ENVIRONMENTAL HEALTH AND SCIENCE
The Public Health Conundrum of Coal Mining
Gregory R. Wagner
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
ORCID ID: 0000-0003-4165-7079 (G.R.W.).
At first glance, the public health
challenges of coal mining and their
resolution seem straightforward. Coal
miners are killed, injured, and sickened
by their work. Coal-burning power plants
emit hazardous pollutants that threaten
the health of the public and the planet.
Eliminating coal-fired power plants—
“radical decarbonization” of electricity
production—seems to be a reasonable
solution. The problem description is right,
as far as it goes.
Coal mining has played an enormous—
almost mythic—role in occupational safety
and health in the United States. By the
1960s, recognition of disease risks and
safety hazards had grown. An activist
miners’ union, black lung advocacy groups,
and surrounding social unrest all
contributed to mounting concern regarding
conditions in the mines. The 1968
Farmington Mine explosion that killed 78
miners was experienced nationally through
real-time TV reporting, bringing the
hazards of mining into the living rooms of
people throughout the country. In response,
Congress passed, and President Nixon
signed, the first modern piece of federal
health and safety legislation, the Coal Mine
Safety and Health Act of 1969. The Act
provided unprecedented federal protections
for coal miners. It placed responsibility
squarely on mine operators to operate
mines free from recognized hazards;
mandated frequent, comprehensive safety
inspections of all mines; gave miners the
right to request immediate inspections of
hazardous conditions and expect a rapid
response; established strong protections
against reprisals; and set a legally enforced
(Received in original form September 14, 2017; accepted in final form October 11, 2017 )
Correspondence and requests for reprints should be addressed to Gregory R. Wagner, M.D., Harvard University T.H. Chan School of Public Health–
Environmental Health, 655 Huntington Avenue, 1-1405, Boston, MA 02115. E-mail: gwagner@hsph.harvard.edu.
Ann Am Thorac Soc Vol 15, No 1, pp 11–13, Jan 2018
Copyright © 2018 by the American Thoracic Society
DOI: 10.1513/AnnalsATS.201709-725OI
Internet address: www.atsjournals.org
Environmental Health and Science
limit to coal mine dust exposure that
was expected to eliminate the threat of
serious lung disease. The Coal Act also
mandated ongoing health surveillance for
underground coal miners and research to
assure that newly identified threats would
be addressed.
The Coal Act and the other mining
safety and health laws and regulations
that followed have conferred tremendous
benefit. Fatality and injury rates from
mining have declined to the point where
mining is no longer the most hazardous
occupation in the United States. The
incidence of coal workers’ pneumoconiosis
(CWP) also declined. However, the
improvements were not continuous: the
mandated X-ray surveillance program
detected a bottoming out and then a rise
in CWP among participants in the late
1990s (1). Troublingly, subsequent
investigations have documented a rise in
the deadliest form of CWP—progressive
massive fibrosis—and also the more
recently described rapidly progressive
pneumoconiosis (2–4) (Figure 1).
The extraction, transportation, and
burning of coal also results in substantial
harm to the environment and public
health—costs that do not show up in the
price of electricity from coal-fired power
plants (5). Surface mining, particularly
utilizing mountaintop removal mining
methods common in central Appalachia,
results in water contamination,
deforestation, increased flooding, loss
of biodiversity, and release of methane,
a powerful greenhouse gas (6). Coal
transportation by truck and rail
stress critical infrastructure and add
particulates and other pollutants to the
atmosphere. Coal-burning power plants
are a primary source of deadly particulate
air pollution and of the greenhouse gas,
CO2 (7).
Residents of the Appalachian
communities or counties with coal
mining, particularly mountaintop removal
mining, report poorer health status for
both men and women when compared
with residents of nonmining counties
after adjustment for smoking rates, age,
income, and obesity (8). Coal-mining
communities have fragile economies,
essentially monopsonies where the local
mine is the only provider of jobs. The
counties with coal mining—generally rural
and often with high poverty rates—are
among those found to have increasing
death rates in recent analyses (9).
Clearly, coal mining remains
hazardous, deadly, and destructive, but it
also provides highly desirable jobs.
For many, mining coal is great work.
Miners talk about their work with passion.
They have a purpose: keeping the nation’s
lights on and manufacturing humming.
They have a tremendous sense of
responsibility for themselves and others.
They work in small teams and form deep
bonds with their work crews, akin to those
many had in the military. And they are well
paid—particularly considering that many
have limited educational attainment in
poorly funded school systems. Miners are
respected at home, in their communities,
and in the national political arena.
Although many miners value their work in
its own right, they also recognize the grim
alternatives available for them if the mines
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 ENVIRONMENTAL HEALTH AND SCIENCE

