An image of mountain top removal in Appalachia. Photo by Mario Tama

Environmentalists have described the Clean Air Act as a “genuine American success story.” No other law has done more to generally improve human health than the amendments passed in 1990, which limited harmful pollutants that can cause heart disease, bronchitis, asthma and other respiratory sicknesses. While these widespread public health improvements are clear, in Appalachia the Clean Air Act has a mixed legacy. Surprisingly, some Appalachian communities are dying at an earlier age due to unforeseen consequences of the 1990 amendments. The Clean Air Act is benefiting the many at the expense of the few.

A recent study brings this untold story of the Clean Air Act to light. It shows that mortality rates are increasing in coal-mining communities in Kentucky, Tennessee, Virginia and West Virginia. All of these states saw an increase in mountain top removal coal mining after the introduction of the 1990 amendments, which promoted the use of clean low-sulfur coal to curb acid rain. Sulfur dioxide is released into the atmosphere when coal burns and transforms stored sulfur into a gas. Once in the atmosphere, sulfur dioxide reacts with nitrogen oxide and water to form acid rain. Acid rain has many ecological effects, but its greatest impact is on water systems and forests.

Coal companies responded to the Clean Air Act amendments by seeking low-sulfur coal in the mountainous Central Appalachian Region of the United States. Coal companies access this coal with a method called mountaintop removal, which is a more efficient method of coal mining that uses fewer workers and accesses more coal than conventional mining. Despite these advantages, mountain top removal is highly damaging to local environments—it pollutes tap water and exposes nearby families and neighborhoods to toxic dust.

Makayla Urias holds contaminated water samples taken from her home, which is surrounded by mountaintop removal coal mining. Cathie Bird

While the sweeping changes of the Clean Air Act improved health outcomes for many people, we cannot forget the people who have borne the costs of mountain top removal mining in Appalachia. Makayla Urias—an 8-year-old girl from Pike County, Kentucky (pictured on the right)— is one child among many living in Appalachia whose home is threatened by mountain top removal and may not have the chance to live a full life.

Researchers from the School of Public Health at Indiana University examined the relationship between mortality rates, mountaintop removal mining, and the 1990 Clean Air Act amendments in Appalachian communities in Kentucky, Tennessee, Virginia and West Virginia. Researchers surveyed the mortality rates between 1968 and 2014 using publicly available data, comparing respiratory mortality due to mountaintop removal by comparing mountain top removal counties to non-mountain top removal counties. The team also considered adult smoking rates, obesity rates, child poverty rates, and per capita supply of primary care physicians when examining mortality rates to ensure that these factors did not account for mortality rates measured in mountaintop removal communities.

Figure 1: Mortality rates from 1968 to 2014, with a divergence between counties with mountain top removal (MTR) and counties with out in years following the Clean Air Act (CAA) amendments.

The comparison revealed that mortality rates between the two groups diverged after the Clean Air Act amendments in 1990, as presented in Figure 1. This is surprising because mortality rates decreased elsewhere in the United States due to improvements in medical care. Advancements in medicine are offset in Appalachian communities by the adverse health effects of mountain top removal. The study concludes that increased mortality comes from respiratory diseases related to mountain top removal, such as bronchitis and emphysema.

The untold story of mountain top removal in Appalachian communities after the 1990 Clean Air Act amendments should serve as a cautionary tale to politicians working to address climate change. The narrow scope of the Clean Air Act amendments promoted a dangerous form of coal extraction rather than incentives to encourage development of cleaner energies. When addressing climate change, environmental policies in the United States focus primarily on limiting carbon dioxide emissions. These kinds of broad policies overlook the local exposure to poisonous toxins associated with the production and extraction of fossil fuels—as demonstrated by the communities in Appalachia.

While issues of environmental justice mostly focus on the environmental concerns that poor communities of color face, the framework of environmental justice should serve as a platform for all vulnerable and marginalized communities. Although coal-mining towns in Appalachia are largely white, both the failure of policy to protect these communities and the lack of public concern towards local air pollution demands our attention. The future lives of Makayla Urias and other children in Appalachia depend on it.