My Old Kentucky Home: Place-based Inequality in America

  • Central and Eastern Kentucky are flooding, with hundreds of homes lost.
  • The loss of coal mining jobs and the opioid crisis are two key hindrances to growth that Kentucky is grappling with
  • Place-based inequality is a tough issue to tackle, and it comes with many nuances.
  • Kentucky is a beautiful, beautiful state.

Off to the Races

I had two qualms when I was leaving Kentucky for Los Angeles. The first was letting go of someone I loved very much (oh, to be human) and the second was leaving Kentucky.

Kentucky was my home. I grew up there, went to university there. Many of my friends still live there. My family still lives there. Kentucky was very good to me.

But Kentucky is struggling. I felt bad about leaving. It felt as though I had an obligation to stay and give back. This place had housed me for years and years, and here I was, leaving it behind. Should I stay and help build this state up to the potential that it has? Is it selfish of me to pursue my own self-interests in the face of a community that is struggling?

But the thing is, I had to leave. Opportunity, for me, was outside of the state limits. So I left. I think of my home often, and talk about it probably too much. And today, I came across this article from The Atlantic, written by Silas House. Parts of KY are flooding, wrecking hundreds of homes.

Source: The Atlantic

The article is beautifully written, and I highly recommend that you read it. Silas paints a picture of the true spirit of Kentucky, beyond that of “the middle of nowhere and flyover country”.

But the comments to this tweet were disheartening. People were poking at the political affiliations of the residents in the flooded lands and essentially stating that this why the state was struggling.

And some components of that are true. It would be foolish to ignore the correlations between policy and economic growth. The state is Republican-leaning, and carry the ideologies that encompass that viewpoint, which can be consequential, just like Democratic ideologies.

(This article is not political. Please do not interpret it as such. I have no agenda.)

But this is so much more than a political discourse.

What really is Kentucky? What potential does it have? Why is the eastern portion of the state flooding to little to no fanfare? What does Kentucky mean in the broader puzzle of the United States?

This piece is a quantitative analysis of Kentucky, but also includes anecdotes from my experience and time there. Basically, I am writing about a place that I love very much that should not be underwater.

This is the Kentucky story.

Kentucky Metrics

US News and Reports publishes state rankings every year, and their most recent ranking placed Kentucky at 40th. The 40th best state. The state really struggles with healthcare, education, and the broad economy. Fiscal stability is difficult to the underfunded pension. However, the state is beautiful, and ripe for opportunity.

Source: US News


Kentucky is ranked 44th in Healthcare, according the US News report, which takes into account Health Care Access, Health Care Quality, and Public Health, equally weighted.

Kentucky’s problems stem from lack of access to preventative medical and dental treatment, as well as the rollback of Medicaid coverage under Matt Bevin. As of November of last year, Kentucky has almost 1.2M people enrolled in Medicaid and CHIP — with a total population of 4.47M, the number of subsidized healthcare participants represents over a quarter of the total population of the state.

Residents are taking advantage of the healthcare plans. When the Affordable Care Act was first rolled out, the number of Kentucky residents without insurance fell from 20.4% in 2013 to 7.8% in 2016. More and more people are getting access to healthcare, which will hopefully have compounding impacts over time. The healthier the population, the more that they can do, and the more that the state grows.

Source: Gallup

Beyond Healthcare: The Opioid Crisis

Kentucky deeply suffers from the opioid crisis. Kentucky has a much higher death rate as compared to the rest of the country, with 81.9% of those suffering from drug dependence living without proper treatment.

Source: Live Stories

The impact that this has on the state is not unnoticed. Kentucky has almost 1.5x the number of opioid prescriptions per 100,000 people as compared to the rest of the nation.

Source: amFAR

This brings a host of other issues, including concerns about infectious diseases related to drug use, an increase in ER visits, and high economic and social costs. According to the National Institute on Drug Abuse, roughly 21–29% of patients prescribed opioids will misuse them and between 8–12% will develop an opioid use disorder.

Source: Value Care Pharmacy

Drug overdoses are the leading cause of death in the United States, more so than traffic crashes and gun deaths. It is removing children from homes (representing one-third of all child removals) and has resulted in a 500% increase in the number of babies born drug-dependent since 2000.

There are a variety of issues in drug treatment, as outlined by Leslie Dye, M.D., from The Doctor Weighs In. Most drug treatment inpatient centers have very long waiting lists, and will require more resources in order to service the growing number of patients. President Trump declared a national emergency, allowing for expanded services and appointments of specialists to address the epidemic quickly.

Fentanyl has only exacerbated the epidemic, and is often interlaced in heroin and other opioids. It is 25 to 50 times more potent than heroin and 50 to 100 times more potent than morphine. It is essentially lethal.

Dr. Dye mentions other issues as well that are barriers to combating the opioid epidemic, including patient information flow, the public view of addiction as a moral calamity rather than a disease, and barriers to treatment. There are solutions to the issue at hand, including medication-assisted treatment, legislative solutions, and enhanced monitoring programs.

