‘Coal’s Human Cost’ Highlights Black Lung Today

Many people wrongly believe black lung disease is a thing of the past, but veteran underground coal miners in central Appalachia are suffering from black lung disease at the highest rates in nearly 50 years. It’s now as bad as in the 1970s, with thousands of miners sick and dying. 

How did this health crisis happen, and why haven’t miners been protected?  

This is all happening while the Trump administration has been boosting coal mining, with a pledge of nearly $700 million to keep coal-fired power plants running and coal exports flowing.  

Those questions are at the heart of Coal’s Human Cost, an investigative documentary eight years in the making from FRONTLINE, NPR, Public Health Watch and the Appalachia + Mid-South Newsroom.  

News Director Eric Douglas sat down with investigative reporter Howard Berkes to discuss it.  

The transcript below has been lightly edited for clarity.

Douglas: Paint me the picture of where you were eight years ago to where we are today. 

Berkes: What’s astonishing really is that we are today kind of where we were eight years ago, only it’s actually worse. And it’s hard to imagine it being worse. And you’ll see in the film Coal’s Human Cost that some of the people we included in the documentary in 2018 are back in this one. And they express that sentiment that they can’t believe that here we are in 2026 talking about the same things we talked about in 2018.  

But this time there’s been the reporting that was done in 2018 and 2019 and later, the studies that have been done and yet the rate of disease now in central Appalachia for miners still working and who’ve been at it 25 years or more is one in three. And that rate of disease has not been seen since 1978.  

Even miners with less tenure underground, like 15 years to 20 years and 25 years, the rate of disease now, according to this study now from the National Institute for Occupational Safety and Health, takes us back to the 1980s. It’s been that long since there’s been a rate of disease that high.  

When we reported in 2018, it was one in five. And to give you a little bit more perspective, in 1999, it was one in 10. So since 1999, there’s been this essentially sharp increase in the rate of black lung disease in West Virginia, in Kentucky, and in southern Virginia. 

Douglas: The blessing behind this is there aren’t as many miners working underground as there used to be, but we’re not at 60,000 underground miners anymore. But now, it’s 40 and under. I mean, these guys are younger and younger each year. 

Berkes: It’s absolutely true that there are tens of thousands fewer miners mining, right? There are still tens of thousands miners mining. And the reality is that we’re talking statistics, percentages, numbers, right? Well, if you look at the hard facts of how many miners have disease, last year, the federally funded black lung clinics reported close to 2,000 new cases of simple black lung.  

We know from an ongoing survey that I’ve done, and our partners have done, of black lung clinics, that the numbers of cases of progressive massive fibrosis, the most advanced stage of disease, now is over 4,000 since 2010. And what we do in Coal’s Human Cost is we take those numbers and we just bring it down to what the human reality is. And in that film, that’s what we’re looking at. We’re looking at coal miners who are affected by this disease, younger miners, as you mentioned, increasingly younger miners getting this disease and getting the worst stage of disease.  

And that’s what this film focuses on is who is impacted, how it impacts them, and also the regulatory and industry failures to do something about it. 

Douglas: Why is this still a problem?  

Berkes: What’s happened in coal mining in the last several decades is that the big coal seams in Appalachia were mined out. And what’s left are thinner coal seams. And it can be as thin as inches or it may be three feet, four feet, but they’re thinner than the mining machines that are digging them. And so the mining machines are also cutting a lot of rock with that coal. And that rock in Appalachia typically is quartz.  

When you grind up quartz with those mining machines, that produces very fine particles of silica dust that are easily inhaled. And so that’s the big change that’s occurred in mining. And silica dust is 20 times more toxic than coal dust alone. And it has never really been directly regulated. And the exposure limit has been the same since 1970. And the National Institute for Occupational Safety and Health (NIOSH), recommended a much tougher exposure limit starting in 1974. And the Mine Safety and Health Administration (MSHA) picked up on a cluster of silicosis among coal miners in Pennsylvania in 1996 and connected that directly to exposure to silica dust and warned the industry back then and tried to do something back then. That was in the Clinton administration.  

