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For decades, people in southern West Virginia have suffered from elevated rates of health problems like lung cancer, cardiovascular disease, and birth defects. In McDowell County, for example, life expectancy for females is about 73 years, approximately .

“We’ve been trying and trying to get them to pay attention to these things.”

Although many attribute these problems to the poverty of the region, scientists and epidemiologists have been looking at a different culprit. Beginning in 2006, more than two dozen studies have explored the possibility of a link between the region’s illnesses and mountaintop removal mining, a common term for the surface mining of coal.

For Janet Keating, executive director of the nonprofit environmental group Ohio Valley Environmental Coalition, that link is a no-brainer. “Long before there were any studies, people knew that mountaintop removal mining was making them sick,” she said.

But policymakers in the state weren’t convinced. Until now, they considered the research inconclusive and continued to let coal companies practice surface mining. On March 18, the state Department of Environmental Protection (DEP) issued a permit renewal to the South Fork Coal Company to continue surface mining at a location in Greenbrier County. Currently, the department cannot deny a permit to any applicant that meets the requirements, according to Communications Officer Kelley Gillenwater.

But what if that policy were to change? On March 13, Randy Huffman, the secretary of the DEP, acknowledged for the first time that reviewing the existing research is necessary. Four days later, the administration of Governor Earl Ray Tomblin announced that the state would conduct an official review of those studies, under the leadership of the state Bureau for Public Health’s commissioner, Dr. Rahul Gupta.

That’s good news for those who blame the health disparities of southern West Virginia on mountaintop removal mining. It’s also good news for environmentalists worldwide, who want to see more urgency in transitioning society away from fossil fuels.

Environmentalists hope that if the review verifies the results of the studies, it could lead to a change in state policy. Some have expressed doubt about this possibility, however, given the economic and political power of the coal industry. But in a phone interview, Gupta insisted that scientific evidence would prevail: “Most of the policies about worker safety, worker health, community health, in this country over the last 150 years have come from science and data.”

Others fear the review could further reduce the already shrinking number of coal mining jobs in a region suffering economically. “In the coal communities of southern West Virginia, the coal industry is the only show in town,” said Jason Bostic, vice president of the West Virginia Coal Association. (To read about emerging solutions to the decline in coal jobs in Appalachia, start here.)

“District 12”

For many local people, these announcements have been a long time coming. “We’ve been trying and trying to get them to pay attention to these things, and it’s just time to really bring down your foot and stomp it and say, ‘You are going to pay attention to me,’” Keating said.

“They kept telling us we are District 12 from The Hunger Games.”

Keating credited the timing of the state’s decision to the publicity surrounding The People’s Foot, a rally held on March 16 in front of the DEP office in Charleston, the state capital. Multiple groups—including OVEC, Coal River Mountain Watch, and Christians for the Mountains—spent months organizing the rally, employing social media, sending postcards in the mail to supporters, and strategically locating billboards demanding that the government “Stop the Poisoning.”

“That’s pretty striking, but it’s the truth,” Keating said of the billboards. “We let them know we were coming and that we would be pretty hard to ignore.”

Speakers at the rally, such as Bo Webb of Coal River Mountain Watch, stressed the importance of the Appalachian Community Health Emergency Act, or ACHE, a federal bill that would place a moratorium on new mountaintop removal permits until the federal government has completed and evaluated studies into health disparities in the region.

Daile Rois was in the crowd at the rally. She’s been an active volunteer with OVEC and other environmental groups since May 5, 2014, when the DEP issued a permit to the Korean mining company Keystone Global that would allow blasting just behind the Charleston house that has been in her family since 1966. Her friends from outside the state were worried, she said, and urged her to move.

“They kept telling us we are District 12 from The Hunger Games,” Rois said. “I refuse to accept that.”

Instead of accepting it, Rois became increasingly involved in the local environmental movement. She said the People’s Foot rally reminded her that those engaged in the fight against mountaintop removal mining were members of a community. “We were sharing stories that were heartrending, and yet there was this expectation that the time was right.”

In a phone interview, Gupta agreed that the timing was good. “The public interest is clearly present in having that unbiased analytical look at this data.”

Debating the data

Yet the validity of that data remains contested.

“I’m convinced with the research I’ve done and what I’ve seen with my own eyes that mountaintop removal mining is harmful,” said Dr. Michael Hendryx, a professor of applied health science at Indiana University. Hendryx has been researching health disparities in Appalachia since 2006 and has authored numerous peer-reviewed articles correlating exposure to mountaintop removal mining to higher rates of birth defects, mortality, cardiovascular disease, and lung cancer. In one frequently cited study of reported live births between 1996 and 2003 across Tennessee, Virginia, West Virginia, and Kentucky, Hendryx and co-author Melissa Ahern found elevated rates of birth defects including circulatory and respiratory anomalies in counties where mountaintop mining occurred.

“The coal industry has a tremendous financial interest in doing what they’re doing.”

Bostic dismissed Hendryx’s works as “health journalism, not public health epidemiology.” Born and raised in southern West Virginia, Bostic did not deny that health problems disproportionately affect rural communities where coal is the main economic base, but he attributed them to general behaviors such as poor diet and tobacco usage.

“Public health has always been a challenge in isolated areas,” Bostic remarked.

Hendryx, however, insists that he has controlled for factors such as alcohol and tobacco use, quality of prenatal care, and diet. Therefore, he says the health disparities he has encountered must be due to the increased chemical exposure, impaired water sources, and air pollutants generated by blasting and mine runoff.

He has maintained in published articles as well as interviews that mountaintop removal mining should be discontinued. He argues that the reason Bostic and others have refused to recognize the validity of his data comes down to money. “The coal industry has a tremendous financial interest in doing what they’re doing,” he said. “I have no financial interest in doing what I’m doing.”

According to Gupta, these conflicting views are “exactly why an unbiased agency from a public health perspective will be engaged in this type of work.” The researchers will include scientists from multiple agencies from different states. He stressed that public health has no agenda, either for pro-mining or for environmental groups.