Coal jobs continue to decline in Eastern Kentucky, while evidence keeps piling up that surface mining is sickening the region's residents.
The most recent addition to this growing body of science is a study by University of West Virginia epidemiologist Michael Hendryx that found residents of an Eastern Kentucky coal county self-reported significantly more cancer, heart disease, asthma and other illnesses than residents of two nearby counties where there is no coal or mining.
The Kentucky study is consistent with earlier research by Hendryx in West Virginia linking health and coal data that show a greater risk of cancer, birth defects and early death among those living near mountaintop mining.
It's consistent too with research by the University of Kentucky that identified two lung cancer clusters in the state's eastern coalfield that cannot be explained solely by the usual culprit, smoking.
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(Something critics of these studies fail to acknowledge is that the researchers use long-accepted statistical methods to filter out the effects of poverty, education levels, smoking and other factors not related to living near surface mining. The studies are reviewed by scientists with no connection to the research project before publication.)
After discovering the cancer clusters, UK researchers began analyzing toenail clippings and discovered that coalfield residents have higher levels of arsenic, cadmium and nickel in their bodies than residents of Louisville.
These heavy metals cause a wide range of illnesses and disabilities from birth defects to cancer; children are especially susceptible to them.
We usually think of industrial smokestacks spreading toxic metals but they also are released into the air and water when mountaintops are blasted off, bringing the Earth's crushed innards to the surface. Coal trucks track the toxics-laced mud from mine sites past homes, schools, churches and businesses; the mud dries into dust that becomes airborne and eventually settles on homes and cars and in people's lungs and bloodstreams.
Both Hendryx and U.S. Rep. John Yarmuth, D-Louisville, have called for a moratorium on mountaintop removal mining and for a definitive study of its health effects. Yarmuth has introduced legislation to that effect in Washington.
Predictably their concerns about health have yielded no response from elected officials or public health agencies in Kentucky.
But the market seems to be taking care of the moratorium on mountaintop removal.
Fewer than 4,000 people are now employed in surface mining in Kentucky, according to state data, a 35 percent decline since 2011.
Of all the nation's coal-producing areas, the drop in production last year was most pronounced in Eastern Kentucky: 28.6 percent versus 7.2 percent nationwide.
Production was up 3 percent in Western Kentucky.
Just two mines in Wyoming produced 20 percent of the nation's coal, a trend that bodes ill for the industry in Appalachia where the remaining reserves are expensive to mine and therefore less profitable.
It adds up to some hard questions about the future in a region tied to a single dying industry that's killing its people.