The U.S. coal industry is experiencing a serious decline, highlighted by many mining companies in coal-rich Appalachia going bankrupt. This leaves behind environmental destruction and a risk of social chaos. When these mines close, the responsibility for cleaning up the damaged land—especially at mountaintop removal sites—falls on state and federal governments and taxpayers. Many fear that as coal companies fail, the costs of cleanup will be pushed onto citizens who have already suffered due to the industry’s greed. Moreover, mountaintop removal mining isn’t just about environmental damage; it also seriously impacts public health and mental well-being. As an immunologist, I researched the immune effects of this mining method, but I found there was a surprising lack of information. However, it is clear that health issues will trouble these coal communities for many years.
The communities impacted by mountaintop removal mining are some of the poorest in the nation and are located in a 65-county region that includes southern West Virginia, eastern Kentucky, southwestern Virginia, and northeastern Tennessee. The economic downturn in the coal industry has worsened their situation. Health statistics reveal that Appalachian residents face higher rates of illness and death compared to the national average. Research from 1979 to 2005 showed that increased mortality rates in Appalachian coal mining areas were linked to socioeconomic disadvantages. A 2011 study confirmed that areas with mountaintop mining had the lowest health-related quality of life scores, even when compared to other coal mining regions.
So, why is mountaintop removal mining causing such severe public health issues? To extract coal, companies cut down forests, strip away soil, and blast off large parts of the mountain, removing up to 800 to 1,000 feet of mountaintops. Huge draglines—machines that can scoop up to 100 tons at a time—push rubble into nearby streams and valleys, destroying local ecosystems and polluting waterways. This leads to a ruined landscape and the spread of toxic pollutants in the environment. A review by the EPA’s James Wickham and his team highlights the many harmful effects of mountaintop removal on water quality, land health, biodiversity, and human well-being.
As someone new to environmental toxicology and human health, I understand the challenges of studying how mountaintop removal mining affects the health of Appalachian communities. Residents are exposed to a mix of pollutants from burning vegetation, explosions, and toxic sludge produced during coal extraction. This sludge—a dangerous mixture of soil, rock dust, water, and coal particles—contains heavy metals and is often dumped into large coal-ash ponds. Residents deal with these toxic pollutants through air and contaminated water for long periods, often as dust settles after explosions.
Most studies on health impacts of mountaintop mining show correlations rather than direct causation. They may demonstrate a connection between increased mountaintop removal and decreased well-being but don’t definitively link pollutants to health issues. Still, the connections to severe outcomes like birth defects, cancer, and respiratory diseases are clear. Health problems arise from contact with polluted streams, exposure to airborne toxins, groundwater contamination, and eating contaminated fish. Recent studies even point to mechanisms that link exposure to specific particulate matter from mountaintop removal to heart issues.
The negative effects extend beyond physical health. Mining disrupts social structures, leading to increased anxiety, insomnia, and substance abuse. Those with strong ties to the land are particularly affected. Environmental philosopher Glenn Albrecht coined the term “solastalgia” to describe the distress felt due to negative changes in one’s environment. Initially coined in Australia, the term captures the longing for a return to a pre-mining state. A 2007 study showed a strong link between solastalgia and coal mining, highlighting loss of place, health risks, and feelings of injustice.
Are there signs of psychological distress in Appalachian coal areas? A survey found that those suffering from environmental damage due to mountaintop removal mining are significantly more likely to experience depression, with a 40% higher risk of major depression in mining regions compared to non-mining areas. This increased risk is specifically tied to mountaintop removal, not seen in other types of mining.
Addressing the mental health impacts of mountaintop mining requires considering the broader context of healthcare in Appalachia, which suffers from economic hardship and limited access to care. For instance, life expectancy for women in Kentucky’s Appalachian region dropped by 13 months from 1990 to 2011, while women in non-Appalachian Kentucky saw an increase during the same time. More research is essential to clarify the connection between increased mountaintop removal and rising mental health issues.
An evidence-based approach, like that used in ecotoxicology, could provide a strong scientific foundation for action. A recent systematic review on health outcomes associated with mining in rural communities highlights the lack of comprehensive studies on this critical issue. This raises the question: who should fund further research and bear the burden of proof?
In my opinion, coal mining companies must be held accountable for assessing the harm they have caused or are causing. However, given their obligations for environmental cleanup, it’s unlikely they will willingly finance such studies. The costs of training mental health professionals and providing treatment will likely fall on communities that have already endured so much.