I’m working on this post in the depth of a winter snow storm in which we lost power, and I had to spend the night at the hospital because the roads were too dangerous to effectively take ICU call from home. I have never been more grateful for the electrical power to my home, keeping my family warm and safe. We definitely missed it when it went out!
It is sobering to consider that the power generation we all need to keep us warm in the winter often comes at the cost of the health of many of the more vulnerable people in our communities. People living next to power plants often bear the brunt of pollution, for example. Nowhere is the cost of a country’s energy production more visible than in the true cost of coal- the lives and livelihoods of coal miners.
As you can see, there has been an increase in progressive massive fibrosis (PMF) both as there has been a slight increase in coal miners, but also the actual rate of PMF is increasing because coal mining is actually getting more dangerous as silica levels increase. I think many of us imagine that working in coal mining must be safer than the old TV shows and movies that depict cave-ins, trapped miners, and people blackened by coal dust. Sadly, this is still a lethal industry. There is a black lung crisis in Central Appalachia with an increase in the risk of the most deadly form of black lung disease- progressive massive fibrosis.
My guest on the podcast accompanying this post is Dr. Drew Harris, MD, FCCP is a lung doctor who specializes in lung disease related to coal mine dust and is passionate about healthcare for rural and disadvantaged populations. He serves as the medical director of the Black Lung Program at Stone Mountain Health Services in southwest Virginia. They published a series of 1177 coal miners with progressive massive fibrosis, all new cases in the last 5 years. Of those cases, 1008 people (86%) came from central Appalachia- Kentucky, Virginia and W Virginia.
He cares for people with coal worker’s lung disease, including that most dreaded complication of progressive massive fibrosis. In our conversation, I was surprised and heartened to hear he thinks it is 100% preventable, which makes the existence of this disease a complete tragedy. He reviews what concrete steps can be taken to protect miners and their communities.
OHSA sets silica dust exposure at 50mcg/m3 and MSHA for miners sets the limit at 100mcg/m3, which sets a dramatic imbalance in health risk. Furthermore, mining companies are allowed to say that miners can use respirators for protection when dust levels are toxic. However, as someone who worked in a PAPR for prolonged periods during the COVID pandemic, that is not a feasible strategy in a hot, cramped mine for prolonged periods.
Furthermore, mine inspections are infrequent and often different rules are followed during an inspection than in the course of regular work. When people are diagnosed with devastating black lung disease, they may, after much fighting, be eligible for a small monthly stipend that is far less than their mining work paid.
There is also concern about “fugitive dust.” Coal dust is carried far and wide from the mine, whether blown off coal trucks or carried by the winds. We have only barely begun to study this. Above, you can see photos that Dr. Harris shared from an individual who showed him the coal dust coating his home, which he has to power wash regularly. He also can swab his HVAC system, and show dense soot. He needs to change filters frequently. He runs multiple HEPA filters, and washes them with completely black water resulting. I’m sure this man is doing all he can to reduce his exposure, but what about kids playing in the neighborhood? What about people who can’t afford to power wash their homes, run HEPA filters, and for whom their home does not include an HVAC system?
Dr. Harris teaches resident seminars on physician advocacy, rural health and a practical approach to the social drivers of health. He is also now the editor in chief of Chest Advocates, a new quarterly journal from the American College of Chest Physicians. In his podcast episode for this post, we discuss his own journey to advocacy, including the importance of Tikkun Olam, or healing the world. We discuss what makes an effective advocate and discuss ways in which everyone can get involved in cleaning up the air we all breathe. This is especially important for those who labor in mines! Everyone deserves clean air and a stable work environment.
To Do:
1- Contact your members of Congress to tell them that you are worried about the health of people who produce our energy. Insist on occupational safety standard improvement for coal workers and other miners.
2- From coal workers lung disease to pollution of local communities to climate change, energy derived from coal is unhealthy. See what you can do in your own community to transition off of fossil fuels to cleaner energy sources.
3- Learn more about this issue from the Appalachian Voice at appvoices.org.
4- If you work in healthcare or have someone in your life affected by lung disease, look into Chest Advocates to learn more about how to advocate in your own community.
5- If you want a framework for how to start advocating, check out the “Clean Air and Climate Advocacy for Busy People” episode from earlier in the season.
6 – Consider a donation to the Appalachian Citizens Law Center at aclc.org who provides free legal representation to coal miners.
References:
Harris, Drew. “Deep Inside Mountains, Work is Getting Much More Dangerous.” Aug 2 2023
Tikkun Olam History– Brandeis University
