The Resurgence Of Black Lung In Appalachia

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FILE - In this Oct. 6, 2015 photo, a miner works underground in the Sewell "R" coal mine in Yukon, W.Va. For the long-suffering communities that depend on coal, a recent Supreme Court ruling temporarily blocking greenhouse gas reductions was seen as a rare victory. But coal country residents say the reprieve may only be temporary as utilities turn away from coal generation and production continues to slide. (AP Photo/David Goldman, File)
FILE - In this Oct. 6, 2015 photo, a miner works underground in the Sewell "R" coal mine in Yukon, W.Va. For the long-suffering communities that depend on coal, a recent Supreme Court ruling temporarily blocking greenhouse gas reductions was seen as a rare victory. But coal country residents say the reprieve may only be temporary as utilities turn away from coal generation and production continues to slide. (AP Photo/David Goldman, File)

Black lung rates, especially among coal miners in Appalachia, are rising to levels not seen since the 1970s. This comes despite the enactment of coal dust safety laws in the U.S. in 1969 and a decrease of the disease in the 1990s that made health officials believe black lung might be a disease of the past.

Here & Now's Robin Young speaks with Howard Cook, 54, a third-generation coal miner who was recently diagnosed with advanced black lung disease. She also speaks with Dr. David Blackley of the National Institute of Occupational Health and Safety (NIOSH), who works with coal miners in West Virginia and published a paper that looked at the increase of cases of black lung disease, a strain more virulent than in the past.

Interview Highlights: Howard Cook and David Blackley

You were around 18 when you started work in the mines?

Cook: “Yeah, I was about 18 to 20.”

That was after these protections were instituted. When were you diagnosed with black lung?

Cook: “I was only diagnosed last year, probably. I was never checked, I didn’t go to get checked until after I retired. I didn’t have a lot of symptoms, it was just something I thought I ought to get checked and keep abreast on in case I did have it.”

But you did. How shocking was that to find out?

Cook: “The most shocking part to me was, my blood test and my breathing was fairly normal of a person of my age, even at any occupation I may have chosen. What was surprising to me was where did the nodulers come from, which is what made my case go into complicated. I still don’t have an understanding of what part of the dust would give you nodulars or what part wouldn’t or anything like that.”

Dr. Blackley, what is causing this resurgence of black lung?

Blackley: “What’s going on is that it’s making a comeback because miners are breathing in too much coal mine dust. We’re seeing new black lung cases in coal fields around the United States, but by far the biggest resurgence has been here in central Appalachia, so Kentucky, Virginia and West Virginia. The current levels of severe black lung, or complicated black lung, in Appalachia are now as high as we have seen since we began keeping records in the early 1970s, so we’ve essentially seen a big U-shaped curve, where it went down almost to zero and then back up. Along with that, we’re seeing more coal miners with disease characteristics resembling silicosis, we’re seeing black lung onset in younger miners, we’re seeing rising numbers of state and federal disability claims and then, I think most troublingly, we’re seeing rising numbers of lung transplants for coal workers with pneumoconiosis or black lung, and lung transplants are a last ditch intervention because there’s no cure for this disease.”

You mentioned silicosis, which comes from a substance in the mine that can also damage the lungs.

Blackley: “There may be several factors that can explain this, for example in Appalachia, many coal operators are now cutting through lots of rock to mine remaining coal, because many of the big thick coal seams that were around years and years ago are now gone, they were mined. Rock can contain high levels of silica, and we all know that silica is incredibly toxic when inhaled, and mixtures of coal dust and silica dust are probably playing an important role in some of the trends that we’ve seen recently.”

Mr. Cook, where you worked, were you seeing people end-run some of the safety restrictions?

Cook: “Not that I’m aware of. While you all were talking, I was kind of going back a few years. When I first started my career in the early ‘80s, our normal work week was basically 40 hours a week, and in probably the last 10 years that I have worked, it was more like a 60 hour week and I’m just wondering, would that contribute more?

