1. 1 Public Health Disparities in Appalachian Coal Mining Communities Michael Hendryx, PhD Presentation for the Kentucky Environmental Foundation October 13, 2010

2. 2 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.” “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 2007 Charleston Gazette newspaper article “Every coal mining job generates between 5 and 6 other jobs somewhere in the local economy.” “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 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.” “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. Friends of Coal, West Virginia Coal Association “Coal Facts 2007” report.

3. 3 Downtown Whitesville, WV

4. 4 Lindytown, WV

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

6. 6 Source: West Virginia Coal Association

7. 7 Increase in Surface Mining as % of Total Mining in West Virginia 1982-2008 Source: EIA, DOE

8. 8 Independent Assessment of Coal Economy For every mining job, 2.38 other jobs are created (not 5-8) 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 Coal mining accounts directly and indirectly for 4.4% of Appalachian employment Direct, indirect and induced benefits: $8 billion in 2005 dollars Direct, indirect and induced benefits: $8 billion in 2005 dollars Source: University of Kentucky report, funded by ARC

9. 9 Disparities in Mining Areas Appalachian Coal Mining Other Appalachian Rest of Nation % college education* 11.713.817.1 Median household income * $28,054$32,596$36,753 Unemployment rate* 7.46.25.2 Poverty rate* 19.615.613.1 Area Resource File 2006 adjusted for age, race/ethnicity and sex * Group differences significant at p<.0001

10. 10 Source: Area Resource File 2008 and EIA

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

12. 12 Sources: Area Resource File and WV Geological and Economic Survey

13. 13 Sources: Area Resource File and WV Geological and Economic Survey

14. 14 Sources: Area Resource File and WV Geological and Economic Survey

15. 15 Sources: West Virginia IHPR Survey and WV Geological and Economic Survey

16. 16 Sources: West Virginia IHPR Survey and WV Geological and Economic Survey

17. 17 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.” 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. Bill Raney, president, West Virginia Coal Association, Oct 2007.

18. 18 Hendryx & Ahern, PHR 2009

19. 19 Age-Adjusted Lung Cancer Mortality per 100,000, years 2000-2004 Hendryx, O’Donnell & Horn, Lung Cancer, 2008

20. 20 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 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 CDC mortality data 2000-2004 Adjustments for smoking, age, sex, race, poverty, education, rural-urban setting, insurance rates, physician supply, region Adjustments for smoking, age, sex, race, poverty, education, rural-urban setting, insurance rates, physician supply, region Hendryx, IAOEH, 2009 Hendryx, IAOEH, 2009

21. 2000-2004 Total Heart Disease Mortality per 100,000 21

22. 22 Self-Reported Chronic Illness Survey in 2001 of ~16,500 adult West Virginians, stratified by county Survey in 2001 of ~16,500 adult West Virginians, stratified by county Greater coal mining is associated with higher rates of: Greater coal mining is associated with higher rates of: Cardiopulmonary disease Cardiopulmonary disease Respiratory disease Respiratory disease COPD COPD Hypertension Hypertension Kidney disease Kidney disease Hendryx & Ahern, American Journal of Public Health, 2008 Hendryx & Ahern, American Journal of Public Health, 2008 National 2006 BRFSS data show higher rates of heart attack and coronary heart disease National 2006 BRFSS data show higher rates of heart attack and coronary heart disease Hendryx & Zullig, Preventive Medicine, 2009 Hendryx & Zullig, Preventive Medicine, 2009

23. 23 Health-Related Quality of Life People in Appalachian mining areas report more days of poor health and activity limitations People in Appalachian mining areas report more days of poor health and activity limitations Men and women, young and old 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 Controlling for smoking, alcohol use, BMI, age, gender, race/ethnicity, marital status, income, education, rural/urban setting, doctor supply Zullig & Hendryx, PHR, 2010 Zullig & Hendryx, PHR, 2010

24. 24 Low Birth Weight WV LBW adjusted OR=1.16 in heavy mining areas; adjusted OR=1.14 in moderate WV LBW adjusted OR=1.16 in heavy mining areas; adjusted OR=1.14 in moderate Ahern, Mullett, MacKay, Hamilton, MCHJ 2010 Ahern, Mullett, MacKay, Hamilton, MCHJ 2010 Appalachian coal mining is associated with an additional 7.4 low birth weight babies per 1,000. Appalachian coal mining is associated with an additional 7.4 low birth weight babies per 1,000. Ahern, MacKay, Carpenter & Hendryx, JEH, in press Ahern, MacKay, Carpenter & Hendryx, JEH, in press

25. 25 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) 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. Controlling for mother’s age, race/ethnicity, education, prenatal care, infant sex, smoking, alcohol use, co-morbid diabetes, and rural setting.