3.5 natural displacement of coal by other

fuel sources, the wait will be long and the
Progressive Massive Fibrosis 5-Year Moving Average

environmental consequences will mount.

3.0 Most advocates in the environmental/public
health communities believe that passive
waiting will take too long, and that
2.5
active public policy engagement is
needed for a more rapid transition away
2.0 from coal.
Any push toward “decarbonization,”
radical or not, will result in dislocation and
1.5 increasing despair in rural communities
dependent on coal mining. Some might
argue that, in the long run, economic
1.0 changes inevitably result in winners and
losers. People in the textile industries or
0.5
shoe manufacturing lost their jobs to
overseas competition and had little
recourse. However, a case can be made that,
0.0 if the loss of mining jobs results from
active, publicly supported efforts to
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Year public responsibility to provide substantive
and continuing supports for former
Figure 1. Prevalence (%) of progressive massive fibrosis among working underground coal miners miners, their families, and their
with 25 or more years of underground mining tenure (1974–2012) in Kentucky, Virginia, and West communities. This case is strengthened
Virginia, according to the Coal Workers’ Health Surveillance Program. Data are 5-year moving when the full cost of coal mining,
averages. Reprinted from Reference 2 with permission of the American Thoracic Society. The
transportation, and consumption is taken
American Journal of Respiratory and Critical Care Medicine is an official journal of the American
into account.
Thoracic Society.
A diverse suite of locally relevant
supports need to be fashioned in
shut down: long commutes, if they are source—natural gas—are, however, likely conjunction with the affected communities.
fortunate enough to find work elsewhere; to result in ongoing demand for coal for The panacea of “job retraining” is a hollow
extended unemployment; low-wage work, if years to come. In addition, international promise when there are no jobs after
any is available; or dislocation to find work economic and political forces are resulting training is finished. Basic income supports
away from their communities and in the expansion of coal-burning power might be acceptable for some, but culturally
sometimes their families. Rural poverty, plants and projected increases in coal dissonant for others. Improvements to the
dislocation, and despair create their own consumption in countries outside the educational system and physical
personal and public health crises. Organization for Economic Co-operation infrastructure can help sustain any
Unemployment is a constant threat: with and Development (OECD) (10, 11). transitional improvements.
mechanization and modern mining U.S. politicians are discussing reducing The pulmonary public health
practices, coal mining employment has restrictions on mining coal on public lands community that cares about miners’ health
fallen from a peak of over 850,000 in 1923 with an eye toward the expanding export and the health of the planet has an
to fewer than 70,000 today. market. opportunity—and an obligation—to take
To some extent, market forces and Perhaps inevitably, market forces and the lead in advocacy for a rapid and
technological change have reduced both the growing public and political concern about compassionate transition to a sustainable
number of jobs and the proportion of power the consequences of climate change will energy future. n
generation from coal, at least temporarily. eventually result in progressive substitution
The continuing demand for electricity and of less-hazardous methods of power Author disclosures are available with the text
the rise in cost of the primary competing fuel production. However, if we wait for the of this article at www.atsjournals.org.

References
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