Health on Both Sides of Coal Workers, people living in coal regions, and the Swiss canton where a coal trader has its office Natalia Zubkova 24 October 2026 From the author I lived and worked in Kiselyovsk, where coal is mined close to people’s homes. I filmed black snow, dust, explosions and burning spoil heaps. But behind all of this there were always people: neighbours, acquaintances, families who invited me into their homes and told me about their lives. I saw a great deal of illness and many early deaths around me. In every family I knew, someone had cancer or had already died from it. People talked about illness all the time, and at some point I noticed how familiar these conversations had become. Illness among workers and residents is part of the price of coal, too. And the people paying that price are not the ones who own the coal companies. I want to understand what is known about the health of people who mine coal, process it or simply live near these operations. Which effects have been studied? What happens to a person after they leave the job? And how fully does official reporting reflect all of this? For this article, I turned to studies from different countries and to data from Kuzbass. For me, behind every figure are people I knew, and questions I could not answer at the time. One of the places I will compare is Appenzell Ausserrhoden, the Swiss canton where MIR Trade AG has its office, in the municipality of Teufen. The company traded large volumes of Russian coal. Its website refers to monthly shipments of almost a million tonnes through the Baltic region; a British buyer’s report names it as a supplier of Russian coal. I chose this canton because I want to look at both sides of the same trade: how people live where our coal was mined, and where it was traded from. The coal in these shipments was mined in Russia; the company that traded it has its office here. [1] [2] [3] Natalia Zubkova The information about MIR Trade comes from documents from different years. The office address appears on the company’s website; the page was saved on 21 October 2026. The page about its markets was checked on 24 October 2026: the company reports monthly shipments of almost a million tonnes through the Baltic region, but does not say which year this volume refers to. A Hargreaves Services announcement dated 22 February 2011 names MIR Trade as a supplier of Russian coal. These sources confirm trade in Russian coal; they do not establish that particular shipments came from Kuzbass. [1] [2] [3] The same themes recur in studies of coal industry workers and people living nearby: cough, chronic respiratory diseases, cardiovascular mortality and lung cancer. A screening programme in Pakistan found tuberculosis among both miners and residents. Separate sections look at children, mental health, suicide and HIV. Below are specific findings from different countries, data from Kuzbass and a comparison with Appenzell Ausserrhoden. The regional indicators cover years up to and including 2021: I am looking at the pre-war period, before Russia’s full-scale war against Ukraine. This is the time boundary for the comparison; later changes fall outside it. Each figure is accompanied by its period, population group and unit of measurement; the numbered links open the sources. The comparison with the canton offers a view of living conditions where a seller of Russian coal has its office. The canton was not selected as a control area for Kuzbass; the entire difference in the indicators cannot be attributed to coal mining. Health problems found among workers and residents Coal passes through underground or open-pit mines, processing plants, storage sites, terminals and coke plants. Studies of workers and their neighbours examine different levels of exposure, but many of the questions are shared. The findings for workers and residents are shown side by side below. Health problems shared by workers and residents: study findings side by side Health problem | Coal industry workers | People living in coal areas Cough and respiratory symptoms | Tanzania, underground mine: in the group with the highest dust exposure, the odds ratio for cough was 2.91 (95% CI 1.06–7.97). Workers with different dust doses were compared. [4] | India, Jharia: dry cough was reported by 17.3% of men in the commercial area and 6% of men in the control area. [5] Deaths from respiratory diseases | Czech Republic, former miners with pneumoconiosis: respiratory mortality was 2.78 times the expected level; for COPD separately, 2.94. [6] | United States, Appalachian counties with the highest coal production: chronic respiratory disease mortality was 7% higher for men and 11% higher for women than in counties without mining. [7] Cardiovascular mortality | Australia, Queensland: among men in the production group, the rate was 22% higher than among other men in the workforce cohort. [8] | United States, Appalachia: mortality from chronic heart disease was 28% higher for men and 18% higher for women than in counties without mining. [7] Lung cancer mortality | Czech Republic: among former miners with pneumoconiosis, the SMR was 1.70; among those without pneumoconiosis at enrolment, 0.83. The comparison was with men