Mining industry opposition kept that from happening. And nothing has happened since until 2024 when the Biden administration finally came up with a regulation that was much tougher on silica dust. 

Douglas: You said regulatory failures. And I’m sure this is politics, I’m sure this is lobbying, but I don’t understand, and I’m sure many of our listeners won’t either, but how do we allow this to continue happening? We’ve always heard that coal safety regulations or mining safety regulations are “written in the blood of coal miners.” Every time there’s a major accident, everybody straightens up and puts new regulations in place.

Why is this still going on? 

Berkes: It’s a combination of the fact that every regulation can cost industry money and could ultimately cost jobs if it’s too onerous. In this particular case, Christopher Williamson, the mine safety chief in the Biden administration, great-grandson of a coal miner who had black lung, as a result, he says of the reporting we did with Coal’s Deadly Dust, put through a tougher regulation on silica dust for the first time. For the first time, direct regulation made the exposure limit twice as tough. The mining industry sued immediately.  

There are two reasons there. One is that Williamson decided to include the non-coal side of the mining world, metal, non-metal side. And there has not been the demonstrated rates of disease among those miners. 

And the regulation included for the first time medical surveillance of those miners and testing of those miners, sampling of dust in those mines by the industry. And so for that side of the industry, it was a whole new set of regulations and they sued.  

But the coal side also sued because while they don’t disagree with the coal dust limit that was set, the tougher limit, they do disagree with the way it’s being regulated or the way the regulation was proposed. They really want more flexibility in what they can do to protect miners. But the bottom line is the industry sued right away and Trump administration came in and agreed with a court ruling that it indefinitely suspended enforcement of the new regulation. And the Trump administration also said it was going to revisit the silica regulation.  

So, yeah, some of it’s politics, you know. There’s a history of resistance to doing something that increases regulation from Republican politicians. And, don’t you have a license plate that says “Friends of Coal” in West Virginia? And you see lawn signs all over the region. That’s an effort to protect coal mining jobs and protect the industry. I get that.  

But I have to say that people who claim to be friends of coal aren’t necessarily friends of coal miners. And that’s because that effort to protect the industry and protect jobs has not included an effort to protect coal miners from the dangers of the job. And that’s where we are. That’s where we continue to be.  

Douglas: What are we going to see in the film? 

Berkes: The film is called Coal’s Human Cost because it focuses on miners who are suffering from this disease, a coal miner who has just been diagnosed at age 44, relatively young, and has a pretty grim future ahead of him. A miner who had a double lung transplant. The surgeons told him that his lungs were so diseased that they couldn’t just be lifted out, they had to be scraped out. I did a little bit of fact checking on that and there was another surgeon who backed that up and said he used a chisel to get lungs out of coal miners who were getting transplants.  

So, we really focus on the sort of human impact, the community impact, as well as the regulatory and industry sort of failures to do anything and the current stalling on doing anything. I know that people in West Virginia and in Appalachia have heard about black lung for a long time. What they don’t often hear about are these impacts on the lives of individuals and their families and their communities. And they are going to see that in this film. 

Douglas: Is there anything that we haven’t talked about that you want to mention? 

Berkes: I think what’s really important for people to focus on in this film is both the human cost of coal and the industry and regulatory failure to do something about it that continues.

And even though there are far, far fewer coal miners out there, there are still thousands of miners working and thousands being diagnosed with disease.

This isn’t a thing of the past. This isn’t your grandpa and great-grandpa’s coal mining world. This is the world as we have it today.

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Watch Coal’s Human Cost at 10 p.m. on Nov. 10, 2026, on WVPB-TV and on FRONTLINE’s YouTube channel, or stream with WVPB Passport. Coal’s Human Cost will also be available on PBS Documentaries on Prime Video.

Coal’s Human Cost is a FRONTLINE production with Five O’Clock Films in association with Forage Media. The writer, producer and director is Molly Born. The producer and correspondent is Howard Berkes. The senior producer is Frank Koughan. The managing editor of FRONTLINE is Andrew Metz. The editor-in-chief and executive producer of FRONTLINE is Raney Aronson-Rath.