The spike in black lung disease and the nexus of regulation, resource depletion, economic change, and culture in occupational environments

Amy M Hay's picture

By Dawn Biehler        19 December, 2016

On December 16, 2016, the U.S. Centers for Disease Control and Prevention announced that an advanced form of coal workers’ pneumoconiosis, or black lung disease, seems to be resurging among miners in Appalachia. An investigation by National Public Radio released last week also found nearly one thousand people with current or past occupational exposure suffering with Pulmonary Massive Fibrosis (PMF) across eleven clinics in four states since 2011. This cluster represents a dramatic spike in reported morbidity after the Coal Workers’ Health Surveillance Program identified only 31 cases of this potentially fatal form of black lung in the entire US during the 1990s.

Measures for preventing and monitoring black lung have long been inadequate. After industry denied its culpability for workers’ sickness and death for decades, the 1969 Federal Coal Mine Health and Safety Act offered free periodic health screenings to coal miners, but few participate in this voluntary program. The CDC found that only 17% of Kentucky miners took advantage of the free screenings over the past five years. In regions with limited economic opportunities, disclosure of diagnoses to employers through this program may result in loss of livelihood, so younger miners may avoid reporting until black lung progresses into PMF. Indeed, since 2011, 99 cases of PMF from across the US have been reported to the surveillance program at National Institute for Occupational Safety and Health, as compared with NPR’s finding of 962 patients across just eleven clinics, where black lung cases went largely unreported to the national program.

The CDC’s report focuses on the breakdown of surveillance of workers’ bodies, but we must also understand why mine environments remain unsafe, in spite of regulations that have tightened ambient dust standards. Historians of environmental health have much to offer here. According to Alan Derickson’s Black Lung: Anatomy of a Public Health Disaster, the state and industry denied that exposure caused disease for much of the early to middle twentieth century, often with the support of company physicians. Along with Derickson’s book, Barbara Ellen Smith’s Digging Our Own Graves chronicled activist miners’ struggles to obtain information from unions, secure federal intervention, and legitimize their own embodied experiences of disease and environment. Their actions resulted in the adoption of the Coal Act of 1969, and of new safety procedures and equipment to limit exposure to dust from coal and the rock in which coal is embedded. Derickson and Smith’s stories about the complicity of the state in corporate exploitation, and the importance of activists in resisting exploitation and defining disease, should give us pause in this moment of weakened worker power and as a new presidential administration promises policies friendly to the coal industry.

Furthermore, Arthur McIvor’s and Ronald Johnston’s oral histories of mine workers in Britain show that mine environments remained unhealthy in part because new equipment functioned poorly. Foremen continued to demand high productivity even as new safety procedures slowed workers down. Male breadwinners in this highly gendered occupation, in communities where mine work defined men’s identities, feared loss of take-home pay and machismo if they could not keep up. Although from a different national context, these stories presage some of the dynamics of the latest chapter of black lung’s story in Appalachia.

Current miners in the US complain that respirators and water sprays are clumsy and cut into their productivity. We also know that industry inspectors for many years forged results of federally-mandated air quality tests. This is also a story about the depletion of a natural resource: coal companies have already mined the thickest coal seams, and are now sending miners after thinner seams, where they must drill through quartz and other minerals, increasing exposure to not only coal but also rock dust. Finally, the loss of coal mining jobs in the US may be bringing about a surge among former miners seeking care as laid-off workers realize they have only three years to claim federal benefits. As miners seek care, often long after the damage is done, their advanced cases are straining the program that provides compensation for those who develop black lung. History can thus help place the story of miners’ vulnerable bodies in the context of our current moment of economic, political, and environmental change.