September 14, 2026 - This conversation originally aired in the Aug. 23, 2026, episode of Inside Appalachia.

A new report from the Centers for Disease Control found that black lung rates are the highest they’ve been since the 1970s. 

The disease can be debilitating, even for young miners. Justin Hicks reported for the Appalachia + Mid-South Newsroom on the new CDC report. Longtime investigative reporter Howard Berkes assisted, continuing his years of reporting on black lung, as previously featured on Inside Appalachia.

Following the story’s release, Inside Appalachia Host Mason Adams reached out to dig deeper.  

The transcript below has been lightly edited for clarity.

Adams: What does this black lung epidemic actually look like on the ground at clinics across coal country?

Berkes: It’s horrific. I mean, horrific. These are people who are struggling to breathe every day, who can’t do the simplest things that you and I can do, who can’t play with their grandkids for more than a few minutes, who can’t walk up the driveway to take the garbage cans out, who have trouble sleeping at night, can’t sleep lying down because that compresses their chest too much. They’ve got to sleep standing up. And miners are dying.

Marcy Freeman, who runs some respiratory therapy clinics in Virginia and Kentucky, she has a stack of funeral programs from her clients who have died, hundreds of them. What’s happening is that miners are dying, miners are continuing to be diagnosed with disease, and more miners are going to be diagnosed with disease.

Hicks: I’ll say too, when one thing that Scott Laney, the lead researcher at NIOSH, the National Institute of Occupational Safety and Health, who produced this new research, he said for folks who live in Appalachia, this is no surprise because you see it every single day when you go to the post office, when you go to the grocery store, you see these guys carrying an oxygen tanks. That’s what it looks like.

It looks like men who have done decades of work and who are experts in their field, now carrying around oxygen tanks to survive after they’ve retired, to the point where they can’t really work anymore.

Adams: Y’all have been reporting on this topic for a while. Howard, you’ve been reporting on this for years. I am still haunted by the sound of a miner breathing who had this acute version of black lung. So, what are the options for miners with black lung today? What kind of quality of life are they looking at? And what’s the expense of treating this condition?

Berkes: That miner you’re talking about, Mackie Branham from Kentucky, he had one of those options, a double lung transplant. It’s helped him breathe better, but he’s having a really tough time. The only option for miners with severe disease is a lung transplant. Now, there have only been 135 or so lung transplants for coal miners with black lung disease since 1995.

2024 was the record year so far. There were 19. The chances of getting a lung transplant aren’t that great for these miners. But the ones who do get them, they have a life expectancy with new lungs, the mean rate of life expectancy is a little less than seven years. So, they do get more life for sure, but it can be a very, very rough go.

I met one miner in Virginia who had a double lung transplant, almost died on the operating table. His kidneys failed. He had to have a kidney transplant. He is very happy to be breathing, but it’s been really rough.

And one of the things that happens is these miners are struggling to breathe so hard, like the miner you mentioned who could barely speak a sentence without pausing for breath. That puts strain on the other organs of their body. So some of them become too sick to have a lung transplant, and some of them die from other organ failure before their lungs stop working.

One pulmonologist we spoke to, who’s treated a lot of coal miners with disease, who’s done a lot of research, basically says that they’re facing suffocation while alive. There are no prospects out of this that look anything other than horrific.

Adams: What’s the outlook going forward? Is there reason for hope? Is there a chance this report can spur action at the policy level? 

Berkes: I have to tell you that I’ve been talking to a lot of people in the wake of this report coming out, and they don’t have hope. They’re frustrated, they’re perplexed, they’re apoplectic, because to them what this means is that despite everything that has been done, the attention that our reporting has brought to this, the action of the Mine Safety and Health Administration in 2024 to actually do something about silica exposure — despite all those things, despite much greater awareness of this now, despite the clear connection to silica dust exposure, despite the overexposures that continue to recur, despite all of that, there still is this rate of disease now among these miners in Appalachia that is back to 1978 — the darker days of coal mining. The question I keep getting is, what else can we do? And I don’t know the answer to that question. This is well known. The politicians know it. The regulatory agency knows it. Anybody who has anything to do with coal mining, the industry knows it. The industry’s known about it for decades, by the way. So, it continues to happen, and it continues to happen because there is not enough attention to protecting coal miners.

Hicks: And to zoom out a little bit too, in broader context, right now we see a hotter market than there was in the past, 10 years maybe or so for coal. We see other countries buying more coal from the U.S. We see the Trump administration forcing coal-fired power plants to stay open so that they have to buy coal to feed those, so you have a captive audience, right? So, I think a lot of these advocates too are very well aware that the economic demand right now for coal could make it more lucrative to ignore safety regulations. So, I think there’s a lot of concern about that, too, the economic realities behind the safety.

Berkes: I’ve always said, you go around Appalachia, especially in West Virginia and I think in Kentucky, too, you see signs that say “Friends of Coal.” Friends of Coal are not necessarily friends of coal miners. And that I think is part of the problem here. I understand the economic dependence in some communities on coal mining. You can do it safely. You can do it more safely than it’s being done. You just have to pay attention and you have to be willing to maybe not make as much money as you could to make things safer. That’s really the bottom line.