A wall of silence has long concealed work-related disease, injury, and death of workers in the United States. In 1968, the black lung movement began to puncture that wall, as coal miners and their families upended physicians’ control over the definition of disease and gained legislative recognition of black lung. They contested the solely technical explanations of disease causation that blamed dust inhalation, and pointed instead to relations of power in the workplace as the ultimate cause of black lung.

Recognizing that collective power was key to protecting their occupational health and safety, they gained for a time through collective bargaining the right to withdraw from dangerous work environments, and they sought to control the primary means of monitoring respirable coal dust, the sampling program. Lamentably, many coal miners today suffer from the disease they sought to eliminate more than fifty years ago, and their slow suffocation is in part a testament to the brutal consequences of the anti-union, anti-worker offensive that destroyed much of their collective power.

Today, as COVID-19 infections are distributed so unevenly across the US, the struggle against black lung disease offers urgently relevant insight into the social causes of disease as well as the politics of prevention. The two prevailing explanations for the resurgence of black lung feature either technical factors, primarily increased silica content in mine dust, or a liberal politics that faults inadequate government regulation. However, speak with coal miners about conditions in their workplaces and why black lung is ravaging the lungs of younger and younger workers, and you hear a different story.