26. 26 Academic Performance Students in mining counties of WV are significantly more likely to fail standardized tests Students in mining counties of WV are significantly more likely to fail standardized tests Grades 3,4,5,6,7,8,10 Grades 3,4,5,6,7,8,10 Controlling for low income, county high school education rate, class size, teacher quality, school size Controlling for low income, county high school education rate, class size, teacher quality, school size Approximately 1,600 excess fails per year. Approximately 1,600 excess fails per year. Cain & Hendryx, EJ, 2010 Cain & Hendryx, EJ, 2010

27. MTM-Specific Effects Birth defects Birth defects HRQOL HRQOL Cardiovascular mortality Cardiovascular mortality Total mortality Total mortality Others still to be tested Others still to be tested 27

28. Age-adjusted mortality per 100,000 by MTM status 28

29. 29 Appalachian Coal Mining Effects: Become stronger as mining levels increase Become stronger as mining levels increase Present for women, men, and children Present for women, men, and children Present across many data sources and health outcomes Present across many data sources and health outcomes Become stronger in closer proximity to mining activity Become stronger in closer proximity to mining activity Hendryx, Fedorko, Anesetti-Rothermel, Geospatial Health, 2010 Hendryx, Fedorko, Anesetti-Rothermel, Geospatial Health, 2010 Concentrated in MTM areas (more to be done) Concentrated in MTM areas (more to be done) Zullig & Hendryx, AJPH, in press Zullig & Hendryx, AJPH, in press Ecologic designs; lack of direct exposure assessment Ecologic designs; lack of direct exposure assessment

30. 30 Coal Extraction & Processing Elements and compounds present in coal and coal processing are linked to observed health problems Elements and compounds present in coal and coal processing are linked to observed health problems 59 trace elements in coal listed by WVGES 59 trace elements in coal listed by WVGES Arsenic, mercury, lead, beryllium, antimony, selenium, cadmium, chromium, cobalt, nickel, uranium, etc. Arsenic, mercury, lead, beryllium, antimony, selenium, cadmium, chromium, cobalt, nickel, uranium, etc. Explosives, cleaning and transportation Explosives, cleaning and transportation Benzenes, ammonia, CO, SO2, PAHs, DPM, etc. Benzenes, ammonia, CO, SO2, PAHs, DPM, etc. Exposure to PM and toxins (eg mercury, lead, arsenic, cadmium) increases risk of BD or LBW Exposure to PM and toxins (eg mercury, lead, arsenic, cadmium) increases risk of BD or LBW

31. 31 Explosion over the town of Dorothy

32. 32 Coal Prep Plant by Sylvester

33. 33

34. 34

35. 35 Second Prep Facility Daily average significantly higher than the standard on 33 of 43 days

36. 36 Well water in the town of Rawl, West Virginia Photo: Antrim Casky, 2008 Photo: Nat Geographic, 2006

37. 37 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) 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) 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 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) Ground water in mined areas of Appalachia had higher sulfate, iron, manganese, aluminum, pH, calcium, magnesium, turbidity, and zinc (McAuley & Kozar, USGS report)

38. 38 Stream Integrity, Mining, and Cancer in WV Mining and stream integrity r = -.62 (p<.0001) Mining and stream integrity r = -.62 (p<.0001) Stream integrity and total cancer mortality r = -.47 (p<.001) Stream integrity and total cancer mortality r = -.47 (p<.001) Hitt & Hendryx, EcoHealth 2010 Hitt & Hendryx, EcoHealth 2010

39. 39 Impacts of MTM on Water and Stream Life Streams below valley fills have elevated sulfate, magnesium, selenium and other chemicals Streams below valley fills have elevated sulfate, magnesium, selenium and other chemicals Increases ph, conductivity, dissolved solids Increases ph, conductivity, dissolved solids Biological health of streams is impaired as a result Biological health of streams is impaired as a result Mitigation efforts are not successful Mitigation efforts are not successful MTM/VF should be stopped MTM/VF should be stopped Palmer, Bernhardt, Schlesinger, Eshleman, Foufoula- Georgiou, Hendryx et al., Science, 2010 Palmer, Bernhardt, Schlesinger, Eshleman, Foufoula- Georgiou, Hendryx et al., Science, 2010

40. 40 What is the Value of a Life (statistically speaking)? VSL research 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 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 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 EPA and FDA studies place VSL at $4.67 to $7.74 million, in 2005 dollars Hendryx & Ahern, PHR, 2009 Hendryx & Ahern, PHR, 2009

41. 41

42. 42 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: 3,9754,4328,84010,923

43. 43 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: 3,9754,4328,84010,923

44. 44 The Human Cost of Coal Mining: Discounted Cost estimate in billions compared to: AppalachiaNation Discounted VSL in millions: $3.83$16.979$41.846 $6.35$28.141$69.356

45. 45 What We Don’t Know Yet: The Links Between… Air and water quality (ambient monitoring data) to.. Air and water quality (ambient monitoring data) to.. Contact and exposure (micro environment data) to.. Contact and exposure (micro environment data) to.. Entry into the body (biomarkers of exposure and dose) to.. Entry into the body (biomarkers of exposure and dose) to.. Altered structure and function (genetic expression) to.. Altered structure and function (genetic expression) to.. Adverse outcomes (morbidity/mortality) Adverse outcomes (morbidity/mortality)

46. The Need for Change “We have more than 200 years of coal remaining at current usage rates.” “We have more than 200 years of coal remaining at current usage rates.” Bill Raney, WVCA website, 9-26-10 Bill Raney, WVCA website, 9-26-10 “Bituminous resources remain in [Appalachia] to last for the next one to two decades at current production.” “Bituminous resources remain in [Appalachia] to last for the next one to two decades at current production.” Ruppert, USGS report 2001 Ruppert, USGS report 2001 46

47. 47

48. Eliminate disparities based on poverty and MTM Tax revisions Tax revisions Economic diversification Economic diversification Jobs programs Jobs programs Agriculture, alternative energy, ecotourism, technology, sustainable timber, industry Agriculture, alternative energy, ecotourism, technology, sustainable timber, industry Investments in education: K-12, college, adult Investments in education: K-12, college, adult Environmental protection & remediation Environmental protection & remediation 48

49. 49 “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.” “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”