Public Event: Doctor van Steenis Speaks

The esteemed Doctor Dick van Steenis will be giving a public lecture next week concerning the health effects of open-cast coal extraction operations.   This is a rare opportunity to benefit from his 14 years of accumulated expertise on this particular subject.

Who:  Doctor Dick van Steenis
Where:  St. Bride Centre, Douglas, South Lanarkshire, Scotland
When:  Wednesday 23 September, 7:00PM

For those who many not be familiar with Doctor van Steenis’ efforts, he is renown for investigating matters of public health in circumstances where the levers of corporate and/or political power may be positioned against the interests of the people whose health is in question.  Over the past 15 years, Dr. van Steenis has researched the health effects of such particulate-generating operations as power stations, rubbish incinerators, and open-cast coal mines.  His work has been noted by Monbiot of the UK Guardian as early as 1999 (see http://www.monbiot.com/archives/1999/06/20/poisoning-the-poor/ ):

Dr Dick van Steenis is a retired GP who, in 1994, was asked to look at the possible health effects of pollution from power stations in South Wales. He struck upon the simple device of mapping the use of asthma inhalers by primary school children. He was astonished to discover that, before long, he was able to predict the number of asthma patients to within one or two per cent, simply by measuring how far they lived from the nearest major source of pollution. In some villages, he found as many as 38 per cent of four and five year olds using inhalers.

On Wednesday’s lecture, Dr. van Steenis will discuss his findings regarding the ill-health effects of open-cast coal mines.  Given his extensive investigations into this topic, and given how pressing the matter is to the residents of Douglasdale and other  communities above Scotland’s extensive coal seams, we ask the public to restrict their questions to the subject at hand.  If enough interest in other topics is noted, the good Doctor will be lobbied for another speaking date.

Dr. van Steenis’ lecture will be recorded, published online, and made available by DVD for those without access to broadband internet.  Those who have questions they would like to ask of Dr. van Steenis, but who are unable to attend, are invited to post their questions in the comment section of this blog post, or to email their questions here to coalhealthstudy@gmail.com — feel free to include your email and phone so that the organizers may contact you.

Time permitting, the organizers will attempt to incorporate your questions in front of the audience, but if that’s not possible will make every effort to interview Dr. van Steenis with your questions and publish the interview online and to the DVD.

New Release: Coal Health Study, Douglasdale Edition

Douglasdale Edition of the Coal Health Study

An extended version of the Coal Health Study has been prepared for use by Douglasdale residents, and some 1400 copies have been locally generated and distributed in anticipation of Doctor van Steenis’ upcoming lecture.  This Douglasdale edition of the Coal Health Study is available for download here:

New:  Douglasdale Edition of the Coal Health Study, 11 Sep. 2009 [PDF, 1MB]

The Douglasdale edition contains several additions, including a striking table of NHS health indicators disaggregated by postcode, and a more thorough literature review that incorporates relevant studies published in Europe, the United Kingdom, India, and the United States.

Of the 16 peer-reviewed studies cited in the Douglasdale edition, 12 examine the incidence of and/or mortality from disease in populations living near open-cast coal mining operations, 2 quantify the quantity and characteristics of the dust emitted, 1 demonstrates that COPD is a precursor to lung cancer irrespective of smoking history, and 1 explains the mechanism whereby pollutants act to damage lung tissue.

Assessing Particulate Pollution near Open-cast Extraction Operations

Open-cast coal extraction involves the lofting of particulates generated by mechanical disruption of the earth’s crust by drilling and transport, as well as the lofting of particulates generated by the combustion of extremely large quantities of low-quality diesel fuel.

Both types of open-cast particulates require further study in order to assess (1) their densities (density in this case refers to the quantity of particulate mass per cubic volume of air), (2) the distribution of particle sizes generated, and (3) the atmospheric lifetimes of all sizes of particulates present.

A further complicating factor is that after their initial generation and settling to the earth’s surface,  particulates appear to be continually re-lofted by passing coal transport lorries and by regular vehicular traffic on local roads.  This re-lofting extends the atmospheric lifetime and cycling of particulates in a manner that cannot be described by atmospheric physics alone, but can be assessed by monitoring particulate densities and size distributions in local villages.

