David Goldman AP
Divided America American Moments
Coal miner Scott Tiller walks through the morning fog before going underground in a mine less than forty inches high in Welch, West Virginia.
My first encounter with black lung, the miners’ disease, came when I was a small child visiting relatives in the coalfields of southwestern Virginia. It was so long ago I do not remember their faces. But I remember the sound of their labored breathing, which is to say I remember the sound of death.
This is how you die of black lung.
You are born by chance into a world where a mineral is more valuable than your body. From a young age, you learn to equate work with danger but also brotherhood. You will outlive friends among these dangers—faulty electrical writing, flooding, roof collapse—only to return one day from the doctor knowing the mountain you pulverized for coal is now part of you, embedded in your lungs. You thought coal was in your blood, but now it’s in your chest.
More coal miners are dying from black lung than ever before, and many are dying younger.
The disease you have is fatal. Your body, in trying to heal the unhealable, has wrapped the coal dust and silica in your lungs in tissue that will become fibrosis. You will feel like an elephant is sitting on your chest; every organ will work harder to compensate for your body’s lack of oxygen as you slowly suffocate.
There is only one treatment that might significantly prolong your life: a $1.2 million lung transplant. You might feel guilty that your family must bear the cost of your illness and suffer with you. You would have preferred, if your life had to be cut short by work, to die quickly in an accident. You will think of the mines and you will think of your friends and you will say “We killed ourselves” over and over, long before you are dead.
More coal miners are dying from black lung than ever before, and many are dying younger. I’ve read this fact many times over the past two years, in news stories that also generate now-predictable Twitter comments. “I refuse to cry over folks who created their own problems,” reads one. “Miners are a big reason why we have Trump . . . . Too bad they didn’t all pass away sooner and we wouldn’t be in this mess,” reads another.
Trump campaigned heavily on promises to revive the country’s dying coal industry, and Appalachia’s roughly 30,000 miners bore the brunt of the reaction. By mid-December 2016, with Trump’s Inauguration looming, the progressive-aligned political website Daily Kos was telling its readers to “be happy” that coal miners’ federally backed health care and pensions would soon be on the chopping block.
The black lung epidemic represents a dilemma that progressives must confront in order to find the heart and soul of the values that will take them into 2020.
It’s not surprising, then, that news of a black lung epidemic in Appalachia has failed to capture the public’s sympathies. With a country awash in crises, why should progressives champion a group of sick workers attached to a dying industry who linked their own fortunes to Trump’s impossible plans?
But the black lung epidemic represents a dilemma that progressives must confront in order to find the heart and soul of the values that will take them into 2020. Workers are dying because politicians on both sides of the aisle were willing to rank their lives below the promise of industry. People are suffering because they cannot afford medical care. Will we be the country that maintains this system of acceptable casualties, or will we build something better?
In 2016, the National Institute for Occupational Safety and Health (NIOSH) confirmed a resurgence of black lung, a preventable occupational disease, in central Appalachia. Brandon Crum, a radiologist based in the coalfields of eastern Kentucky, had contacted NIOSH in June of that year to report an alarming increase in the number of advanced black lung cases at his practice.
NIOSH monitors the health of working miners through a voluntary program which, from 2011 to 2016, reported only ninety-nine cases of advanced black lung. But between January 2015 and December 2016 alone, Crum’s clinic had identified sixty cases. Equally troubling, the disease appeared to be presenting in younger miners.
While NIOSH worked to confirm the data from Crum’s Kentucky clinic, NPR reporter Howard Berkes launched an independent investigation in collaboration with regional media partners to gather data from eleven additional black lung clinics. By December 2016, NIOSH was reporting evidence of a black lung resurgence that was “unprecedented by any historical standard,” echoing the results from NPR’s investigation, which found 962 cases of advanced black lung across the region in the previous ten years.
Why were cases of black lung rising exponentially at a time when U.S. coal consumption was in decline, and why had NIOSH been underreporting cases of black lung? We now have some idea, due to the persistence of diligent reporters and whistle-blowing physicians like Crum.
Why were cases of black lung rising exponentially at a time when U.S. coal consumption was in decline, and why had NIOSH been underreporting cases of black lung?
