1 Public Health Disparities in Appalachian Coal Mining Communities Michael Hendryx, PhD Presentation for the Kentucky Environmental Foundation October.

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Public Health Disparities in Appalachian Coal Mining Communities

Michael Hendryx, PhD

Presentation for the

Kentucky Environmental Foundation

October 13, 2010

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Industry Statements “Within a few years, 10,000 replacement miners will be

needed…For every miner, 8 other workers are needed for support jobs. That’s 90,000 good paying jobs with good benefits.”

2007 Charleston Gazette newspaper article

“Every coal mining job generates between 5 and 6 other jobs somewhere in the local economy.”

West Virginia Coal Association website, accessed 08-24-08

“It’s frequently noted that “every coal mining job creates another 5 to 8 jobs somewhere in the economy.” Anyone who has ever visited a coal oriented community in West Virginia would have no hesitation in believing that statistic.”

Friends of Coal, West Virginia Coal Association “Coal Facts 2007” report.

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Downtown Whitesville, WV

4

Lindytown, WV

5Source: Annual Coal Reports, Energy Information Administration (*figures for 1986-1989 imputed)

1986

*

1987

*

1988

*

1989

*19

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

080

20000

40000

60000

80000

100000

120000

140000

Number of Appalachian Coal Miners 1985-2008

Nu

mb

er

6Source: West Virginia Coal Association

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

200000

0

10000

20000

30000

40000

50000

60000

West Virginia Coal Production and Employment 1980 - 2008

Production Employment

Pro

du

ctio

n i

n 1

000

To

ns

Em

plo

ymen

t

7

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

0

10

20

30

40

50

Chart Title

%

Increase in Surface Mining as % of Total Mining in West Virginia 1982-2008

Source: EIA, DOE

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Independent Assessment of Coal Economy

For every mining job, 2.38 other jobs are created (not 5-8)

Coal mining accounts directly and indirectly for 4.4% of Appalachian employment

Direct, indirect and induced benefits: $8 billion in 2005 dollarsSource: University of Kentucky report, funded by ARC

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Disparities in Mining AreasAppalachian Coal Mining

Other Appalachian

Rest of Nation

% college education*

11.7 13.8 17.1

Median household income *

$28,054 $32,596 $36,753

Unemployment rate*

7.4 6.2 5.2

Poverty rate* 19.6 15.6 13.1

Area Resource File 2006 adjusted for age, race/ethnicity and sex

* Group differences significant at p<.0001

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2000 2001 2002 2003 2004 2005 2006 20070

5

10

15

20

25

30

35

40

45

Poverty Rates for Children 0-17 by Mining Activity 2000-2007 for KY, TN, VA, & WV

MTMOther coalNo coal

Year

%

Source: Area Resource File 2008 and EIA

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Median Household Income by County Coal Production

$28,163

$29,883

$32,260No Coal

Up to 4 miltons

> 4 mil tons

Figures on slides 11-16 based on WV coal production in 2001. Sources: Area Resource File and WV Geological and Economic Survey

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Percent in Poverty by County Coal Production

15.5

16.9

20.1

No Coal

Up to 4 miltons

> 4 mil tons

Sources: Area Resource File and WV Geological and Economic Survey

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Percent High School Graduates by County Coal Production

51.2

50.5

46.2

No Coal

Up to 4 miltons

> 4 mil tons

Sources: Area Resource File and WV Geological and Economic Survey

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Percent without Health Insurance by County Coal Production

12.9

13.8

15.6

No Coal

Up to 4 miltons

> 4 mil tons

Sources: Area Resource File and WV Geological and Economic Survey

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Percent who Report Poor or Very Poor Health by County Coal Production

8.46

9.24

11.82

No Coal

Up to 4 miltons

> 4 mil tons

Sources: West Virginia IHPR Survey and WV Geological and Economic Survey

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Percent Who Report No Usual Source of Health Care

15.9

15.2

18.2

No Coal

Up to 4 miltons

> 4 mil tons

Sources: West Virginia IHPR Survey and WV Geological and Economic Survey

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Evidence for Health Disparities…

I have “seen nothing to indicate any greater incidence of disease near coal mines. There’s a lot of allegation without proof.” Bill Raney, president, West Virginia Coal Association, Oct

2007.

