Workers Have Always Been Fighting Against Disease

More than fifty years ago, the black lung movement shone a spotlight on the ways that hazardous and exploitative conditions were making coal workers sick. In the age of COVID-19, we’re reminded once again of the need for collective organization to fight against disease where we work.

The exterior of the United Mine Workers of America union hall, Sundial, West Virginia, 1995. (Lyntha Scott Eiler / Library of Congress)

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.

Black Lung and Union-Busting

In the coal camps of southern West Virginia, the black dust of the mines is everywhere. It collects at the sides of the narrow, two-lane roads, coats the green grass of lawns, and settles on children’s toys left in yards. Dust grays the sheets hung out to dry in the sun; it dulls the paint of houses, cars, and fence posts. When coal is cut from the seam where it has laid for eons, dust boils up like a thick soup and overflows onto every nearby surface. Even after a vigorous scrub in the shower, many miners emerge with the startling eyes of heavily made-up women, the mascara of the mines still clinging to their eyelids and lashes.

From the perspective of science and engineering, this dust is the cause of occupational respiratory disease; human interaction in the mines where dust is produced is of little relevance. The isolated physical object — dust — and the isolated biological object — the respiratory system — are the primary focus of scientific research, analysis, and intervention.

And yet, within a deeper meaning of causation, this scientific perspective appears profoundly ideological, even ironically magical, for it robs human beings of their proper powers of action and creation and invests these powers in lifeless things, inanimate objects. Dust does not arise like a ghost in the night from the underground graves of the mines. Dust and disease are produced — no less than coal itself — through the agency of human beings in the workplaces of the coal industry.

Today, the power relations that miners experience on the job are dangerously asymmetrical, and their outcomes grim. The fierce, protracted, largely successful anti-union offensive that certain coal operators began to spearhead in the late 1970s has left most miners without the protection of union representation. In central Appalachia, current epicenter of black lung disease and once a union stronghold, only 7 percent of working miners now belong to the United Mine Workers of America (UMWA).

The respiratory dangers of working in an underground coal mine without union protection are especially evident to miners who have worked both union and nonunion. As Danny Whitt from Mingo County, West Virginia puts it: “Nonunion, they don’t care about dust; it’s how much can you produce.”

The Causes of Disease

The political economy of the collapsing bituminous coal industry is also at stake in the production of black lung disease. With the market for thermal coal, destined for coal-fired utilities, in free fall, some operators have turned to mining the dwindling supply of top-grade metallurgical coal in central Appalachia, which is used primarily in the global steel industry. Employers’ endgame maneuver to extract coal from seams that are often thin and barely accessible requires miners to cut into silica-laden rock that works like ground glass to destroy lung tissue far more quickly than coal dust alone.

Even as they cut corners with dust control and ventilation, employers may also require miners to work double shifts and, in extreme cases, even sleep underground overnight. Paying overtime is cheaper than hiring more workers. Thus, although technical explanations for the resurgence of black lung tend to fault the changing composition of mine dust, many union loyalists point to their loss of power in the workplace. Terry Lilly: “I think the coal miners lost their voice, and I think their voice is in the UMWA.”

At stake in these two contrasting explanations for the steep rise of black lung is a crucial distinction, relevant to COVID-19 and numerous additional public health challenges, between the microscopic agent and the underlying social, economic, and political causes of disease. Once dust is viewed as the definitive cause of black lung, many of the analytical tools and political claims necessary to address the resurgence of disease among miners in central Appalachia are forsaken. Similarly, once the novel coronavirus is defined as the sole cause of COVID-19, it becomes impossible to grapple fully with the disproportionate burden of disease among front-line workers and people of color.

Nor is the problem merely a matter of disproportionate workplace exposure to agents of disease, a common refrain among public health experts, as this implies that such exposures are unavoidable. But there is nothing inevitable about inadequate ventilation, excessive dust inhalation, coercive work rules that require double shifts, or lack of personal protective equipment (PPE).  In a question that resonates across industries, workers, and diverse occupationally related diseases, one West Virginia miner asked: “Should we all die a terrible death to keep those companies going?”

More than fifty years ago, the black lung movement catalyzed attention to the ways that far too many workers become ill and even die from sickeningly asymmetrical power relations and hazardous physical conditions at their jobs. Textile workers fashioned their brown lung movement after coal miners’ example. Asbestos workers pressed for a federal compensation program similar to that covering death and disability from black lung.

Today, members of the Chicago Teachers’ Union threaten to walk out over plans to reopen schools, and thereby avert the potential spread of the novel coronavirus. Health care workers at Cook County (Stroger) Hospital stage a sit-down in their break room to gain access to the PPE that their supervisors control. These and many other workers’ actions exemplify a central lesson of the black lung movement: unrestrained employer authority over the workplace is a fundamental cause of work-related disease, and workers’ collective resistance is their most important strategy for occupational health.