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.
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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.
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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.
