When Johnathan Wright began working underground in coal mines more than 25 years ago, the percentage of veteran working coal miners in Central Appalachia diagnosed with black lung disease was down to roughly one in 10.
Today, that reported rate is the highest it’s been since 1978: One in three — and Wright, age 44, has joined them.
“It’s awful,” says Wright, who was diagnosed with the incurable disease in 2023 after he started struggling to breathe when climbing the Kentucky hills, and began coughing up grey phlegm. “You work your whole life to enjoy the rest of it, and then you can't enjoy it.”
Wright is among the coal miners who share their stories in Coal’s Human Cost, a new documentary from FRONTLINE, NPR, Public Health Watch and the Appalachia + Mid-South Newsroom. Its Nov. 10, 2026, premiere comes as the Trump administration has been boosting coal mining, including through a pledge of nearly $700 million to keep coal-fired power plants running and coal exports flowing.
Against that backdrop, Coal’s Human Cost tracks the resurgence of black lung disease in Appalachia, the impact on miners and their families, and the role of the government and the mining industry in failing to protect them.
“It seems like they've just not cared about it, you know, for the last 25 years to really do anything about it,” Wright says in the video drawn from the documentary.
In the video, correspondent Howard Berkes unpacks one attempt to safeguard miners from getting black lung — and how it fell apart. Berkes has spent 15 years reporting in and out of the coal fields of West Virginia, Virginia and Kentucky chronicling black lung’s comeback. In the 2019 FRONTLINE/NPR documentary Coal’s Deadly Dust, his reporting revealed an ongoing epidemic of severe black lung disease connected to decades of overexposure to toxic silica dust, which has become a more common threat in modern mining: With big, pure coal seams mined out, mining machines have been cutting into rock while mining thinner and thinner seams of coal.
Five years after Coal’s Deadly Dust aired, the Biden administration put in place the same strict limits on exposure to silica dust in mines that already governed every other industry. Violations could trigger fines and even shutting down mine sections with excessive dust.
For Chris Williamson, who led the Mine Safety and Health Association in the Biden administration and is the great grandson of a coal miner who had black lung, the move was a moral necessity.
“For me, it was just a great injustice that coal miners, metal and nonmetal miners, every miner in this country, the thousands of them that get up and go to work and do things that we wouldn't do for our benefit, did not have at least the same level of protection that every other worker in this country had,” Williamson says in the video. “And I was going to try to do something about that.”
But the new silica dust limits have never been enforced. The mining industry sued, and a federal court suspended enforcement indefinitely as the Trump administration said it would consider changing the silica regulation.
Current MSHA officials wouldn’t agree to an interview or answer written questions, but Berkes spoke with a consultant for the leading mining industry trade group, the National Mining Association. The consultant, Michael Peelish, said that the group does not oppose the new limit on silica dust exposure, and that it challenged the regulation in court because it wanted more flexibility with compliance.
“It does not give the miners what they need. It doesn't give the operators the opportunity to comply in an efficient, effective way, period,” Peelish tells Berkes in the video. “If we had that ability to do that, that rule, I think, would be much more effective.”
Peelish also said that the industry has done a lot already to protect miners — and that what’s needed now is the ability to require miners to use dust masks or respirators when the other protections fail to keep dust controlled.
Berkes has interviewed dozens of coal miners and most, he reports, complain about wearing dust masks and respirators while doing strenuous and dangerous work. Miners told Berkes that the devices become too hot to wear, clog easily, fail to filter finer dust particles, and interfere with communication in an environment where a lack of clear communication could mean death.
Dr. Drew Harris, a University of Virginia pulmonologist and medical director at black lung clinics in Virginia and West Virginia, has worked with hundreds of sick miners over the years. Harris told Berkes that requiring miners to wear respirators would be neither effective nor practical.
“Every workplace should be providing for their workers a safe environment, and that requires in coal mining that they have the right ventilation and have the right safety equipment and water sprays on the machines to keep the dust levels down,” Harris says in the video. “We should not be relying on coal miners to wear respirators in any way, shape, or form as a primary means of protection because it is impractical for coal miners to wear these respirators.”
In the meantime, 1,700 black lung deaths were reported from 2020 to 2023, 2,000 new cases of black lung were reported by clinics last year alone, and miners in Appalachia like Johnathan Wright continue to struggle for breath.
The mine he worked at closed last year. Wright now sells overstock and surplus merchandise from a small warehouse he bought after being laid off. In the video, he reflects on how black lung rates among veteran miners like him have risen to their highest level since the 1970s, and the government and industry’s role in allowing the deadly resurgence to happen.
“It is crazy to think that they've just let it go,” he says.
Wright is also aware of what is coming: the progression of a disease that will steal his breath and his ability to do most of what he takes for granted now.
“I don’t want to get to where I’m a burden on everybody else,” Wright says in the documentary. “I do know what the end cause is going to be… I know it’s coming. I don’t like to think about it.”
For the full story, watch Coal’s Human Cost starting Nov. 10, 2026, at 10/9c on PBS stations (check local listings) and on FRONTLINE’s YouTube channel, and at 7/6c at pbs.org/frontline and in the PBS App. The documentary will also be available on PBS Documentaries on Prime Video.
Coal’s Human Cost is a FRONTLINE production with Five O'Clock Films in association with Forage Media. The writer, producer and director is Molly Born. The producer and correspondent is Howard Berkes. The senior producer is Frank Koughan. The managing editor of FRONTLINE is Andrew Metz. The editor-in-chief and executive producer of FRONTLINE is Raney Aronson-Rath.
This story was produced in conjunction with the Appalachia + Mid-South Newsroom, a collaboration between West Virginia Public Broadcasting,WPLN andWUOT in Tennessee,LPM,WEKU,WKMS andWKU Public Radio in Kentucky, and NPR. Sign up for the weeklyPorch Light newsletter here for news from around the region.