However, as Dr. Dye also writes,

“ We need to understand that opioid addiction is a multifactorial problem with multifactorial solutions. This crisis didn’t appear overnight and neither will any meaningful solutions. While President Trump’s declaration of emergency should produce more available resources, let’s hope the resulting action isn’t mired in a tangle of red tape. If there are more bureaucrats involved in the administrative aspects than there are addicts getting help, we are fighting a losing battle.

Source: Dr. Leslie Dye
Source: Live Stories

This epidemic is getting national attention. Allocation of resources and proper rehabilitation programs will be vital in encouraging the health and re-stabilization of the people impacted, from those addicted, to their families, and to their children.

Source: WV Public Broadcasting


I am a product of the Kentucky public education system. Some of elementary, and all of middle and high school. I went to a Kentucky public university (Go Tops!). I was extremely lucky — I received a full ride to university. I didn’t pay a dime. That’s a rare story, and it’s part of the reason I was able to move to one of the most expensive cities in the world to pursue a dream career.

That flexibility isn’t afforded to everyone.

Kentucky is ranked 43rd in Higher Education and 32nd in Pre K-12 Education. Our universities are good, objectively speaking, but budget cuts have cut the limbs off from some of the institutions, and have exacerbated the lack of flexibility mentioned above.

My alma mater, Western Kentucky University, has experienced volatility and uncertainty in the face of statewide cuts compounded by the problem of declining enrollments. It’s a terrible rinse-and-repeat, as explained by a WKU Professor, Guy Jordan,

“ WKU has for a long time now been caught in a vicious cycle. State funding is cut. Students bear the brunt of those costs through higher tuition and fees. As a result, few students can afford to attend WKU. This feeds a decline in enrollment and triggers further budgetary shortfalls.

Source: WKU Herald

But even outside of Kentucky, higher education has experienced a squeeze in funding. The University of Kentucky and University of Louisville, the other two big state schools, are nationally known for their athletics. That brings in more funding and more support. Not every school has that.

Source: 4ICU

In Kentucky, the cuts are more intense due to the previous administration. Kentucky spent almost $3,000 less per student in 2018 as compared to 2008, compared to the average nationwide cut of $1,200. That kind of gap will compound over time, as the impact of 1) paying more and 2) any potential reduction in the quality of education due to cuts will impact these students for the rest of their lives.

Source: WFPL

This makes education more expensive for students, as they are forced to pay the brunt of the load. This leads to the notorious student loan cycle, in which the next generation is completely strapped by debt.

On the other side of the funnel is the underfunded state pension system, which most of the universities participate in. The total debt of the pension is ~$43B, and state university obligations have doubled over the past ten years.

Source: Dr. Aaron Thompson

Universities are faced by declining state funding, reduced enrollment because of higher tuition costs, and a unstable pension system. That makes it difficult for all stakeholders, and leaves the university with two hands tied behind their backs.

To ease the blow, the government divvied up $31M among all the public universities based on performance, including metrics like “ student success, course completion and an institution’s operational needs”. The bigger schools, like University of Louisville and University of Kentucky, received a large portion of the funding, but schools like Kentucky State University and Morehead State, received $0. That’s a tough situation.

Jobs were cut. Online degrees were added. Athletic teams ended. Programs were slashed. Regional campuses were closed. Tuition costs were hiked. It was an extremely tough and tense time, and students felt that.

Source: Courier-Journal

The cuts compound over time, and Kentucky is hit hard by the losses. The below infographic summarizes the situation well.

Source: KY Policy

I do not know if college is for everyone. But according to the KCPE, there is a high return on students that stay in the state and go to college. The Kentucky Center for Education and Workforce Statistics found that :

“ More than 80 percent of the Kentucky students who graduated with a bachelor’s degree from one of the Commonwealth’s public universities were working in Kentucky a year later, compared to less than 30 percent of the out-of-state students”

Source: Kentucky Coucil on Postsecondary Education

The students are staying in state and working when they graduate. That is promising for the state, because that means they are getting a high ROI on their students. As those students continue working and paying taxes, the economy should benefit.


Louisville is one of my favorite cities in the world. It is small, but there are so many pockets of life and uniqueness that makes it extremely enjoyable. I love to run in Cherokee Park and spend time in Nulu. The city is growing.

The state is growing too. It’s inexpensive to live in Kentucky, and the mass migrations from states like California and New York have helped to support population growth. Ford, General Motors, and Toyota all have large manufacturing operation in Kentucky.

Humana, YUM! Brands, and Papa Johns are all headquartered in the state as well. Bourbon is a huge product, with 95% of the world’s bourbon produced in state limits. According to Think Kentucky, that state is:

Also, 65% of the U.S. market and population is within a day’s drive of KY borders. That’s a pretty fun fact. Also makes it very accessible for manufacturing, which explains the existence of the many car manufacturing plants.

However, there are some issues. Only 24.3% of KY adults have a bachelor’s degree, which is low. There is also a low percentage of venture capital deals, patents awarded per capita, and STEM jobs, according to USA Today. These metrics make it the 46th best state for business — or the fourth worst, depending on how you read the glass.