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Figure 1. Total Age-Adjusted Mortality per 100,000 for the Years 1979-2005, by County Group

700

800

900

1000

1100

1200

Coal mining counties Other Appalachian counties Rest of Nation

Hendryx & Ahern, PHR 2009

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0

10

20

30

40

50

60

70

80

Coal-Mining Other Appalachia Nation

Age-Adjusted Lung Cancer Mortality per 100,000, years 2000-2004

Hendryx, O’Donnell & Horn, Lung Cancer, 2008

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Cardiopulmonary and kidney disease mortality

Chronic heart, lung, and kidney disease mortality rates are higher in coal mining areas than the rest of Appalachia or the nation CDC mortality data 2000-2004 Adjustments for smoking, age, sex, race,

poverty, education, rural-urban setting, insurance rates, physician supply, region

Hendryx, IAOEH, 2009

2000-2004 Total Heart Disease Mortality per

100,000

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Mining > 4 million Mining up to 4 million Non-mining 0

50

100

150

200

250

300

350

MaleFemale

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Self-Reported Chronic Illness

Survey in 2001 of ~16,500 adult West Virginians, stratified by county

Greater coal mining is associated with higher rates of: Cardiopulmonary disease Respiratory disease COPD Hypertension Kidney disease

Hendryx & Ahern, American Journal of Public Health, 2008 National 2006 BRFSS data show higher rates of heart attack

and coronary heart disease Hendryx & Zullig, Preventive Medicine, 2009

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Health-Related Quality of Life

People in Appalachian mining areas report more days of poor health and activity limitations Men and women, young and old Controlling for smoking, alcohol use,

BMI, age, gender, race/ethnicity, marital status, income, education, rural/urban setting, doctor supply

Zullig & Hendryx, PHR, 2010

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Low Birth Weight WV LBW adjusted OR=1.16 in heavy

mining areas; adjusted OR=1.14 in moderate

Ahern, Mullett, MacKay, Hamilton, MCHJ 2010

Appalachian coal mining is associated with an additional 7.4 low birth weight babies per 1,000.

Ahern, MacKay, Carpenter & Hendryx, JEH, in press

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Birth Defects in MTM zones

Babies born in MTM zones have higher risk of birth defects (OR=1.57, 95% CI 1.46 – 1.69) Controlling for mother’s age,

race/ethnicity, education, prenatal care, infant sex, smoking, alcohol use, co-morbid diabetes, and rural setting.

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Academic Performance

Students in mining counties of WV are significantly more likely to fail standardized tests Grades 3,4,5,6,7,8,10 Controlling for low income, county high

school education rate, class size, teacher quality, school size

Approximately 1,600 excess fails per year.

Cain & Hendryx, EJ, 2010

MTM-Specific Effects

Birth defects HRQOL Cardiovascular mortality Total mortality Others still to be tested

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Age-adjusted mortality per 100,000 by MTM status

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2000 2001 2002 2003 2004 2005 2006700

800

900

1000

1100

MTMOther AppalachianNon-Appalachain

Year

Rate

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Appalachian Coal Mining Effects:

Become stronger as mining levels increase Present for women, men, and children Present across many data sources and

health outcomes Become stronger in closer proximity to

mining activity Hendryx, Fedorko, Anesetti-Rothermel,

Geospatial Health, 2010 Concentrated in MTM areas (more to be

done) Zullig & Hendryx, AJPH, in press

Ecologic designs; lack of direct exposure assessment

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Coal Extraction & Processing

Elements and compounds present in coal and coal processing are linked to observed health problems 59 trace elements in coal listed by

WVGES Arsenic, mercury, lead, beryllium, antimony,

selenium, cadmium, chromium, cobalt, nickel, uranium, etc.