Absolute and Relative Rates of Douglasdale COPD Incidence

To reduce printing costs, the new Douglasdale edition does not contain every graph that reinforces the conclusions of the preliminary Coal Health Study.   The figure below illustrates the absolute rates of COPD at the four sites examined in the Coal Health Study:  Dalmellington, formerly the site of 10 operational open-cast coal mines, Douglasdale, currently the site of 3 operational open-cast coal mines, Prestwick, a nearby seaside town, and the UK.

Number of cases of Chronic Obstructive Pulmonary Disease diagnosed at two open-cast coal mining sites and at two control sites.

In Dalmellington, the COPD incidence is unusually high, at 7.6%, which is 5 times the UK average of 1.5%.  The Douglasdale incidence values are currently 2.4 times the UK average.

Normalized cases of Chronic Obstructive Pulmonary Disease diagnosed at two open-cast coal mining sites and at two control sites. Normalization was performed by dividing each yearly incidence value at a site by the 2004-5 incidence value. This is done for purposes of comparison, to see what incidence would like like if all sites began at the same COPD incidence.

This figure demonstrates that the rate of COPD is increasing much faster at Douglasdale than at any other site considered, up 63% from 2005, concurrent with the increasing extent of open-cast coal mining activities in the area.   At the current trajectory of the Douglasdale curve, Douglasdale would attain the value of absolute Dalmellington COPD incidence in 6 or 7 years.

Coal Health Study Literature Review

There has been no commissioned research into the effects of open-cast coal mining on the health of Douglasdale residents.  There has, however, been a single individual, Dr. Dick van Steenis, who has investigated the health impacts of open-cast coal mining as a public service, and without payment.

As such, Dr. van Steenis’ work cannot be found in the peer-reviewed literature, but his results on open-cast mining and his references can readily be accessed at The Country Doctor Magazine, which features a section on Dr. van Steenis’ findings on the front page.

For the past few decades, Dr. van Steenis’ work has comprised the bulk of the available research into the health effects of open-cast coal mining on the local population.

In 1992, however, a study entitled “Asthma and open cast mining” [1] appeared in the British Medical Journal, with the finding of greatly increased asthma in the populations adjacent the mine.  The onset of the dramatic asthma increases occurred immediately after the mine began operations.  The local physicians were not informed about the commencement of mine operations until several weeks after the mine had opened, to assure that the increased diagnoses of asthma were factual, not occurring due to bias on the part of the physicians.  The final line in the study conclusion states:  “The results of this small study give cause for national concern in view of the current increasing trend toward open cast mining in Britain”.

The next peer-reviewed study, published two years later, was entitled “Respiratory Morbidity in Merseyside schoolchildren exposed to coal dust and air pollution” [2].  In this study “an increased prevalence of respiratory symptoms in primary schoolchildren exposed to coal dust was confirmed”.  The study noted that although “the association with known coal dust pollution is suggestive, a cross-sectional study cannot confirm a causal relation and further studies are needed”.

The following year, the study “Status of Air Pollution Caused by Coal Washery Projects in India” [3] was published in Environmental Monitoring and Assessment, and noted that 50% of the suspended particulate matter arising from the coal washing activities was of diameter less than 10 microns (a micron is 1 millionth of a meter).

The revelations of this 1995 study are important because the single coal-associated activity that they investigated revealed the presence of substantial quantities of particles less than 10 microns.  Regrettably, most particulate-measuring studies performed in the 1990’s neglected to measure particles less than 10 microns, but it has since been demonstrated by numerous studies that repeated exposure to particles of diameter less than 10 microns, and in particular, particles of less than 2.5 microns, damages the lining of the lung [9,10].

In a 2002 article entitled “Air pollution and health” [9], reviewed the evidence at time of publication, finding that the body of medical literature indicates that “exposure to pollutants such as airborne particulate matter and ozone has been associated with increases in mortality and hospital admissions due to respiratory and cardiovascular disease”.  The authors observed that “these effects have been found in short-term studies, which relate day-to-day variations in air pollution and health, and in long-term studies, which have followed cohorts of exposed individuals over time”, and that “effects have been seen at very low levels of exposure”.  Another review, published in 2008, entitled “Air Pollution, Oxidative Stress, and Dietary Supplementation:  A Review” [10], confirms the results from the 2002 review.

