The black lung crisis deepens in Appalachia

In 2023, NPR’s Howard Berkes reported that one in five career coal miners in Appalachia had black lung disease. By 2026, that number had jumped to one in three. The rate of the incurable, fatal lung disease among miners who have worked underground for at least 25 years has not been this high since 1978, nearly 50 years ago. Even miners with just 15 to 20 years underground are testing positive at rates not seen in four decades. The resurgence, driven largely by exposure to silica dust from cutting through rock to reach thin coal seams, represents a 65% increase in less than a decade—and the experts who track it say the worst is still ahead.

The disease that was supposed to be history

Black lung disease, or coal workers’ pneumoconiosis, was once considered an old miner’s affliction. After a 1969 wildcat strike by 40,000 West Virginia miners, Congress passed strict limits on coal dust exposure, and the rate of black lung plunged 90% over the next two decades. But that progress has reversed. Berkes, who has investigated the crisis for over a decade, first noticed the shift after the 2010 Upper Big Branch mine explosion in West Virginia, which killed 29 miners. Autopsies revealed an extraordinarily high rate of black lung among the victims—including Gary Wayne Quarrels, who was just 33 years old. His father, also a former miner, told Berkes: “He had black lung. Being in the mi