Coal plant closures impact more than the air we breathe

To the Editor: “Reductions in respiratory hospital visits after a coal coking plant closure: a natural experiment” by Yu and Thurston1 is an important illustration of the health benefits of clean air. The shutdown of the Shenango coking plant in western Pennsylvania led to reductions in regional air pollution and was associated with significant decreases in respiratory-related emergency room visits and hospitalizations for nearby residents. Although this study highlights important health benefits associated with the coal plant’s closure, it only tells part of the story regarding the health of the surrounding community. As health care professionals and lawyers specializing in the health and safety of coal miners, we are well-aware of the environmental and health hazards of the coal industry. We have cared for thousands of coal miners with lung diseases caused by the mining, processing, or burning of coal. We have visited families sickened by fugitive dust escaped from coal trains, trucks, or plants. Our water supplies have been repeatedly poisoned by ash left over from coal plants. Recent floods that have literally destroyed our offices are in part due to the impact of the coal industry.2 However, it is indisputable that our communities depend on coal for our economic livelihood. As the coal industry declines, so has the economic prospects for our community in the coal fields of Appalachia. Seventy-five counties in Appalachia (including western Pennsylvania) are designated as “economically distressed” by the Appalachian Regional Commission, ranking in the bottom 10% nationally for poverty rates and unemployment.3 Those in our communities who are fortunate to gain employment in the coal industry are at great risk of suffering premature and permanent disability from lung disease4 or injury—often are unable to subsequently provide for their families. Poverty is an important determinant of health—and a major reason why the life expectancy in the coal fields of Appalachia is nearly 15 years shorter than those living in wealthier U.S. communities.5 When coal mines or coal plants shut down, our community is affected by far more than the air that we breath. DTE Energy Services, who owned and operated the coal plant in Pennsylvania, announced that 173 employees lost their job when the plant closed. To assist their employees, these terminated workers remained on the payroll for 60 days.6 What happened to the terminated workers’ (and families) economic well-being, health insurance, health care access, and health outcomes after that? To fully characterize the public health impacts of the Pennsylvania coking plant shut down (or any shut down of a coal mine, preparation plant, or power plant), understanding the economic and health consequences of the newly unemployed workers and their families is paramount. The broader health of a community is measured by far more than air quality. In our communities, the economic collapse that has followed the decline of coal brings with it rising rates of unemployment, substance abuse, family instability, population decline, and the loss of essential services like schools and health care. Although the study rightly celebrates improved air quality following a coal plant closure, fresh air doesn’t negate the negative impact on multiple social determinants of health. Public health gains must be understood in context—if we want to improve health outcomes in the coal-dependent regions of America, we should consider how to invest not only in cleaner environments but in stronger and more resilient communities. The drawback of the EPA’s Green Bank for Rural America, which had included $500 million to diversify the Appalachian economy, create good-paying jobs, and protect the natural environments within Appalachia is a disheartening step in the wrong direction.7 Supplementary material is available at American Journal of Respiratory and Critical Care Medicine online. Please see the ICMJE disclosure forms, which have been provided as supplementary material.