Returning to the open-cast coal mining literature review:  in 1998, there was a single, preliminary study performed on the Lanarkshire population, entitled “Does open-cast coal mining increase respiratory disease?” [4].  Because the study was presented at the Annual Meeting of the Society for Social Medicine, it does not constitute part of the body of peer-reviewed literature.  The study used geographical methods that are common now, although the methods were untested at that time, but nonetheless “a small but significant association” was found between living near open-cast coal mines and contracting a respiratory disease.  It was noted that “this association warrants further investigation”.

Three studies came out of the University of Newcastle upon Tyne over the 2000-2001 period, all of which considered the health of children with regard to open-cast coal mines.

The first, “Living near opencast coal mining sites and children’s respiratory health” [5], studied children in five communities and found “little evidence for associations between living near an opencast site and an increased prevalence of respiratory illnesses … but children in opencast communities 1-4 had significantly more respiratory consultations”.   The second, “Consultations of Children Living Near Open-Cast Coal Mines” [6], found that “Consultations were higher in opencast communities for respiratory, skin, and eye conditions ” and “for respiratory conditions alone”, but noted that “increases in consultation rates in open-cast communities were generally not seen over the portions of the 52-week periods when the open-cast sites were either active or inactive”.  The third, “Prevalence of asthma and other respiratory symptoms in children living near and away from opencast coal mining sites” [7], found “little evidence for associations between living near an opencast site and an increased prevalence of respiratory illnesses, or asthma severity.”

In 2004, a study that examined most of the life-cycle of coal was published, entitled “Environmental Impacts of Coal Mining In India” [8].  This article provides a comprehensive review into the environmental and health impacts arising along the path coal takes, beginning with deforestation of the point of extraction, continuing along with the particulate pollution and accidents associated with extraction and haulage, and finishing with the sulfur, particulates, and greenhouse gases emitted at the point of combustion.

A study of Czech children living in a coal mining district came out in 2007, “Early Childhood Lower Respiratory Illness and Air Pollution” [11], with the finding that “ambient PAH and fine particles were associated with susceptibility to bronchitis” and suggested that “Preschool age children may be particularly vulnerable to air pollution-induced illness”.  Polycyclic aromatic hydrocarbons (PAH) are found in coal and oil, and are released in combustion.  Particulates are produced by mechanical means (crushing, drilling, etc) as well as by combustion.

Two studies regarding the dusts produced by mechanical means at open-cast coal mines came out in 2007: “Generation and Quantification of Hazardous Dusts from Coal Mining in the Indian Context” [12], and “Characteristics of Hazardous Airborne Dust Around an Indian Surface Coal Mining Area” [13].  The first study determined that it is possible to assess the quantity of particulates generated by activities such as drilling and transport at an open-cast coal mining site.  The second study concluded that “more stringent air quality standards should be adopted for coal mining areas and due consideration should be given on the particle size distribution of the air-borne dust while designing control equipment”.

In 2008, the first study examining the health of the open-cast coal mining communities in the United States was published in the American Journal of Public Health:  “Relations between Health Indicators and Residential Proximity to Coal Mining in West Virginia” [14]   This study found that people living in proximity to open-cast coal mines have higher rates of cardiopulmonary disease, chronic obstructive pulmonary disease, hypertension, lung disease, and kidney disease, even after correcting for the effects of covariates such as smoking and poverty.

Another Appalachian study came out in 2008 in the Lung Cancer journal, with the primary finding noted in the title: “Lung Cancer Mortality is elevated in coal-mining regions of Appalachia” [15].   This finding of lung cancer disease in populations living in the presence of pollution may be attributable to the incidence of COPD (Chronic Obstructive Pulmonary Disease) occurring in the population in these areas, according to an article published this year in the European Respiratory Journal, entitled “COPD Prevalence is Increased in Lung Cancer, Independent of Age, Sex, and Smoking History” [16].

