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Black Lung Clinics Program Turns 40

"They’re a really dedicated group to help those miners who are disabled from pneumoconiosis and can’t no longer perform work and they work hard to assist those miners in their treatment of black lung to make the pain a little less, you know?”
– Bethel Brock, retired coal miner

This year is the 40th anniversary of the Black Lung Clinics Program that the Federal Office of Rural Health Policy (FORHP) in the Health Resources and Services Administration (HRSA) administers. The Black Lung Clinics Program (BLCP) provides funding for medical, outreach, educational, and benefits counseling services to active, inactive, and disabled coal miners throughout the country. The purpose of this program is to reduce the morbidity and mortality that is associated with occupationally-related coal mine dust lung disease. BLCP awardees range from public, private, and state entities. BLCP is authorized by Section 427(a) of the Federal Mine Safety and Health Act of 1977 as amended which called for the creation of the Mine Safety and Health Administration, quarterly mine inspections, and limits on coal dust exposure. BLCP officially started at HRSA in 1979 in the Bureau of Community Health Services and included a community health centers program.

Health profession and a retired coal mine worker
In about the last two decades, there has been an uptick
in the prevalence and severity of black lung.

In the 1970s, about one-third of coal miners were affected by Coal Workers’ Pneumoconiosis (CWP), also known as black lung disease, and the rates of CWP fell to their lowest in the 1990s.(Arnold, 20161; Blakley 20162). Additionally, in a report from the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC), the most severe form of black lung disease, Progressive Massive Fibrosis (PMF), has also dramatically increased, especially in certain regional clusters such as in Appalachia.3 Doctors that work in the black lung clinics, such as Dr. Robert Cohen of Northwestern University and University of Illinois at Chicago, have observed this trend first-hand. He reported, “We’re seeing many more severe cases. We’re also seeing cases in younger miners which we hadn’t seen before.”

When miners breathe in the coal dust, particles settle in the bronchi of the lungs which causes mucus formation, cough, and eventually, chronic bronchitis.4 A widespread inflammatory response occurs in reaction to these particles, causing tissue damage and scarring which is known as simple CWP. The disease can progress to PMF, also known as complicated CWP, and the lung tissue becomes blackened and fibrous. The symptoms of black lung disease are chronic cough, increased phlegm production, shortness of breath, and an increased risk of emphysema. Due to the unprecedented rise in PMF trends, BLCP services are needed now more than ever.

There are nearly 60 clinic sites across 15 states, and BLCP awardees served over 13,000 coal miners between July 2016 and June 2017. These clinics are located in areas where miners live so they are able to cultivate trust and develop strong bonds with the coal mining community. This close connection has allowed the clinics to employ creative ways to tailor services to the needs of their local populations. For example, Miners’ Colfax Medical Center in Raton, New Mexico, has telemedicine and mobile screening units, specialized Department of Labor examination clinics, and telementoring programs. These innovative programs allow for reduced travel time for patients, increased participation in the program, and a better understanding of the coal mining community. Many of the services that black lung clinics provide are not reimbursable. Debbie Johnson, the Patient Care Coordinator at Bluestone Health Center in Princeton, West Virginia views the grant as a God-send that allows her to help underinsured and uninsured miners and their families with benefits counseling and medical examinations.

When asked about the personal impact that BLCP has had on his life, Robert Bailey, a retired coal miner who received a bilateral lung transplant said, “Well, it’s not an easy journey once you get the black lung, complicated part. The simple, you can kind of live with and deal with, like almost a normal life, but once it gets complicated, it’s a lot different, you require a lot more medical help and assistance. There’s very few places that you can find that help, and through the clinics, that’s one place that you can find it.”

Despite coal mine regulations, miners are still at great risk for developing health issues including black lung. With the help of BLCP, these coal miners have hope and can look forward to a healthier future.

Arnold, Carrie. “A Scourge Returns: Black Lung in Appalachia.” Environmental Health Perspectives, vol. 124, no. 1, Jan. 2016, doi:10.1289/ehp.124-a13.

Blackley, et al., “Resurgence of Progressive Massive Fibrosis in Coal Miners— Eastern Kentucky, 2016,” CDC Morbidity and Mortality Weekly Report Vol. 65, No. 49, Dec. 2016.

Blackley, D.J., Halldin, C.N., & Laney, A.S. "Continued Increase in Prevalence of Coal Workers' Pneumoconiosis in the United States, 1970–2017" American Journal of Public Health. Published online before print July 19, 2018.

National Institute for Occupational Safety and Health. "Prevalence of Black Lung Continues to Increase among U.S. Coal Miners.

Date Last Reviewed:  February 2019