Across more than a decade of reporting on black lung, the incurable and preventable disease that disables coal miners and disjoints their families, Howard Berkes keeps having the same conversations, and they keep getting more dire.
In Frontline’s new documentary, “Coal’s Human Cost,” one of them is with Ron Carson, the former director of Stone Mountain Health Services. Stone Mountain clinics dot small main streets and peel off backroads in Southwest Virginia, with black lung programs operating at the St. Charles and Vansant locations.
“Does it feel like déjà vu?” the longtime National Public Radio reporter asked Carson over the summer, reflecting on when they last sat down in 2018. Berkes spent months tracing the epidemic of severe black lung related to the exposure of silica, the fine and toxic dust released as miners cut thinner coal seams, to create the film “Coal’s Deadly Dust” in 2019.
“Absolutely,” Carson replied in the film. “For us to be sitting here, discussing what we’re talking about over the past eight years, and nothing’s been done … it’s horrifying.”
Berkes’ new project, airing Tuesday night, continues to document the toll of the disease and probe the regulatory failures that have allowed it to get to a point where today’s rates in central Appalachia’s working miners are at the highest since the 1970s. A study released in August by the National Institute for Occupational Safety and Health found that one in three miners who have been working underground for at least 25 years tested positive for coal workers’ pneumoconiosis, or black lung, in Kentucky, Virginia and West Virginia.
That’s up nearly 12 percentage points from the last time he reported on rates in 2018.
After Berkes reported on the institute’s study, Frontline, an investigative documentary series based in Boston, tapped him to do another film. Berkes flew to the coalfields from his home in Utah in late August, another pause on attempted retirement to start filming.
“As we visited people, especially people we had connected with eight years ago, they were just beside themselves. Here we were, not only talking about this again, but it being worse,” he said in an interview.
Berkes worked alongside a team including Molly Born, a journalist and West Virginia native who produced and directed the work. They were able to squeeze a typically six-month process into three months, spending the bulk of their time in Southwest Virginia and Eastern Kentucky. Born said they wrapped up shooting just last week before heading to Boston to finalize the film.
“I’ve been doing a lot of reflecting this week on how many people were willing to come back out to finish the story,” Born said in an interview on Monday, referencing Berkes’ retirement and the commitment of team members, many native to the area, to get the work done.
The film, just under an hour, documents how we got here, from the first landmark regulation in the late 1960s to limitations on silica dust by the Biden administration that have not been enforced by the Trump administration, which also announced close to $700 million in June to sustain the industry. There were 2,000 new cases of black lung reported last year, according to the film.
It opens with a miner from Eastern Kentucky roaming on a foggy hillside and describing how he first noticed his symptoms. Jonathan Wright, who worked in a Virginia coal mine that closed a year ago, was diagnosed in 2023 with black lung, Berkes said.
While they can’t confirm that Wright was one of the participants of the new federal study, he fits the demographic perfectly, Berkes added — Wright, 44, worked underground for 25 years and was now looking at a life spent battling the disease, which becomes fatal as it advances.
The film spends time with other miners at various stages, several of whom Berkes spoke with in 2018. Years later, one is too sick to do an interview, another is diligently taking medication after a lung transplant and some are no longer here. At a respiratory clinic in Norton, Berkes thumbs through funeral programs and pulls out four miners he knew.
He also reconnects with the doctors and advocates who have made it their careers to fight the disease, in clinics and in Washington, and have seen little progress despite numerous studies and 1,700 deaths between 2020 and 2023. Berkes contrasted their commitment to the federal regulators who avoid talking to him for the film, but whose absence does not go unmentioned.
Scenes inside clinics, chapter meetings and lobbying trips emphasize both the progression of the disease and the calls for those in power to pay attention to it, which, as one doctor points out, comes back to historic neglect of the area. Southwest Virginia, with its estrangement from wealthier parts of the state and central location in the Appalachian coalfields, lies in the heart of it, Berkes said.
“After billions and billions of dollars have been spent, we’re right back to the same place we was when our grandfathers were mining, and our great-grandfathers,” Brandon Crum, a radiologist in Kentucky, said during a September meeting of a Black Lung Association chapter in Big Stone Gap, featured in the film. “So it’s been a failure of the entire system for our miners in central Appalachia.”
In September, Crum presented a trove of his research at the National Black Lung Association conference in Abingdon and implored people to continue sharing their stories with media and politicians. “We’re far past saying it’s bad … now we need to start doing something about it,” he told a crowd, including many people who are highlighted in Berkes and Born’s project.
The film will stream Tuesday at 10 p.m. Eastern time on local stations, including PBS Appalachia. It can also be found on Frontline’s YouTube channel, website, the PBS App and Prime Video.
In the years since he retired following his last film, Berkes said his sources have not left him uninformed, continuing to tell him what’s going on in their communities and dropping documents in his lap.
“We have the privilege of being able to walk away from this; they don’t. And that’s part of what kept drawing me back into this,” Berkes said. “I’ve said many times that sometimes to get change, the people who have responsibility for making change need to see horror and they need to feel shame for failing to do something about it.
“So far, that hasn’t worked,” he added. “We’ve documented, and others have, plenty of horror. There doesn’t seem to be enough shame out there for action to take place that will be meaningful for miners.”