Blackely: “Sure. We know what the trends are for coal mining in the United States, now there are fewer miners working in the United States than there were years ago, there are fewer now than there were in the ‘80s. But those who are working find themselves under pressure to keep production levels high, and it sounds like that may have been the case here. This means longer working hours, as Mr. Cook described, and it could also mean increased use of powerful cutting tools, and together these two factors could result in longer and more intense dust exposures.”

Mr. Cook, how are you coping with having a disease that was supposed to be eradicated?

Cook: “Well, I never did really see it as eradicated. My whole career has been in the mines and I have not seen enough change from the first day I started to the last day I worked to make me think ‘well, this is all gone now.’ I never did consider it to be all gone.”

Dr. Blackley, what do you think is happening? Are people not abiding by the regulations?

Blackley: “NIOSH is part of the Center for Disease Control and Prevention and we’re not a regulatory agency. The Mine Safety and Health Administration is the group that regulates the mine environment. I think the single most important way to end this problem that we’re talking about today is to reduce coal mine dust exposures in the mines. The U.S. circuit court recently upheld the Mine Safety and Health Administration’s new rule designed to lower miners’ dust exposures, and that rule will lower the amount of dust that is allowed to be in the air in the mines and it will also equip miners with wearable dust monitors. I feel very strongly, and my organization feels very strongly, that effective implementation of this rule is gonna be a big step towards eliminating black lung in the United States.”

Howard, this is completely preventable, what you have.

Cook: “That would be great to know, that it was completely preventable. I guess I might be one of the unlucky ones. I’m like a third-generation coal miner. My grandpa, he contracted black lung. My dad has it now, and now me so I’m probably talking 30, 50, 70 years and, we’re definitely not there now. If it is preventable, we’re not doing a very good job preventing it, if that be the case.

It is completely preventable?

Blackey: “Yes, you’re absolutely correct. It’s a completely preventable disease. It’s totally associated with work and otherwise there would be no black lung if it weren’t for these dangerous exposures in the mines. I think there’s hope here, partially because we know that it’s preventable and we know that we can control it, but I think we’ve even demonstrated as a country once before that we can eradicate this disease, especially the most severe form of this disease. We had it close to eradication in the early 1990s and we need to do everything we can as a country to get back to that point and push it over the finish line and end black lung in the United States.”

Howard Cook, do you have children that want to go into mining?

Cook: “No, I think this being 2015 and ’16 that things is quite a bit different now than they were maybe in the ‘80s. I maybe done a little more talking to my kids than maybe my dad did, or his dad did and kind of steered them into another direction. Neither of them wants to have a career in the mines.”

How do you know if you are protected from black lung?

Blackley: “First of all, if you’re a coal miner and you’re working underground, you’re gonna know what the rules are. You’re trained and we need to empower people to speak up if they see a problem and then to identify it, but also, black lung is a disease that can be detected very early and I would encourage any coal miner working in the United States to participate in the x-ray programs - a free program that operators are required to offer to their employees - and that way you can know your status and you can make informed decisions moving forward.”

Cook: “As a coal miner myself, I’ll be honest, I didn’t know I could be getting periodical checks without raising some kind of red flags, you know or, lack of no better way of putting it, I guess the company looking down on you. It would be a thing that I would probably do if I was still working before I had my 27 years or so in, and even myself, I guess I would have made a decision if I saw some trace of black lung then I would have to ask myself, where do I go from here? If I can’t feel like I can change something underground to help that, do I need to look for other work? And I would say to any young coal miner, you know the rules and regulations, or you wouldn’t be there, and there’s no one that can make you go against that, so stick with the guidelines, the rules and regulations and try to protect yourself all you can.”


  • Howard Cook, former coal miner from Letcher County, Kentucky.
  • David Blackley, epidemiologist at the National Institute of Occupational Health and Safety (NIOSH).

This segment aired on March 2, 2016.


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