Too much Cash and no panache
by Bernard Corden
Better to die on one’s feet than to live on one’s knees
Jean-Paul Sartre
On 30th December 1969, following the Farmington mining disaster and threat of a nationwide strike the incumbent US president eventually capitulated. Although Richard Nixon declined to meet many of the inconsolable widows of the 78 deceased miners at the White House oval office, he reluctantly endorsed the Federal Coal Mine Health and Safety Act. After almost a century of intense political polemic, the controversial black lung benefits scheme was finally ratified. This involved a prolonged and often bitter campaign to convince mine owners, political leaders and health professionals about coal workers’ pneumoconiosis or black lung. It was somewhat ironic but less than six months earlier on 20th July 1969, the Apollo 11 astronaut, Neil Armstrong walked on the moon. 1–4
The legislation created an agency that became the Mine Safety and Health Administration, which required statutory quarterly inspections of underground operations and six monthly assessments of open cut mines. It also established coal dust exposure limits and a health surveillance program supported by a compensation scheme for coal miners debilitated by occupational lung diseases. In the early 1970s, almost one third of miners who worked more than 25 years in underground coal mines, were diagnosed with black lung symptoms. The new federal legislation began fulfil its objectives as cases of coal workers’ pneumoconiosis declined. In less than three decades the prevalence rate plummeted and the disease was almost eradicated. 5–8
Over many decades the biomedical scientific approach became embroiled with the political economy of the coal industry. A misinformed complacency vitiated the medical, engineering and legal professions and failure to establish a causal nexus disparaged American medicine and tarnished its integrity. People in positions of authority sacrificed truth and accountability to protect reputations and advocated that breathing coal dust was relatively harmless and even beneficial to health. Entrenched disrespect was eventually defeated using passionate social engagement, confrontational collective action and speaking the truth to power. Plain and simple vocabulary such as miners’ asthma or black lung replaced enigmatic scientific jargon to reveal masses of breathless and incapacitated men exhausted by their work. An enthusiastic and determined communal response succeeded where intricate scientific investigation and private subtle negotiation failed. 9–12
This reflects and aligns with the work and philosophy of deceased British anthropologist, Mary Douglas. Indeed risk has moved from a collectivist to individualist paradigm throughout most western cultures. The commitment to methodological individualism increasingly objectifies risk and disregards many of its cultural, metaphysical or social psychological aspects. Moreover, extirpating a language has a profound impact on cultural change and during any coup d’état control of media outlets remains a priority. The rapid expanse of communications technopoly with antisocial media platforms such as Twitter and Facebook has sinister totalitarian objectives and furtively surrenders culture to technology. However, the real tragedy is that precautionary action in the early 1900s would have saved many lives. The billions of dollars invested in the black lung benefits program could have prevented a significant amount of unnecessary suffering. 13–17
Under the coal workers’ health surveillance program, voluntary screening continued and included an initial chest x-ray and periodic examinations every five years. However at the turn of the millennium in 2005, a scheme physician raised concerns regarding patternicity and clustering of abnormal symptoms. It implied a rapid onset of severe cases of black lung with evidence of progressive massive fibrosis. However, additional data was required to establish statistical significance. Further extensive research using a mobile medical unit to monitor the prevalence in remote regions confirmed initial observations. The symptoms were rampant throughout Appalachia, especially across the West Virginia coal fields. Moreover and somewhat ominously, screening under the surveillance program was voluntary, which suggested the frequency rate could significantly increase. Additional corroborating evidence was duly provided following the Upper Big Branch mining disaster. The explosion claimed the lives of 29 miners and autopsies on 24 of its victims revealed 71% displayed the classic symptoms of black lung. 18–21
Exploratory data analysis between 2000 and 2012, confirmed the prevalence had increased by a staggering 900%. This matched incidence rates that were common before legislation was enacted in 1969. The exceedingly rapid onset of progressive massive fibrosis also generated significant concern amongst epidemiologists. Indeed, black lung can only emerge through inhaling excessive amounts of coal dust. It inferred existing legislative arrangements were somewhat ineffective and other unidentified exogenous or endogenous risks may be contributing to the enigma. 22–23
