For coal miners, coal worker’s pneumoconiosis (CWP) or black lung disease is a devastating consequence of devoting years of work in coal mines.
Black lung is a disabling occupational lung disease that is caused by long-term exposure to excessive levels of coal mine dust. A cure is yet to be discovered, but it can be prevented.
In the United States, 76,000 deaths have been recorded since 1968, and $45 billion spent on federal compensation. In 2014, the landmark respirable dust rule went into effect, providing increased protections for coal miners and closing loopholes that masked their exposure to unhealthy coal mine dust. The rule is the centrepiece of the government’s initiative to put an end to this debilitating disease.
Other countries have reported higher incidences of the disease. A Wall Street Journal report highlighted the surge in black lung cases in China with diagnoses rising to about 750,000 from 2005 to 2013 at an average pace of 35% annually.
Black Lung in Australia
A survey for the Queensland Coal Board in 1984 identified 75 cases of pneumoconiosis during that time. Black lung was thought to have been eradicated in Australia until Percy Verrall, a retired coal miner was diagnosed with the disease in November 2015. The 72-year-old man was a miner in Queensland’s Ipswich coalfields.
Since then, four more cases have been confirmed, and CFMEU Queensland district president Steve Smyth is worried there will be more.
“Right now we don’t know how far this disease has spread and continuing to work in conditions that cause black lung will put more people’s lives at risk,” he said.
Coal miners are worried that hundreds of them may already have the disease. In December 2015, coal miners walked off the job to express their concern about the resurgence of black lung.
“I’m shit scared,” CFMEU Industry Safety & Health Representative Stephen Woods told ABC. “Shit scared that we are going to have a major epidemic, another James Hardie, but in my industry.”
Areas of concerns
Since 1947, x-rays and lung tests have been used to detect black lung. However, modern mining techniques and industry boom have exposed more coal miners to harmful dust.
Last year, the Queensland Commissioner for Mine Safety and Health released a report revealing that sixty per cent of mine workers were exposed to dust levels “equal to or greater than the adjusted regulatory exposure limit (3 mg/m3) during 2014 compared with 10 per cent in 2012”.
“Concern has been raised by the Mines Inspectorate in relation to the exposure of underground coal mine workers to dust generated by mining activities. In response to these concerns, all underground coal mines were requested to provide appropriate personal respirable dust exposure records for statistical analysis, the report stated.
“This analysis has shown workers in production areas, particularly development and longwall areas, may be exposed to hazardous levels of respirable dust.”
An issue on the system for identifying black lung among workers has also been identified. Queensland Mines Minister Anthony Lynham conceded to ABC’s 7.30 that “thousands of miners’ x-rays stored by the Mines Department have not been reviewed”, but he assured people concerned that he will work on having these x-rays reviewed.
“I’m here to look after the health and safety of our coal workers here in Queensland,” Dr Lynham told 7.30.
“I’ll be doing everything possible to make sure that these x-rays are appropriately read.”
The current system of diagnosing pneumoconiosis is being questioned by CFMEU. The union’s Queensland district president, Steve Smyth aired his concern over the failing monitoring system.
“People have been relying on a system that is broke,” he said.
Concerns were also raised about the qualifications of local radiologists to diagnose black lung disease.
Mr Smyth said authorities should just embrace “the ugly truth”.
“The questions are: Who is checking the x-rays and are they qualified and why did the Department write to workers in December stating all Queensland radiologists are qualified to carry out checks?” he said.
The union called for a public clarification to identify which radiologists are trained to the International Labour Organisation (ILO) standard.
Royal Australian and New Zealand College of Radiologists (RANZCR) refuted claims that Australian radiologists lack the competence to detect black lung in its early stages.
“Clinical radiologists in Australia have been participating in clinically appropriate and effective disease screening programs for many years – including in the area of pneumoconiosis,” said RANZCR President Dr Greg Slater.
“Australian radiologists are well accustomed to reporting to a checklist, in the same way, they do for many other procedures such as breast scans, brain scans and bone scans.
“There’s an inherent risk in using U.S. B-Readers and the documented fact that they may be are open to incorrect readings and over-diagnosis, particularly within the context of the highly litigious US health system.
“Our first and foremost consideration is the welfare of patients in Australia and we are working to ensure that the re-emergence of pneumoconiosis is managed in a sustainable way within the Australian health system. Outsourcing health procedures offshore is absolutely unnecessary, costly, and is not a solution.
“There is ample local expertise amongst clinical radiologists to meet the current demand for coal mine workers screening X-rays,” he said.
Government responds with an action plan
On January 14, the Queensland Government released a five-point plan to help identify and prevent black lung among coal miners. Action on the five points includes: a review to improve the current screening system, taking action on coal mines exceeding regulated limits on dust levels, improving how information is collected and used to ensure cases aren’t missed, investigating regulatory changes, and placing the issue on agenda for the national council of mining ministers.
“We have confirmed five cases of coal miner’s pneumoconiosis in Queensland and I have asked for Queensland Health data on any other possible cases,” said Dr Lynham.
“There’s still research to be done on the medical and workplace records, but I suspect there are more cases to come.
“I am determined to get on top of this issue to protect workers now and into the future and to be open and transparent as we progress.”
Dr Lynham also welcomed RANZCR’s move to process applications for a register of clinical radiologists who are committed to using the ILO classification of radiographs for pneumoconiosis. The register will be available soon.
“I know the workers’ representative, the Construction, Forestry and Mining Employees’ Union, and the Queensland Resources Council are taking this issue very seriously,” he said.
“All the stakeholders on this issue – miners and their families, the unions, employers, and the medical profession – are working together in the best interests of workers past and present.”
More miners are expected to be diagnosed with the black lung diseases in the months to come but the government is determined to address the issue and ensure the protection of mine workers, including those who have already been diagnosed and are suspected to have pneumoconiosis.
An American black lung expert has been tasked to review the current safety procedures and look at the x-rays of Queensland mine workers.
Dr Robert Cohen of the University of Illinois will assist Dr Malcolm Simm of Monash University and his team in reviewing the Coal Mine Workers’ Health Scheme.
“I expect an interim report by the end of the first quarter and detailed recommendations by the middle of the year,” said Dr Lynham.
Controlling black lung is everybody’s business
While there is no cure for black lung, there are measures to control exposure to deadly coal dust. Minimising dust exposure as well as knowing and utilising all dust control plans available to workers can help prevent the development of the disease.
As for people living with pneumoconiosis, proper care and support are necessary to control the symptoms. A treatment plan, which may include smoking cessation, avoiding further exposure to dust, oxygen use, and medications should be in place.
Raising awareness of the health hazards associated with coal dust inhalation and implementing safe and healthy work practices in coal mines will help prevent more coal miners from being affected by pneumoconiosis.