Black Lung in the Era of Regulatory Advancement: An Public Health Governance Analysis

Coal workers pneumoconiosis (CWP), widely referred to as black lung disease, persists as a preventable occupational respiratory disorder despite decades of regulatory reform and technological progress in dust control. The continued occurrence of new cases suggests that the challenge lies not in scientific uncertainty but in systemic governance gaps. This paper re-conceptualizes black lung disease as an indicator of regulatory performance and institutional accountability within occupational health systems. Using a structured narrative policy synthesis, we examine enforcement variability, surveillance fragmentation, healthcare integration gaps, and socioeconomic vulnerability among mining communities. The analysis demonstrates that insufficient cross-sectoral coordination, limited transparency in exposure monitoring, and under-integration of occupational health into public health systems contribute to preventable disease burden. A governance-oriented prevention framework emphasizing accountability, integrated surveillance, and structural equity is proposed. Sustainable elimination of black lung disease requires institutional coherence and proactive health system alignment rather than reactive compensation-based approaches.