The term “coal mining” conjures up images of subterranean tunnels, but modern mining in Appalachia has moved closer to the surface over the last three decades to allow coal operators to access rockier, thinner seams of coal. These seams have a mineral composition that is heavy in silica. Silica is more dangerous than coal dust, but the government’s Mine Safety and Health Administration links most of its safety protocols to coal dust testing alone and does not require air sampling for toxic dust if coal is not present.
Berkes, the reporter, confirmed that the agency has been aware of the dangers posed by these and other loopholes since the late 1980s, but had failed to adopt new rules until the Obama Administration, in part due to pressure from the mining industry and its political allies.
NIOSH offers black lung screening, but the federal program is voluntary and underused. NIOSH tells miners that it keeps their health data confidential, but with the industry shrinking every year, miners have been reluctant to use the program for fear that this might make them targets for early termination. NIOSH does not screen retired or laid-off miners.
When retired or laid-off miners do initiate health screenings, it is often to assess their eligibility for state and federal disability benefits, and clinics like Crum’s, which are located throughout Appalachia, assist miners with this process. The presence of significant black lung clusters, then, is a combination of the consequences of known safety loopholes and wave after wave of job losses that have led to more frequent contact between former miners and health professionals.
That is the nuanced and concise explanation for the current resurgence, but the blunt answer is important, too: Miners are dying because it has always been acceptable to kill them.
In January 2019, NPR and PBS Frontline capped off a two-year investigation into the new black lung epidemic with the documentary Coal’s Deadly Dust. The documentary humanized miners, detaching them from the highly politicized lens of Trump’s coal industry pandering. Producers captured a moving record of the distressing health challenges miners face, interspersed with interviews between Howard Berkes and mine safety officials who served in administrations dating back to Clinton.
The documentary also happened to air just weeks before the fiftieth anniversary of an event not well remembered outside of Appalachia: 1969’s black lung strikes. During this pivotal moment in West Virginia’s history, progressive politicians, a sympathetic public, and, most importantly, dissenting workers willing to pressure the industry from within created conditions favorable to the passage of our modern mine health and safety laws.
Exploring past struggles to secure worker protections should be an occasion to reflect on the nation’s progress. But the need for reform today might actually be greater than it was fifty years ago. The current U.S. President is bent on deregulating the coal industry, even though this has failed to spur coal recovery, and much of the public is hostile to miners for their perceived alliance with Trump. On their own, miners lack the kind of critical mass necessary to bring industry to their will.
And yet, understanding broken promises requires learning the terms under which they were forged.
In 1968, an explosion at a mine in Farmington, West Virginia, killed seventy-eight miners. The accident occurred at a time when the gulf between union leaders and workers was wider than it had ever been.
Tony Boyle, the unpopular president of the United Mine Workers of America (UMWA), who would later be convicted of the murder of his challenger, Joseph Yablonski, downplayed the explosion.
“I share the grief. I’ve lost relatives in a mine explosion,” he said after Farmington. “But as long as we mine coal, there is always this inherent danger of explosion.” Boyle’s apparent indifference to the deaths of miners caused widespread dissent among the rank-and-file, including the widows and children of dead workers.
The Farmington disaster received substantial media coverage. Just months earlier, a mine flooding in Hominy Falls, West Virginia, had required a five-day rescue operation. Hoping for a similar dramatic outcome, the national press dispatched reporters to Farmington. Miners and community members, including local physicians, seized the opportunity to air their grievances about inadequate mine safety and the apathy of the union on a national stage.
This level of scrutiny and the resulting outcry helped prompt federal and state hearings about the disaster and the broader issues of mine safety. For West Virginia miners, it was of utmost importance that any discussion of reform include laws mandating compensation for sick and injured miners, particularly those with black lung.
In January 1969, a contingent of West Virginia miners formed the first chapter of the Black Lung Association (BLA) to mobilize support for new compensation laws. By the end of the month, thousands of miners were attending BLA meetings, and the organization could count a number of progressive physicians and lawmakers among its supporters.
