阿巴拉契亚中部黑肺病重现:矿工的沉默和有毒职业暴露

The Resurgence of Black Lung in Central Appalachia: The Silencing of Coal Miners and Toxic Occupational Exposure

煤矿工人尘肺病通常被称为'黑肺病',人们曾经以为这种病已成为过去。在历史上,为了让黑肺病获得法律承认,矿工罢工,一些抱有同情的医疗界和政界人物也一起为之斗争,促成美国《煤矿健康与安全法》(Coal Mine Health and Safety Act)在1969年被签署立法。《煤矿法》成为法律之后,曾经患病率极高的这种疾病在头30年就大幅减少。然而,最近在阿巴拉契亚中部的煤矿工人中,黑肺病重现,且致命性更强。与之前相比,今天矿工们感染黑肺病的病情更为严重,患病年龄也降低。但是,对于这种有毒职业暴露,矿工大多保持沉默。本研究采取定性分析方法,所依据数据形式包括:半结构式访谈、直接观察、报纸新闻,以及政府数据和报告。其主要发现表明,'煤炭危机'(即煤层贫化、机械化、监管疏漏、天然气竞争和大规模倒闭)加剧了阿巴拉契亚中部黑肺病的重现,并助长了实际工作的矿工中的'恐惧文化'。这种'恐惧文化'源于缺乏替代就业机会和工作场所保护措施以及去工会化,让在职矿工担心会因为直言真相而失去工作、受到污蔑并遭受报复。外界维权人士和专家的工作带来一些有益的改变;但是,矿工们在预防黑肺病并获得赔偿方面还需要进行艰苦的斗争。本研究为讨论一种被掩盖的疾病提供可行的机会,希望能减轻今后黑肺病的发病。

Coal Workers’Pneumoconiosis(CWP),commonly known as black lung disease,was once thought to be a disease of the past.Historically,striking miners and a few sympathetic medical and political figures fought for the recognition of black lung as a legitimate illness,and as a result,the Coal Mine Health and Safety Act was signed into law in the U.S.in 1969.Following the institutionalization of the Coal Act,the prevalence of the disease declined greatly over the first three decades.However,miners have recently experienced a deadlier resurgence of the disease in central Appalachia.Today,miners are developing more severe cases of black lung and at younger ages than ever before.Yet,miners are largely silent about this toxic occupational exposure.This research utilizes a qualitative approach and relies on several forms of data including:semi-structured interviews,direct observation,newspaper coverage,and government data and reports.Major findings suggest that the'coal crisis'(i.e.depleted seams,mechanization,regulatory oversight,competition from natural gas,and large-scale bankruptcies)have intensified the resurgence of black lung in central Appalachia and has contributed to a'culture of fear'among active coal miners.Limited alternative employment opportunities,lacking protection in the workplace,and deunionization has created a'culture of fear'which leaves employed miners fearful of job loss,stigmatization and retaliation for speaking out.The work of lay advocates and experts has led to some beneficial changes;however,miners continue to face an uphill battle with black lung prevention and compensation.This research offers a viable opportunity to discuss an obscured disease in hopes of mitigating future cases of black lung.