Mechanization and Black Lung in Appalachia

“Black lung” is an umbrella term for lung diseases that afflict coal miners. Its very use is a testament to the importance of workers’ experience in shaping medical knowledge. But the link between coal mining and too often deadly respiratory disease has been known, if obscured, by coal companies and their doctors, since the early-to-mid-nineteenth century. Like many occupational diseases, the struggle for recognition of the disease encountered many obstacles: the tendency of doctors to consider pathologies individually rather than collectively, the structures of medical practice that meant doctors often worked for the companies invested in the link between work and disease not being known, and the professionalization of expertise that discounted workers’ experiences.

Miners never volunteered to die for their work, whether in a roof collapse, methane explosion, or slowly, struggling to draw a breath more and more each day. Smith documents the longer history of worker activism to address the dust problem in the mines. But the problem was exacerbated in the immediate aftermath of World War II, the result of three separate but related trends.

First, underground mining became mechanized, and the huge machines produced much more dust than older methods of mining. That mechanization, which also put nearly two-thirds of the nation’s miners out of work, was supported by the United Mine Workers of America, who had agreed to go along with mechanization in return for the establishment of a UMW Welfare and Retirement Fund, which was paid into by the operators and, in practice, administered under strong union influence.

The Welfare and Retirement Fund was an incredible achievement, a social contract for the coalfields that journalists referred to as UMW president John L. Lewis’s dream of a welfare state. But as the political economy of coal was reshaped by changing markets in the postwar period, the incredible achievement looked to some miners more like a Faustian bargain.

For the next fifteen years, coal mining employment dropped precipitously, and around two-thirds of the nation’s miners lost their jobs. Job losses were even more acute in the anthracite regions of eastern Pennsylvania. UMW leadership — first under Lewis and then his successors Thomas Kennedy and Tony Boyle — accepted the idea that coal had to be economically competitive to survive and pursued greater collaboration with industry leaders than would have been imaginable before WWII. Miners found themselves in a position where the institution that was supposed to protect them was instead browbeating them back into workplaces that had always been dangerous, but had also rapidly become dangerous in new ways.

The miners that survived this first wave of mechanization were terribly afflicted by black lung, helping to precipitate a new wave of organizing efforts. At the same time, Tony Boyle’s corruption and cooperation with the operators further drove rank-and-file organizing, though it struggled to spread across the coalfields under Boyle’s autocratic rule.

But coal miners weren’t just workers. They were part of families, communities, and a region. The War on Poverty, welfare, and women’s activism would play a huge role in shaping the black lung movement. Coal dust accumulated in miners’ lungs, turned them black, and stole their breath. But the costs accumulated much more widely, especially among miners’ wives and widows who often were left struggling to support their families. Especially before the passage of Title VII of the Civil Rights Act, which barred sex discrimination in employment, women who worked in the coalfields tended to work in extremely low-wage jobs: waiting tables for $35 a week, doing textile piecework out of their homes. The UMW’s pension helped, but was not nearly enough to raise a family.

The War on Poverty, meanwhile, targeted Appalachia, especially after the passage of the Appalachian Regional Development Act in 1965. Many Appalachians felt there was a large gap between what was promised and delivered, and although it was shaped by recent discourse pathologizing Appalachian poverty and failed to address structural problems, the impacts of two groups — the Appalachian Volunteers (AV) and Volunteers in Service to America (VISTA) — helped to coalesce regional organizing efforts and connect issues that might otherwise have been kept disparate.

By the end of the 1960s, things escalated, and the political situation in the coalfields grew increasingly volatile. In November 1968, the worst mine disaster since the early 1950s killed seventy-eight miners in Farmington, West Virginia. The arrival of national reporters and renewed political attention to the coalfields helped black lung and mine safety activists raise the profile of their struggles and build wider support for new federal and state regulations.

The apex of the movement came just three months after the Farmington disaster, when the West Virginia coalfields were completely shut down, and miners marched on the state capital in Charleston. The strike lasted for three weeks, and it put disabled miners like Carl Michelbacher before Congress to tell their stories. By the end of the year, President Richard Nixon would sign the Federal Coal Mine Health and Safety Act, which contained a provision for a black lung benefits program.

But as Smith shows, despite the remarkable accomplishments of the movement, the strategy it pursued presented problems for eliminating black lung, or even for ensuring that miners entitled to compensation received it. By acceding to the workers’ compensation model, she writes, “they began a relationship with the established processes of reform that gradually and subtly redefined the target of their anger, the goal of their activism, and the political meaning of their discontent.”