This significant resurgence came as no surprise to many supervisors, miners and their immediate families. However, the response from employers and industry associations was invariably nonchalant and remains rather lacklustre. Most employer representatives and industry associations can regurgitate legislative requirements but conveniently disregard many of the sociopolitical issues or exogenous risks that render industrial health and safety legislation ineffective. 24–25
From 1969 to 1972 corporate America experienced a series of significant political setbacks or impediments. It consisted of radical social reform with increasing regulatory enforcement from Washington. This included severe restrictions on business via rigorous industrial safety, environmental and consumer protection legislation, which was frequently supported by the dissident activist, Ralph Nader. The preliminary response from corporate America to this paradigm shift was often a mixture of disbelief, outrage, retribution and anxiety. 26
An aggressive strategy with brutal tactics orchestrated by Lewis Powell and Bryce Harlow soon followed with a massive redistribution of power and the merger of corporate and state interests. This political and economic pincer movement advocated deregulation, diminution and privatisation. It infiltrated academia via the University of Chicago and Chicago School of Economics. Additional support was provided by the financial services sector with readily available credit and unsecured mortgages for the masses. In under a decade this corporate revolution restructured Washington and set the foundations for casino capitalism. A winner take all philosophy was paradoxically promoted as trickle-down economics and offered freedom of choice via Margaret Thatcher’s sophism……There is no alternative. 27–29
Its social impact soon emerged via a devastating resurgence of black lung amongst US coal miners with the rapid onset of progressive massive fibrosis. Since the late 1970s, free trade agreements with a laissez faire doctrine have circumvented legislation. Major resources projects are invariably a race to the bottom and contingent labour hire has obfuscated duty of care. The merger of state and corporate interests has increased the risk of regulatory capture throughout every structural level of government, especially in Business Queensland. The fundamental tenets of work health and safety, which include genuine independence and tripartite arrangements, have been relinquished via the attenuation of trade union power. Thomas McGarity provides further extensive discussion and analysis of these sociopolitical issues in Freedom to Harm: The Lasting Legacy of the Laissez Faire Revival. 30–33
Emasculation of mining unions across the United States during the 1980s undermined many preventive mechanisms enacted by legislation and a production over protection dichotomy prevailed. Most inspections from regulatory authorities were often prearranged or merely symbolic. Employees holding statutory positions would fabricate dust monitoring reports and instruments were strategically located near ventilation supply shafts. It produced compliant results and guaranteed that documented records of atmospheric conditions in the working environment conformed to legislative requirements. 34–35
Most of the larger coal seams were depleted by rapacious demands and remaining sections in many underground mines are much narrower and more restrictive. This requires additional blasting through surrounding rock to accommodate larger cutting machinery, ventilation ducts and materials handling equipment. It increases the risk of exposure to highly toxic respirable crystalline silica, which can cause silicosis. Innovative processes were also introduced to increase productivity, such as longwall top coal caving that generates even more dust. Furthermore, miners are offered substantial performance bonuses to achieve extraordinary production targets that require extended rosters with prolonged shifts and reduced recuperation periods. Additional scientific research indicates chemically reactive substances such as iron pyrites are having a synergistic effect and contributing to the rapid onset of progressive massive fibrosis. A most frustrating aspect for epidemiologists and other scientists investigating resurgence of black lung is knowing that the disease is entirely preventable. It can only emerge following prolonged exposure with inhalation of excessive amounts of respirable coal mine dust. Irrespective of the cause, preventive measures are required and controls must be reliable and proportional to the associated risk. 36–40
