1 Public Health Disparities in Appalachian Coal Mining Communities Michael Hendryx, PhD Presentation for the Kentucky Environmental Foundation October 13, 2010
Apr 01, 2015
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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
15
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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34
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”