In other words, using the workers’ compensation system took the focus off the operators, the day-to-day experiences of work, and the situation of disease as a political-economic relation. Narrowly defining the disease — though thanks to miners’ activism, it was broader than it might have been — meant that the social meaning of disease was lost to individual diagnoses. And most miners were never compensated even when they were disabled. If we are to reclaim the power of workplace medicine for our contemporary era, we will have to reclaim occupational health not as addressing individual illnesses but social maladies.

In assessing the limits of the black lung movement this way, Smith perhaps underplays the importance of state compensation. Taking a broader view of the black lung benefits program as part of the political side of the political economy of coal, we would see that the federal program played an important part in reshaping energy governance. When the program finally came before the Supreme Court, Thurgood Marshall would note the importance of the program for balancing the burdens and benefits of economic life in a high-energy society. The federal government in these years looked to coal-fired electricity as its lifeblood, and miners understood these political relationships as a central component of their workplace power in a time when coal was synonymous with electricity production.

From my perspective, however, this political component only underscores her central point more: that building workplace power and pursuing policy — even from the grass roots — can present serious challenges with how to navigate the different processes, the different axes of power, the different organizations and political communities that are party to each.

The Power of Workplace Organizing

Because Smith’s approach to understanding the disease centers on the political economy of the coal industry and the social politics of the coalfields, the updated edition of Digging Our Own Graves could not be timelier. The shadows of 1969 are long, stretching in many directions.

Perhaps the most directly pressing is that history is “going in the wrong direction.” Not only are miners still dying from black lung, but they are dying of it faster and younger. Advanced black lung disease which used to take thirty-five years underground to acquire is now being seen in miners with just ten to fifteen years on the job.

Black lung compensation is needed, yes, and also investments in black lung clinics and rural hospitals. As Smith argues, for these goals to be achieved — and to stop more miners from getting black lung — we also need urgent and immediate support for workplace organizing and for the new black lung chapters which have emerged in recent years. If black lung is caused by the workplace’s asymmetry of power between miners and operators, then increasing miners’ power on the job must be a central component of the strategy to halt its spread. Here, Smith’s updates prove incredibly useful as she includes new interviews and an evaluation of current black lung organizing efforts.

And if we step back further, the larger political implications of this strategy also become clear. Fossil fuel extraction has only proceeded and been kept profitable precisely because miners’ lives, their families, and their communities have been structurally devalued to keep coal cheap. While climate discourse often discusses carbon-intensive energy systems as mortgaging the future, we also need to acknowledge that coal communities have already been paying the costs for a long time. The costs can be measured in hundreds of thousands of shortened lives in the United States alone.

Miners’ struggle against black lung is a climate justice issue. A just transition program can’t only be about jobs or industrial transition. It must also put at its center repairing the harms that the coal-fired economy wrought and address the problems of extractivism that goes beyond coal.

This book also intervenes in a long and ongoing debate about the place of Appalachia in national politics. Mainstream discourse around the region — like Hillbilly Elegy, or the beyond-parody preelection pilgrimage by journalists to West Virginia diners — have contorted the political complexities of “coal country,” instead feeding long-standing stereotypes of Appalachia as conservative and backward, even pathological. But Smith’s book stands as part of an equally long series of corrective narratives, including Appalachian Reckoning and What You Are Getting Wrong About Appalachia. By putting everyday people — coal miners, their wives and widows, disability and welfare activists — she highlights an important thread in a rich organizing tradition that had impacts far beyond the region and well beyond the 1968–1972 period of rebellion.

The organizing by black lung activists had a much wider impact on organizing efforts for occupational health and on Appalachian labor organizing. The Black Lung Association inspired the Brown Lung Association in Southern textiles mills, even though the efforts of the latter were less successful, in part because of lower union density and a regional decline in the industry that occurred at the same time as the textile industry shifted into the Global South. And of course, forty-nine years after the 1969 Black Lung Strike began, almost to the day, more than twenty thousand West Virginia teachers descended on the state capital in Charleston, the first wildcat strike in what would become the red state teachers’ rebellion which spread across the country, all the way to places like Oklahoma, Arizona, and North Carolina.

Beyond the politics of just transition and occupational health, Digging Our Own Graves’ assertion of disease not as mere medical fact but rather as socially produced also helps to clarify the politics of the pandemic and highlights, as other labor activists have over the last eight months, the importance of workplace organizing in slowing the spread of COVID-19, despite its different pathology and forms of transmission from the diseases we call black lung. Smith’s account shows that while medical and regulatory infrastructure — like testing and access to personal protective equipment (PPE) — are critical, they cannot be fully understood outside of the relationships of workplace power. This book offers us a long view on the power of organizing around workplace health and safety that can help frontline workers — from teachers to grocery and sanitation workers — strategize now, but also develop long-term strategies for workplace organizing around the impacts of the less-understood, long-term impacts of COVID-19, which are going to force us to bring disability politics more centrally into workplace organizing.