During 2014 the Mine Safety and Health Administration in the United States established statutory requirements for continuous monitoring of coal dust. The exposure standard was reduced to 1.5 mg/m3 and if concentrations are exceeded, immediate measures must be taken to reduce dust levels below the prescribed limit. Precautionary health controls include lung function testing via spirometry, which detects respiratory tract impairment and assists with the diagnosis of black lung. However, additional preventive actions are required using advanced mechanical extraction and local exhaust ventilation techniques with improved design to further reduce dust exposure. This must be supported by mandatory participation in health screening and surveillance protocols. 41–43
Another intriguing enigma emerged during investigations into the resurgence of black lung across the United States. This involved prevalence of the disease amongst Australia’s coal miners, especially throughout Queensland. It is a significant regional producer and currently accounts for 52% of the nation’s black coal production. This includes many underground and open cut coal mines employing approximately 30,000 people. 44–45
A review of the Queensland Coal Board Coal Miners’ Health Scheme during the early 1980s identified 75 suspected cases of black lung. The subsequent Rathus report generated an insouciant response from regulatory authorities and most coal mine operators. Over many years a collective perception emerged across the entire Australian coal mining industry. It foolishly accepted that black lung had been eradicated and was a disease of the past. This view was widely acknowledged by coal mine operators, regulators, trade unions, safety professionals, industry associations, occupational hygienists and many miners. It was quite extraordinary and rather astonishing given the prevalence rate throughout the United States fluctuated between 2% and 12%. Moreover, operating conditions and exposure risks across the Australian coal mining industry were almost identical. 46–48
However in May 2015, a Queensland coal miner was officially diagnosed with coal workers’ pneumoconiosis. It was formally publicised several months later as the first case of black lung in the Queensland coal mining industry for over 30 years. Before September 2015, coal miners in Queensland were routinely informed that its health scheme had failed to identify any cases since 1984 and the disease had been eradicated. This bad faith was accepted at face value and remained unchallenged over several decades. A misinformed complacency inculcated many people throughout the coal mining industry to underestimate a significant operational risk……..It was perfectly foreseeable but nobody was looking. 49–51
This was corroborated in March 2017 by testimony from Dr Robert Cohen during the Queensland parliamentary inquiry into the resurgence of black lung. If approximately 30,000 miners are producing almost 250 million tonnes of coal each year without a single diagnosis of coal workers’ pneumoconiosis, maybe the surveillance program is ineffective. Recognition or plaudits for eradicating the disease appears rather illogical and somewhat naïve. Indeed, a frequently repeated axiom from the medical profession resonates……….Absence of evidence is not evidence of absence. 52–54
The Safe Work Australia Act 2008 prescribes requirements covering the establishment and functions of Safe Work Australia. This includes liaising with other countries or international organisations on matters relating to work health and safety or workers’ compensation. There are good lessons to be had from global networking. Indeed, a recent review of its functions confirms international engagement and liaison is probably a legitimate responsibility. It suggests a single entity should correspond with overseas agencies and act as a national repository and interface. This guarantees consistency and relevant information can be disseminated to individual jurisdictions. However, any collaboration with the International Commission on Occupational Health or black lung research establishments was somewhat ineffective. It appears Safe Work Australia’s international delegates maybe suffering from noise induced hearing loss or……Too much Cash and no panache. 55–59
Substantive evidence during the Queensland parliamentary inquiry into black lung indicates administration of the Coal Mining Safety and Health Act and subordinate regulations was appalling. There was a catastrophic breakdown of its regulatory system that was intended to secure and protect the health of coal miners. The Department of Natural Resources and Mines failed to assure the safety and health of persons at coal mines or other people affected by mining operations. The risk of injury or illness was unacceptable and provisions for monitoring administration and effectiveness of the legislative framework were deplorable. It is neatly summarised within the Federal Coal Mine Safety and Health Act 1969 US Public Law 91-73 (USA). This was endorsed by President Richard Nixon almost 50 years ago and confirms…The first priority and concern of all in the coal mining industry must be the health and safety of its most precious resource – the miner. 60–63
