1. 1 Slurry pond Edge of mine Elementary School Coal processing plant

2. Mountaintop Removal Mining Removes the entire tops of mountains and ridges Explosives and draglines reach coal seams hundreds of feet deep Spoil is deposited into adjacent valleys Has permanently buried over 1,200 miles of streams Occurs in Central Appalachia, USA, over an area about 50,000 square km 2

3. Explosion over the town of Dorothy 3

4. 4

5. Well water in the town of Rawl, West Virginia 5 Photo: Antrim Casky, 2008 Photo: Nat Geographic, 2006

6. 6

7. Age-adjusted total mortality rates per 100,000 by MTR status 7 Hendryx, JHDRP 2011

8. 8 Age-Adjusted Lung Cancer Mortality per 100,000, years 2000-2004 Hendryx, O’Donnell, Horn, Lung Cancer, 2008

9. 2000-2004 Age-Adjusted Heart Disease Mortality per 100,000 9 Hendryx, IAOEH 2009

10. Disease Symptoms in MTR Areas 10 Prevalence ratios controlling for age, sex, education, marital status, current and former smoking, overweight and obesity, occupational exposure. Hendryx, J Rural Health 2013

11. Family Illness in MTR Areas 11 Prevalence ratios controlling for age, sex, education, marital status, current and former smoking, overweight and obesity, occupational exposure. (JRH 2013)

12. Adjusted Prevalence Ratios (PR) of Birth Defects are High in MTR Areas PR

13. Environmental Samples These findings prompted environmental sampling studies

14. Mountaintop Mining (MTM) Dust in People’s Yards MTM dust is primarily silicon, sulfur, other elements (e.g., Al, Fe, Ti) and organics 14 MTM No MTM Blank

15. Ultrafines Total Count /cm3Deposited count/cm3 MTR68303082 Control in WV47702315 15 Particulate matter <o.1µ High surface to volume toxicity, high deposition rate Kurth, et al. J Exposure Science & Environmental Epidemiology 2014

16. MTR dust accelerates cancer development in human lung cells Luanpitpong et al., Environmental Science and Technology, 2014

17. Public Water Uncertainties From 2001 through 2009, there were 17,362 water quality violations reported to the EPA from West Virginia: – 86 per facility in MTR areas – 15 per facility in rest of the state Hendryx, Fulk and McGinley, Water Quality, Exposure & Health, 2012 17

18. Conductivity in Water The EPA established that water from MTR sites should have maximum conductivity of 500 microsiemens/cm. (A healthy mountain stream will average about 100.) We found …. Drinking water samples NOT MTR = 267 Drinking water samples MTR = 552 Former MTR ground water drinking samples = 1,614 MTR stream samples (non-drinking) = 1,234 Non-MTR streams (non-drinking) = 95 18

19. Summary: MTR and Public Health Poor health concentrated in MTR areas Impacts stronger as mining levels increase Present for women, men, and children Present across multiple data sources and health outcomes – Cancer, cardiovascular disease, respiratory disease, birth defects, others Become stronger in closer proximity to MTR Air and water pollution exists in mining communities Strong environmental and public health evidence that MTR should be halted – Political resistance! 19