ABSTRACT Driven by climate and energy policy priorities in national and global contexts, coal phase‐out is expected to improve public health outcomes by reducing human exposure to air, water, and soil pollution and decreasing the number of workers in dangerous mining conditions. However, the transition may also increase economic distress in mining communities leading to poorer health outcomes—possibly offsetting the benefits of phasing out coal. We examine this hypothesis by assessing the relation between coal production, working hours per miner, coal mining employment, and life expectancy in 3076 U.S. counties (97.9% of all U.S. counties) from 2012 to 2019. We develop and apply a novel spatial modeling approach that combines the high‐dimensional half‐panel jackknife fixed effects estimator with the spatial lag of X model and examine whether increases and decreases in each predictor are associated with life expectancy. We find that an increase in coal mining employment in adjacent counties increases life expectancy in the focal county in the short and long run and vice versa for a decrease in employment, and that decreases in miner labor hours in adjacent counties increase life expectancy in the short and long run in the focal county. We also find that effects differ in Appalachia compared to the rest of the country—where increases in coal production are associated with decreases in life expectancy and is also where the effects of coal mining employment are concentrated. These findings suggest that both increasing and decreasing reliance on coal can negatively impact population health, and that these competing exposures underscore the importance of a Just Transition away from fossil fuels.
Thombs et al. (2026) studied this question.