A significant amount of criticism during the Queensland parliamentary inquiry involved ethics and genuine independence of the regulatory authority. This was initially raised in June 2008 and included an investigation by the Queensland Ombudsman. It concluded the Department of Mines and Energy compliance activities were acceptable and did not raise any cause for concern. However, there is reasonable perception of regulatory capture throughout the inspectorate. This was recently corroborated by Jeremy Buckingham and supported via extensive research from Graham Readfearn on behalf of the Australia Institute. It indicates revolving doors are spinning like a roulette wheel in an era of casino capitalism, especially throughout Business Queensland. 64–70
Another issue of significant concern involved the regrettable performance of the Health Surveillance Unit within the Department of Natural Resources and Mines. It was established in 1998 to administer the Coal Mine Workers’ Health Scheme. However, during the mining boom it was hopelessly under resourced with meagre and often variable staff levels. Its role was purely administrative with insufficient capacity, capability or competency to provide any meaningful exploratory data analysis or clinical review of health assessment records. 71–74
Preliminary chest x-rays and spirometry tests were used by nominated medical advisors to diagnose a disease that manifests over a prolonged period and initial assessments were despatched to the Health Surveillance Unit. The results did not receive any further specialist vigilance or additional meaningful analysis and were rudimentarily stored in a feeble attempt to ensure confidentiality. The department was unable to offer any worthwhile data or trend analysis of coal mine dust diseases. It failed to fulfil the scheme’s policy objectives and merely served as a health records storage facility. 75–77
Even basic administrative functions and data entry activities were overwhelmed during the resources boom. An enormous backlog of health records accumulated and at one location confidential documents were bunged into a janitor’s broom cupboard adjacent to the female toilets. Additional storage facilities, which included shipping freight containers, were eventually acquired at its Redbank research facility. However, unsuitable and improper environmental conditions destroyed most of the x-rays and rendered many documents illegible. 78
In 2002, the Department of Natural Resources and Mines with assistance from a tripartite working group reviewed the functions of its Health Surveillance Unit. It identified many major inconsistencies pertaining to health surveillance components of the Coal Mine Workers’ Health Scheme. A subsequent report published in 2003 provided significant opportunities for improvement with many substantive recommendations. Most were ignored and almost 14 years later the Monash review in 2016 discovered many similar anomalies. The failure to implement initial recommendations rendered the scheme meaningless. It further delayed any preventive action and compounded the misery, anxiety and suffering of many affected miners and their dependents. The toll currently stands at 71 confirmed cases and evidence from the United States, following its extensive experience with the disease, indicates it will most likely escalate. 79–85
Working Man – Rita MacNeil
It’s a working man l am
And I’ve been down underground
And I swear to God if l ever see the sun
Or for any length of time
I can hold it in my mind
I never again will go down underground
At the age of sixteen years
Oh, he quarrels with his peers
Who vowed they’d never see another one
In the dark recess of the mines
Where you age before your time
And the coal dust lies heavy on your lungs
It’s a working man l am
And I’ve been down underground
And I swear to God if l ever see the sun
Or for any length of time
I can hold it in my mind
I never again will go down underground
At the age of sixty four
Oh, he’ll greet you at the door
And he’ll gently lead you by the arm
Through the dark recess of the mines
Oh, he’ll take you back in time
And he’ll tell you of the hardships that were had
It’s a working man l am
And I’ve been down underground
And I swear to God if l ever see the sun
Or for any length of time
I can hold it in my mind
I never again will go down underground
It’s a working man l am
And I’ve been down underground
And I swear to God if l ever see the sun
Or for any length of time
I can hold it in my mind
I never again will go down underground
It’s a working man l am
And I’ve been down underground
And I swear to God if l ever see the sun
Or for any length of time
I can hold it in my mind
I never again will go down underground
God, I never again will go down underground
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