Source: USA Today

The employment situation is growing, but not as densely as the coastal cities. However, compared to other pockets in the Midwest, there are more opportunities in Kentucky to find work.

Source: BLS

The Closing of the Coal Mines

The coal mines were the livelihood of many small Kentucky towns. In 2001, there were more than 30,000 coal mining jobs in Eastern Kentucky, a number that has dwindled to less than 4,000 over the past twenty years.

This is a necessary step in terms of climate maintenance and encouraging environmental safety. Coal mining was a dangerous job, and the longer you spent in the mines, the worse off your health could potentially be. Black lung, caused by coal mine dust entering the lungs, is worse than it was 50 years ago.

Source: NPR

The state changed black lung benefits two years ago, which resulted in a more complex process to apply and a much lower approval rate. The insurance company can have the claim read by a chosen physician and a third reading from a “designated evalutor” who basically has the final say.

Source: WV Public

House Bill 2, passed in 2018, made it so only certain pulmonologists, rather than radiologists could serve in the role. According to Tom Moak, an attorney representing a miner in their black lung case, the pulmonologists might have conflicting interests between the industry and the miners- and tend to side with the industry.

Source: WV Public

That leaves many miners without the care that they need. But the sickness is just one worrying factor for the miners. The other is the fact that coal mining is a dying business, and a large portion of the state relies on it. Below is a map depicting the coal fields in Kentucky, concentrated primarily in the Eastern and Western side of the state.

Source: WMKY

In September of last year, there was a protest on the rail tracks in Harlan County, preventing the coal from being moved. The workers protesting are fighting for their unpaid wages from the Blackjewel bankruptcy, which occurred in July of 2019. Blackjewel violated the Warn Act, which requires that layoffs of 100+ employees require 60 days of written notice.

But they didn’t. And so paychecks bounced. And the miners were left without pay. Despite promises by the President to rebuild the industry, jobs have remained stagnant, despite an uptick in international demand for metallurgical coal. Kentucky lost almost 10% of all coal jobs since Trump took office, and the number keeps dropping.

Source: WV Public

What makes the situation difficult is that the miners are not prepared for a life outside of coal. As Chris Rowe, a previous miner explains,

“There is nowhere to get a job unless you move away. For some of us, that’s not possible.”

Source: Washington Post

Even if you get a college degree, there are not many opportunities in town to utilize that knowledge. That has led to population leakage from the coal towns. The issue is that there is not income diversification in these areas-it’s coal or nothing. And that is painful in the current situation.

Unemployment brings a whole host of other issues, including health problems and societal ills. The Appalachia area struggles with health, with high rates of “obesity, smoking, diabetes, heart disease and prescription drug abuse” which places a large burden on the local governments that are already experiencing deficits due to the shrinking coal industry.

Retraining people for a new way of life is not an easy task. Dan Mosley, the country judge-executive of Harlan County has been focused on diversifying the industries in the coal-dependent country. But as BLANK wrote, “training those people in new lines of work — and making that work available — is a real test.” You can train people for any job, but if those jobs don’t exist at the end of the day, the effort was futile.

However, the opportunitity that Eastern Kentucky has to rebuild is compared to Houston’s decimation in the 1980s and their path to regrowth. The opportunity is there. The state just needs the resources and support to retrain and allow their population to grow and learn. If that can be accomplished, Kentucky has the opportunity to truly achieve it’s potential.

The Natural Environment

Kentucky is a beautiful state. Below is the Red River Gorge. To go here is to experience an incredible view, with endless views of the state. It’s phenomenal.

Source: The Crazy Tourist

There’s something about the hills that are absolutely astonishing. This is Harlan, Kentucky. The home to coal mines described above.

Source: HailStateBeat

This is my home, Louisville.

Kentucky is ranked 20th in terms of infrastructure, bolstered by affordability and equality. The state is ~20% cheaper than the rest of the United States, with extremely low housing costs and cheaper transportation costs.

Source: Best Places

Kentucky is one of the most livable places in the world. Lexington ranked 29th in Business Insider’s 50 Best Places to live in America, for the horse parks and the love of local sports. Also Red River Gorge, as pictured above, is close by.

Rural America is Still Here.

Kentucky has its fair share of issues. But it is beautiful, it carries great potential, and most importantly, it is here.

There have been variables that have created volatility, including the decline of the coal industry and the impact of the opioid crisis. Both of those issues have resulted in a tough environment for economic development and growth in the state. But both can be overcome with proper strategy and resource allocation.

Kentucky doesn’t deserve to be left behind as flood waters ravage Central Appalachia. Rural America should not be a second thought, especially if we want to encourage equality.

Place-based inequality is a difficult issue to tackle, and it comes with a lot of nuances. These people don’t want to just “pack up and leave”, nor should that be a requirement. Some small towns are withering away.

A rising tide will lift all boats. It’s a difficult conversation to have, but encouraging economic reform and growth in these pockets of the country will go a long way in the growth of the nation.

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