rank on this list. As the coal industry declined in the second half of the 20th century, so has Harlan County’s population. Currently, 27,500 people live in Harlan, down from a peak of 75,300 in 1940. In the last five years alone, the number of people living in the county declined by 5.7%.
Life expectancy in the United States has declined in recent years, largely due to opioid overdose deaths. Kentucky is one of the states hardest hit by the opioid epidemic, and in Harlan County, life expectancy declined slightly between 2010 and 2014. Life expectancy in the county is just 71.5 years, nearly eight years below the average life expectancy nationwide.
9. Bell County, Kentucky
> 5-yr. pop. change: -4.0%
> Poverty rate: 38.0%
> Bachelor’s degree attainment: 9.3%
> Life expectancy: 72.7 years
Bell County is located in the southeastern corner of Kentucky, along the Virginia and Tennessee state borders. Life expectancy in the county is less than 73 years, about six years below the national life expectancy. Poorer Americans have less access to health care and can afford fewer healthy options related to diet and lifestyle and therefore often report worse health outcomes — and many Bell County residents struggle financially. The county’s poverty rate of 38% is well more than double the 14.6% national poverty rate.
8. Leslie County, Kentucky
> 5-yr. pop. change: -5.9%
> Poverty rate: 34.5%
> Bachelor’s degree attainment: 8.9%
> Life expectancy: 71.2 years
Leslie County is located in Kentucky’s Eastern Coal Field region. Like much of the region, the county’s population has declined along with the U.S. coal industry. Currently, 10,600 people live in Leslie County, down from a peak of 15,500 in 1950. In the last five years alone, the county’s population fell by 5.9%. Much of that population decline is likely attributable to the lack of jobs. The county has a higher than average unemployment rate, and the majority of the labor force commutes to work outside of county limits.
7. Breathitt County, Kentucky
> 5-yr. pop. change: -4.6%
> Poverty rate: 36.0%
> Bachelor’s degree attainment: 12.6%
> Life expectancy: 70.2 years
Breathitt County sits in the foothills of the Appalachian mountains in the Eastern Coal Field region of Kentucky. Coal country has been hollowed out as the American coal industry has steadily declined for decades — and Breathitt has not been spared. In the last five years alone, the number of people living in the county fell by 4.6%.
Life expectancy in the county is just over 70 years, about nine years less than the national average life expectancy. Breathitt is also one of the poorest counties in the United States. Most households earn less than $26,000 a year, and over a third of the population lives below the poverty line.
6. Clay County, Kentucky
> 5-yr. pop. change: -4.4%
> Poverty rate: 39.5%
> Bachelor’s degree attainment: 9.5%
> Life expectancy: 71.8 years
Clay County is another southeastern Kentucky, coal-producing county to rank on this list. In addition to coal mining, tobacco, timber, and corn are critical components of the local economy — industries that typically do not require much in the way of a formal education. Less than one in every 10 adults in Clay County have a bachelor’s degree or higher, less than a third of the 30.6% national bachelor’s degree attainment rate.
Like other counties on this list, life expectancy in Clay County is low and falling. Life expectancy is just 71.8 years in the county, well below the 79.1 year national average, and down 0.3 years from 2010.