A Scourge Returns: Black Lung in Appalachia

Carrie Arnold


Environ Health Perspect. 2016;124(1):a13 

In This Article


Once a month, a group of men in t-shirts, jeans, and baseball caps gather around a long table at the New River Health Clinic. The clinic, a small, one-story yellow clapboard building, is located in the tiny town of Scarbro, nestled in the bituminous hills of southern West Virginia. The members of the Fayette County Black Lung Association greet each other by name while they pour bitter black coffee into small Styrofoam cups.

Amidst the chatter and the coffee are the coughs. Some of the men hack loudly, others more quietly. All of them have advanced black lung, a disease they acquired working in the local mines. Although roughly 22% of underground miners smoke,[1] compared with about 18% of U.S. adults in general,[2] none of these men do. They gather not just as a support group but also to help one another complete the stacks of paperwork necessary to apply for government-mandated benefits for black lung and navigate the tortuous appeals process.

Aside from the group's leader, a bespectacled septuagenarian named Joe Massie, all the other members are in their 50s or early 60s. That's relatively young for someone with advanced black lung, and other workers are getting sick even earlier. These miners, who have gotten so sick so fast, are on the forefront of a wave of new black lung cases that are sweeping through Appalachia.

Scientists first noticed a troubling trend in 2005, when national surveillance conducted by the National Institute for Occupational Safety and Health (NIOSH) identified regional clusters of rapidly progressing severe black lung cases, especially in Appalachia.[3] These concerns were confirmed in followup studies using a mobile medical unit providing outreach to coal mining areas,[4,5] with later research showing that West Virginia was hit particularly hard.[6] Between 2000 and 2012, the prevalence of the most severe form of black lung rose to levels not seen since the 1970s,[7] when modern dust laws were enacted.[8]

Scarier still, the new generation of black lung patients have disease that in many cases progresses far more rapidly than in previous generations. Today, advanced black lung can be acquired within as little as 7.5–10 years of beginning work, says Edward Petsonk, a pulmonologist at West Virginia University. But not all cases progress so quickly; thus, occupational health researchers fear that what they are seeing now is only the tip of the iceberg.