It's unclear what will be the practical effects of a federal judge's ruling last week against the U.S. Environmental Protection Agency and in favor of the coal industry and the states of Kentucky and West Virginia.
Becoming more clear is what's at stake if the EPA once again abdicates its duty to industry-friendly state regulators.
It's not just "the need to preserve the verdant landscapes and natural resources of Appalachia" that District Judge Reggie Walton acknowledged in striking down an EPA guidance that's blamed for blocking 36 surface-mining permits in Kentucky.
Nor is it just protecting water and aquatic life.
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What's at stake are the people who live near surface mining, their health and their children's health.
A growing body of science links living in mountaintop mining areas to an array of bad medical outcomes, including premature death.
Most of this research has been led by Michael Hendryx, director of the West Virginia Rural Health Research Center at West Virginia University, and has been published in peer-reviewed journals.
Hendryx, whose work is not funded by anti-coal groups, has accounted for other factors, such as poverty, smoking and lack of medical access, that affect Appalachians' health. Even then his studies reveal higher rates of disease among residents of Appalachia who live near surface mining than among those who don't.
Birth defects are 42 percent higher for children born to residents living closer to surface mining. Cancer rates are 50 percent higher, kidney disease 70 percent higher, emphysema and similar lung diseases 64 percent higher, high blood pressure 30 percent higher.
As a follow up to Hendryx's research, the U.S. Geological Survey recently measured toxic compounds near mountaintop mining and found high levels of cancer-causing polycyclic aromatic hydrocarbons in soil and streams and elevated particle pollution in the air.
While the EPA may have erred, as the judge said, in the process it used to crack down on mountaintop mining, the agency most certainly should keep up the pressure on the industry and state agencies.
The EPA has a duty to protect human health and the environment — and both are at risk from current coal industry practices and state enforcement.
In Kentucky, the cabinet that sued the EPA reports a steady deterioration in the quality of coalfield streams.
In 2004, 27 percent of the Big Sandy River basin fully supported aquatic life; by 2010 that had declined to 18 percent, while the rest of the streams partially supported aquatic life or were pretty much dead.
The top culprits in the Big Sandy basin's deterioration, reports Kentucky's Cabinet for Energy and Environment, are sedimentation, lack of conductivity (water's ability to conduct electricity) and dissolved solids. The Clean Water Act has long required states to consider these factors in issuing mining permits; the overturned EPA guidance tried to put a sharper point on the requirement.
Since the industry and states sued the EPA, the market has moved away from coal toward cheaper, cleaner natural gas, costing thousands of miners their jobs.
Given coal's projected continued decline as an economic force, ruining the region's health to keep some strip-jobs going is not a good long-term strategy for the future.
Judge Walton issued no passes to violate the Clean Water Act; the EPA should keep the pressure on to protect the environment and people.