When the BLA called upon the union for support, Boyle refused and threatened to expel participating members. In February 1969, several hundred miners in Raleigh County, West Virginia, went on strike to protest a management decision. Their walkout quickly spread as miners statewide seized the opportunity to escalate the strike as a means to pressure coal operators, their union, and lawmakers to support mine safety and compensation reform.
By the end of February, more than 40,000 miners in West Virginia were engaged in a “no law, no coal” strike. Strike assistance from disabled miners, widows, and children was organized by the West Virginia-based dissident group Miners for Democracy.
The strike was long, but ultimately successful. West Virginia passed a compensation bill in early March, and in December 1969 President Nixon signed the Federal Coal Mine Health and Safety Act into law. The act set stricter limits on acceptable levels of coal dust and established a federally backed compensation program for sick and injured miners. Congress strengthened provisions relating to black lung in 1972 in a separate act of law, the Black Lung Benefits Act.
During the last fifty years, the Mine Safety and Health Administration estimates that 76,000 miners have died from black lung. The hard-won 1969 and 1972 laws were meant to provide clarity about the coal industry’s financial obligations to disabled miners and prevent the coal industry from passing on its obligations to taxpayers.
But successive administrations, both Democratic and Republican, have allowed the coal industry more and more leeway to do exactly that. The federal government has paid out $45 billion in black lung compensation since 1968, and the fund that pays claims on behalf of the coal industry is currently $4.3 billion in debt.
In order to fund black lung benefits, Congress established the Black Lung Disability Benefit Trust and created a provision to fund it through an excise tax charged to the coal industry. Disabled miners or the dependents of deceased miners, currently about 25,000 claimants, draw from the fund for payments that range from $660.10 a month for a single person to $1,320.10 for a family. And although they’re given little assistance, those claimants are fortunate.
Earl Dotter
A West Virginia miner undergoing lung-capacity testing at a clinic in Chicago.
The process of attaining benefits remains filled with bureaucratic hurdles and allows employers to challenge claims. Environmental reporter David Hasemyer found that coal industry employers resist 70 percent of benefit claims, meaning that between adversarial challenges and strict disability criteria, fewer than one in ten applications for black lung benefits are approved.
A resurgence in black lung is unlikely to marshal resources to improve the benefits process for claimants. On a federal level, Congress authorized additional funding in 2018 to study the epidemic, but Kentucky recently passed a law intended to make it more difficult to file a claim.
As a result, radiologists in Kentucky are no longer allowed to diagnose black lung for the purposes of a benefit claim, meaning that physicians like Crum, who brought the epidemic to the attention of NIOSH, must defer to certified pulmonologists. As of last year, there were only six physicians in the state that can diagnose black lung and at least four of those have a history of helping the coal industry with claim appeals.
There are only six physicians in the state that can diagnose black lung and at least four of those have a history of helping the coal industry with claim appeals.
Moreover, those approved for benefits must endure the yearly ritual each December to see if Congress will reauthorize the tax provision that funds their benefits. In 2018, with a Republican majority, Congress let the provision die. The government can still collect taxes for sick miners, but the coal industry is now paying taxes set at a rate that dates from when the trust was created in the 1970s.
In 2017, the Trump Administration provided another gift to the coal industry executives when it appointed David Zatezalo, a former coal executive, to lead the Mine Safety and Health Administration. Zatezalo was twice cited by the agency for serious safety violations. In short order, he announced plans to review new dust standards, a move that likely signals the agency intends to reverse the stricter Obama-era rules regarding acceptable dust limits at mining sites.
When these rules went into effect in 2014, four years after they were proposed and arguably forty years after they were needed, Obama’s Secretary of Labor Tom Perez declared, “Today we advance a very basic principle: You shouldn’t have to sacrifice your life for your livelihood.” I prefer the Ken Hechler version of this sentiment. Hechler was a West Virginia lawmaker who supported the 1969 black lung strike and pledged to his constituents, “No longer are we going to live and work and die like animals.”
One senses that, as 2020 approaches, every concern must now be wrapped in a politically expedient narrative. This does not bode well for Appalachia, where both conservatives and progressives often see a place where people take much more than they contribute. But the gift of Appalachia—and the story of black lung and the worker uprisings that sought justice for the coal industry’s victims—is the lesson that narratives don’t have to be expedient, only true.