The Fate of US Coal Miners

Struggling with black lung disease and fighting for safer working conditions

By Joy Victory
March 5, 2024 | WINTER 2024 ISSUE

Every morning, retired West Virginia coal miner Gary Hairston wakes up and does a breathing treatment. At night, he wears a CPAP machine to keep his airway open. Hairston uses supplemental oxygen, mainly in the evenings. His doctor has advised him to use it continuously, but he’s reluctant.

Gary Hairston

Gary Hairston
President, Black Lung Association

Photo courtesy of Postindustrial Media and Chris Jackson Photography

“It would be better on my heart, but I’m worried about it being something I’m totally dependent on,” he said.

Hairston spent nearly 3 decades working in coal mines as an electrician, scoop operator, and repairman. About 2 decades ago, at age 48, Hairston suddenly became short of breath. Not long after, he wound up in the hospital with pneumonia. His diagnosis? Black lung disease.

“I was out for a year, and when I tried to go back, my doctor said if I did, within a couple of years, I’d be on oxygen all the time,” he said.

He quit working and, after a complicated process requiring a lawyer's help, began receiving benefits through the US Department of Labor’s Black Lung Program. “The [coal] company fought it up until the last stage,” he said.

Hairston now serves as the President of the National Black Lung Association, one of several nonprofit organizations trying to help miners who have the disease. As documented in a Pulitzer Prize-winning investigation, their work is an uphill battle that pits mine workers against coal companies, politicians, and even hospital systems.

A devastating disease on the rise

Black lung—caused by frequent and prolonged exposure to rock dust, especially silica—may sound like a disease from the past. In fact, the number of cases decreased for decades thanks to improved worksite conditions, surveillance programs, and a shift toward clean energy. However, research shows that cases are once again on the upswing—an alarming change that comes at a time when improved disability benefits and tougher environmental standards are desperately needed.

“Being disabled at such a young age nearly broke my spirit.”

The reason for the increase? As the large coal seams get tapped out, miners are now busting through thicker rock layers to reach ever-thinner layers of coal. This means far more dust circulating in the air—so much so that the filters in respirators intended to protect miners are quickly clogged with dust.

“One of the turns of phrase I hear a lot is, ‘You can’t see your hand in front of your face,’” said Willie Dodson, the Central Appalachian Field Coordinator for the environmental nonprofit Appalachian Voices.

Also known as coal worker’s pneumoconiosis, black lung affects roughly 16% of coal miners, according to the American Lung Association. The tiny particles of crystalline silica released by mining are easily inhaled deep into the lungs, where they embed in and inflame the alveoli, causing swelling, fibrosis, and scar tissue nodules. In the early stages, the disease may have no symptoms, but it eventually causes shortness of breath, chest tightness, and coughing. As it worsens, black lung can lead to low blood oxygen levels, straining the heart. The disease is linked to an increased risk of early death.

“It’s very common for folks in the coalfields to talk about how awful it was to watch their dad’s or granddad’s breathing get worse and worse until they are just laid up gasping and ultimately suffocate,” Dodson shared.

Silica standards are outdated, advocates say

Despite heightened levels of silica dust exposure from modern mining methods, the silica standard—the permissible exposure limit set by the US Mine Safety and Health Administration—hasn’t changed since 1985. It no longer matches stricter standards followed in other industries. A proposed rule announced on June 30, 2023, would toughen the standard, but advocates note that it’s far from perfect, with unclear language around enforcement mechanisms.

Another big issue: If a miner is diagnosed with black lung, they can apply for compensation and medical care via the Black Lung Program. The problem? The application process is cumbersome and outdated, and attorneys who can help are hard to find, advocates say.

“Less than a third of miners who apply ultimately receive benefits. And many more miners never bother applying because they’ve heard how difficult the process is from friends and colleagues who’ve attempted [to do so],” wrote Quenton King of Appalachian Voices in a blog post on two proposed bills now being considered by Congress.

The federal Relief for Survivors of Miners Act, introduced to the US House of Representatives in December 2023, aims to simplify the application process for miners and widows.

“It’s very common for folks in the coalfields to talk about how awful it was to watch their dad’s or granddad’s breathing get worse and worse.”

A related bill, the Black Lung Benefits Improvement Act, would tie the monthly black lung stipend to inflation and make it harder for coal companies to use bankruptcy as a shield against black lung liabilities. It’s currently under review in the US Senate.

In recent years, there have been some wins. The Inflation Reduction Act in 2022 secured permanent partial funding for the Black Lung Disability Trust Fund via a tax on coal.

Hairston, who spoke at a 2019 House Workforce Protections Subcommittee hearing, is hoping to bring another group of miners to DC this year.

“Being disabled at such a young age nearly broke my spirit,” he testified. But his presence—and that of other fellow miners—on Capitol Hill was crucial. It put a face to the issue and forced policymakers to consider the harsh realities of living with black lung disease.

Hairston’s work reinforces the National Black Lung Coalition’s mission to build a “unified national voice” for patients suffering from mining-related respiratory disorder issues. Because for him, and thousands of coal miners in the US, it doesn’t get more personal than this.

Check out podcast on black lung disease

To learn more about black lung disease, listen to a special episode of the Air Health Our Health podcast. Host, Erika Mosesón, MD, and CHEST Advocates Editor in Chief, Drew Harris, MD, FCCP, take a deep dive into black lung disease and silica dust, highlighting the science and research, prevention efforts and challenges to implementation, and the overall importance of advocacy work.