Black lung cases surge to highest levels since 1978 among US coalminers

8 September 2026facebook iconCoal miners return on a buggy after working a shift underground at the Perkins Branch Coal Mine in Cumberland, Kentucky. [AP Photo/David Goldman]A new study by the National Institute for Occupational Safety and Health (NIOSH) has confirmed what miners, their widows and black lung clinic physicians have warned for years: the deadly and preventable disease has returned to levels not seen in nearly half a century.

Published in the American Journal of Respiratory and Critical Care Medicine, NIOSH researchers found 32.5 percent of sampled veteran underground coal miners in Central Appalachia—those with at least 25 years underground—suffer from the disease. The last time prevalence among miners with the same work history reached such a level was in 1978. In 2018, the rate was 20.6 percent.

The new findings represent more than a fourfold increase since the disease hit a low point of 7 percent in 1999—three decades after the Coal Mine Health and Safety Act of 1969 established federal dust limits and black lung benefits.

The resurgence has been driven by miners’ increasing exposure to respirable crystalline silica. As the thick, easily mined seams of Appalachia were exhausted, operators turned to thinner remaining seams, forcing miners to cut through far more rock rich in quartz. Silica dust can cause especially severe forms of black lung and is roughly 20 times more toxic than coal dust alone.

Tim Balthis, a 57-year-old former miner and mine foreman, described working in silica-laden air to NPR reporters: “It’s like opening your front door and letting the sunshine [in]” with dust particles floating in the light, “and then multiply that by 10 billion times. … It’s like a fog.”

Stone Mountain Health Services in southwestern Virginia alone has diagnosed 2,400 new cases in the past five years. A 2019 NPR/FRONTLINE investigation documented 21,000 instances of silica dust overexposure over 30 years.

An account of the historic struggles of U.S. coal miners, from the mine wars of the early 20th century to the A.T. Massey and Pittston strikes of the 1980s.

Last week, the Black Lung Association of Southeastern Kentucky wrote to Rep. Hal Rogers urging him to co-sponsor the Support Our Miners Act. The Kentucky Republican responded by defending the industry’s record and blaming the crisis in the federal Black Lung Disability Trust Fund on environmental regulation.

“We all agree that the Black Lung Disability Trust Fund needs significant reform to ensure that our coal miners get their hard-earned benefits before this painful disease robs them from seeing a dime,” Rogers’ office told LEX18 News. Rogers boasted of an “$18 million increase” in the fund, then blamed Democrats for “regulat[ing] coal mines out of business” in a “targeted War on Coal,” leaving “only 3,600 coal miners in Kentucky today” and “sticking taxpayers with the bill.”

Rogers’ account leaves out the role of coal operators in shifting black lung liabilities onto the federal fund. The fund, financed primarily by an excise tax on coal, pays benefits when no responsible operator can be identified or when the liable operator does not pay. Bankruptcies of just three self-insured coal companies—Alpha Natural Resources, James River Coal and Patriot Coal—transferred an estimated $865 million in benefit liabilities to the fund. The fund has borrowed from the Treasury almost every year since 1979 to meet its obligations.

NIOSH first recommended an exposure limit of 50 micrograms of respirable crystalline silica per cubic meter of air in 1974 and reiterated the standard for coal miners in 1995. The Obama administration’s dust rule, fully implemented in 2016, lowered the overall respirable coal mine dust limit from 2.0 to 1.5 milligrams per cubic meter but left the silica standard essentially unchanged.

It was not until 2024 that the Biden administration adopted the 50-microgram silica limit NIOSH had recommended half a century earlier. Mining industry groups challenged the rule. Days before coal operators were due to comply in April 2025, the Trump administration’s Mine Safety and Health Administration announced a temporary enforcement pause, and the Eighth Circuit Court of Appeals then stayed the rule’s compliance deadlines. The judicial stay remains in effect, and MSHA is reconsidering portions of the rule.

On February 18, 1969, West Virginia rank-and-file miners launched a 23-day wildcat strike, forcing the state to recognize black lung as a compensable occupational disease and helping drive passage of the federal Coal Mine Health and Safety Act later that year.

The National Mining Association now argues that because black lung takes years to develop, current cases “do not reflect the conditions, practices, protections or regulations that are in place today.” At the same time, the industry has pressed for greater use of administrative controls and personal protective equipment, including respirators, when engineering controls do not keep silica exposure below federal limits.

Federal mine law requires operators to control mine air rather than substitute respirators for environmental controls. Respirators can supplement those measures, but they place part of the burden of protection on individual miners and can impede communication in dangerous, noisy conditions. Ventilation, water sprays and other engineering controls attack the hazard at its source.

The gains miners wrested from the coal operators and the government through mass industrial struggle have been steadily undermined as the UMWA bureaucracy integrated itself with the companies and the state and worked to contain the class struggles that had historically built the union. Beginning under President Richard Trumka, who first took office in 1982, the UMWA abandoned the tradition of industry-wide action in favor of selective strikes, isolating workers at individual companies while production continued elsewhere.

The consequences were demonstrated in the 1984–85 strike against A.T. Massey, which ended with hundreds of miners fired or blacklisted and helped accelerate the spread of nonunion coal in southern West Virginia. At Pittston in 1989–90, rank-and-file miners repeatedly broke through the union’s selective-strike strategy, launching sympathy strikes that spread across the coalfields and at their height involved tens of thousands of miners in 11 states. John McCoy, a 42-year-old UMWA member, was killed on a West Virginia picket line during the struggle.

The same course continued after Trumka left the UMWA. Under Cecil Roberts, the union accepted repeated concessions on wages, benefits, hours and working conditions as union organization collapsed across the coalfields. At Warrior Met in Alabama, miners struck for nearly two years beginning in 2021 to recover concessions the UMWA had accepted after the bankruptcy of Walter Energy. After workers rejected an initial union-backed agreement by 1,006 votes to 45, the UMWA kept the struggle isolated and ultimately ordered miners back to work in 2023 without a contract.

More than 1,700 coal miners died from black lung between 2020 and 2023. Ending a disease caused by preventable exposure requires placing miners’ health and lives above the profitability of the coal industry. That requires workers’ control over the mines as part of the socialist reorganization of production on the basis of social need rather than private profit.