Explosives, cleaning and transportation Benzenes, ammonia, CO, SO2, PAHs, DPM,

etc. Exposure to PM and toxins (eg mercury,

lead, arsenic, cadmium) increases risk of BD or LBW

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Explosion over the town of Dorothy

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Coal Prep Plant by Sylvester

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Daily PM10 Means Near a Coal Processing Facility

0

10

20

30

40

50

60

70

80

1/3/2008 2/22/2008 4/12/2008 6/1/2008 7/21/2008

PM10

Standard

Mean PM10

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Second Prep Facility

Figure 1. Daily PM10 Mean Values in Two Locations

0

50

100

150

200

6/10

/200

8

6/17

/200

8

6/24

/200

8

7/1/

2008

7/8/

2008

7/15

/200

8

7/22

/200

8

7/29

/200

8

8/5/

2008

8/12

/200

8

PM

10 Standard

Mean PM10

Daily average significantly higher than the standard on 33 of 43 days

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Well water in the town of Rawl, West Virginia

Photo: Antrim Casky, 2008 Photo: Nat Geographic, 2006

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Tests of well and ground water

Arsenic in almost ½ of 179 wells in central Appalachia, most at levels known to increase cancer risk (Shiber)

Tests of 15 wells exceeded primary standards for 5 metals: lead, arsenic, barium, beryllium and selenium (Stout) Secondary standards exceeded for iron,

manganese, aluminum, zinc Ground water in mined areas of

Appalachia had higher sulfate, iron, manganese, aluminum, pH, calcium, magnesium, turbidity, and zinc (McAuley & Kozar, USGS report)

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Stream Integrity, Mining, and Cancer in WV

Mining and stream integrity r = -.62 (p<.0001)

Stream integrity and total cancer mortality r = -.47 (p<.001)

Hitt & Hendryx, EcoHealth 2010

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Impacts of MTM on Water and Stream Life

Streams below valley fills have elevated sulfate, magnesium, selenium and other chemicals

Increases ph, conductivity, dissolved solids Biological health of streams is impaired as

a result Mitigation efforts are not successful MTM/VF should be stopped

Palmer, Bernhardt, Schlesinger, Eshleman, Foufoula-Georgiou, Hendryx et al., Science, 2010

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What is the Value of a Life (statistically speaking)?

VSL research If a person will pay $600 to reduce

personal mortality risk by 1/10,000, then 10,000 people, jointly, will pay $6,000,000 to save 1 life

To society, the value of that life is $6,000,000

EPA and FDA studies place VSL at $4.67 to $7.74 million, in 2005 dollars

Hendryx & Ahern, PHR, 2009

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Figure 1. Total Age-Adjusted Mortality per 100,000 for the Years 1979-2005, by County Group

700

800

900

1000

1100

1200

Coal mining counties Other Appalachian counties Rest of Nation

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The Human Cost of Coal Mining

Cost estimate in billions compared to:

VSL in millions:

Appalachia 1979-2005

Appalachia 1999-2005

Nation 1979-2005

Nation 1999-2005

$4.67

$7.74

Excess annual deaths:

3,975 4,432 8,840 10,923

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The Human Cost of Coal Mining

Cost estimate in billions compared to:

VSL in millions:

Appalachia 1979-2005

Appalachia 1999-2005

Nation 1979-2005

Nation 1999-2005

$4.67 $18.563 $20.697 $41.283 $51.010

$7.74 $30.766 $34.304 $68.422 $84.544

Excess annual deaths:

3,975 4,432 8,840 10,923

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The Human Cost of Coal Mining: Discounted

Cost estimate in billions compared to:

Appalachia Nation

Discounted VSL in millions:

$3.83 $16.979 $41.846

$6.35 $28.141 $69.356

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What We Don’t Know Yet: The Links Between…

Air and water quality (ambient monitoring data) to..

Contact and exposure (micro environment data) to..

Entry into the body (biomarkers of exposure and dose) to..

Altered structure and function (genetic expression) to..

Adverse outcomes (morbidity/mortality)

The Need for Change

“We have more than 200 years of coal remaining at current usage rates.” Bill Raney, WVCA website, 9-26-10

“Bituminous resources remain in [Appalachia] to last for the next one to two decades at current production.” Ruppert, USGS report 2001

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Eliminate disparities based on poverty and MTM

Tax revisions Economic diversification

Jobs programs Agriculture, alternative energy, ecotourism,

technology, sustainable timber, industry Investments in education: K-12, college,

adult Environmental protection &

remediation48

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“My tongue, every atom of my blood, form'd from this soil, this air, Born here of parents born here from parents the same, and their parents the same, I, now thirty-seven years old in perfect health begin, Hoping to cease not till death.”

Walt Whitman, “Song of Myself”