The most recent comparative study in the United States came out this year in the Archives of Occupational and Environmental Health, entitled “Mortality from heart, respiratory, and kidney disease in coal mining areas of Appalachia” [17].  This 2009 study demonstrated unusually high mortality rates for respiratory, cardiac, and kidney diseases in counties with open-cast coal mines, with the worst effects manifesting in populations near mines with extraction rates of greater than or equal to 4 million tonnes over a 4-year time period.

As these ill-health effects have been observed to occur for extraction rates in the United States that are less than the open-cast extraction rates ongoing in and proposed for the Douglasdale area, an preliminary examination of the health of the Douglasdale residents was performed in August 2009, entitled “Adverse effects of coal-mining”.  This preliminary examination does not form part of the peer-reviewed literature, but as the study findings have demonstrated striking ill-health in the populations living adjacent open-cast coal mines, it has formed the seed for ongoing research to be submitted for peer-review.

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[1]  Asthma and open cast mining.  J.M.F. Temple and A.M. Sykes, British Medical Journal, 1992.

[2]  Respiratory Morbidity in Merseyside schoolchildren exposed to coal dust and air pollution. B. Brabin, M. Smith, P. Milligan, C. Benjamin, E. Dunne, and ,M. Pearson, Archives of Disease in Childhood, 1994.

[3]  Status of Air Pollution Caused by Coal Washery Projects in India.  M.K. Ghose and S.K. Banerjee, Environmental Monitoring and Assessment, 1995.

[4] Does open cast coal mining increase respiratory disease?  G.C. Leng, A.C. Douglas, M. Donaghy, D. Gordon, Plenary Presentation, Society for Social Medicine Annual Meeting, 1998.

[5]  Living near opencast coal mining sites and children’s respiratory health  T. Pless-Mulloli, D. Howel, A. King, I. Stone, J. Merefield, J. Bessell, and R. Darnell, Occup. Env. Med., 2000.

[6]  Consultations of Children Living Near Open-Cast Coal Mines.  D. Howel, T. Pless-Mulloli, and R. Darnell, Environmental Health Perspectives, 2001.

[7]  Prevalence of asthma and other respiratory symptoms in children living near and away from opencast coal mining sites.  T. Pless-Mulloli, D. Howel, and H. Prince, International Epidemiological Association, 2001.

[8] Environmental Impacts of Coal Mining In India.  Krishnamurthy, K.V.  Proceedings of the National Seminar on Environmental Engineering with special emphasis on Mining Environment, NSEEME-2004, March 2004.

[9]  Air pollution and health.  B. Brunekreef and S. Holgate, Lancet, 2002.

[10]  Air Pollution, Oxidative Stress, and Dietary Supplementation:  A Review.  I. Romieu, F. Castro-Giner, N.Kunzli, and J. Sunyer, European Respiratory Journal, 2008.

[11]  Early Childhood Lower Respiratory Illness and Air Pollution. I. Hertz-Picciotto, R.J. Baker, P-S. Yap, M. Dostal, J. Joad, M. Lipsett, T. Greenfield, C.E.W. Herr, I. Benes, R.H. Shumway, and K.E. Pinkerton,  Environ Health Perspect. 2007.

[12]  Generation and Quantification of Hazardous Dusts from Coal Mining in the Indian Context.  M.K. Ghose, Environmental Monitoring and Assessment, 2007.

[13]  Characteristics of Hazardous Airborne Dust Around an Indian Surface Coal Mining Area.  M.K. Ghose and S.R. Majee, Environmental Monitoring and Assessment, 2007.

[14]  Relations between Health Indicators and Residential Proximity to Coal Mining in West Virginia. M. Hendryx and M. Ahem.  American Journal of Public Health, 2008.

[15]  Lung Cancer Mortality is elevated in coal-mining regions of Appalachia.  M. Hendryx, K. O’Donnell, and K. Horn, Lung Cancer, 2008.

[16]  COPD Prevalence is Increased in Lung Cancer, Independent of Age, Sex, and Smoking History.  R.P. Young, R.J. Hopkins, T. Christmas, P.N. Black, P. Metcalf, and G.D. Gamble, European Respiratory Journal, 2009.

[17] Mortality from heart, respiratory, and kidney disease in coal mining areas of Appalachia.  M Hendryx, Archives of Occupational and Environmental Health, 2009.