nationwide. [6] | Spain, near open-pit coal mines: RR 1.22 for both sexes; 1.29 for men and 0.57 for women. The comparison was with municipalities without mining within a 5 km radius. [9] Tuberculosis | Pakistan, Balochistan: 19 confirmed cases among 8,149 workers screened — 233 per 100,000 people screened. [10] | In the same programme: 15 cases among 6,392 people from neighbouring communities — 235 per 100,000 people screened. [10] The table compares the themes examined in the studies. OR: odds ratio; RR: relative measure; SMR: standardised mortality ratio. Sample sizes, years and confidence intervals are given in the text and the study table. Studies of residents looked at more than living near a mine. The selection includes open-pit mining, a coke plant, a coal terminal and the effects of plant closures. Studies of workers considered occupation, length of service, dust exposure and the years after leaving work. What emerges is not a single “coal disease”, but several different health problems that recur on both sides of the workplace boundary. Some of the results below are expressed as odds ratios, or ORs. Odds compare the probability of an event with the probability that it will not happen; risk is the probability of the event itself. An odds ratio therefore cannot be read as a risk ratio or as the proportion of people who become ill. Risk ratios and rate ratios express how many times greater or smaller the corresponding measures are in one group than in another. SMR is the ratio of recorded deaths to the number expected from the rates in a chosen comparison population, allowing for age and other elements of the calculation. The value indicating no difference depends on the scale: for OR and most relative measures it is 1; in the Australian study, SMR is expressed on a scale where 100 means no difference. In the Czech study, the corresponding SMR value is 1. [28] [6] A confidence interval shows the uncertainty around an estimate. If the interval for a relative measure includes the value indicating no difference — 1 on the usual scale, or 100 for SMR on the Australian scale — the data, within that calculation, are also compatible with no difference. A result that is not statistically significant does not establish that there is no effect. Intervals for proportions, percentage reductions and other measures must be read on their own scales. Coughing at work and at home In Tanzania, 250 men at an underground coal mine in Mbeya were examined in 2003–2004. Researchers measured dust, reconstructed work histories and asked about respiratory symptoms. Among the 10% of workers with the highest cumulative coal dust exposure, the odds ratio for cough was 2.91 compared with the quarter of workers with the lowest exposure. The calculation accounted for age and smoking. [4] In India’s Jharia coalfield, researchers studied residents. Among men living in the area the authors described as commercial, 17.3% reported a dry cough. In the control area, Chandankiyari, the figure was 6%. This comparison included 127 and 100 men respectively. The findings were published in 2015. [5] For Tanzania, the way the comparison was made matters. The elevated estimate of 2.91 applies to the top 10% of cumulative dust exposure. Taking the entire upper quarter of workers gives an OR of 1.50, with an interval of 0.68–3.35. Here, responses to questions about cough were compared with measurements of workplace dust. The odds ratio describes the difference between two groups. [4] Jharia offers another way to see the problem: the proportion of people reporting a dry cough can be read directly — about 17 in 100, compared with 6 in 100. But these figures concern men in one defined area. For men in the residential area, the authors report an OR of 2.01 and note that the difference from the control group was not statistically significant. Residents’ occupations were not separated out in this comparison. [5] For children, the consequences of respiratory symptoms can be seen even in school attendance. In Merseyside, England, a 1991 study collected questionnaires from parents of 1,872 children aged five to eleven. Five schools were between half a kilometre and two kilometres from the coal terminal in Bootle. These children had higher odds of missing more than one school day in a year because of cough, wheeze or breathlessness: the odds ratio was 1.59. The port also handled other cargo. [11] In Appenzell Ausserrhoden, the 2017 population health survey provides a local reference for respiratory disease: 3.17% of residents aged 15 and over reported a doctor’s diagnosis of asthma, and 2.48% reported chronic bronchitis, COPD or emphysema. The corresponding proportions for Switzerland were 4.76% and 2.00%. These are responses from people living in private households, not a survey of workers. [12] When illness continues after the job ends Coal miners face a particularly serious problem: pneumoconiosis, a dust-related lung disease. In Colombia’s Boyacá and Cundinamarca regions, 447 underground workers with at least ten years of service were examined in 2013–2014. Radiographic signs of pneumoconiosis were found in 35.9%. Workers from 29 companies took part in the study. [13] The disease can progress after dust exposure at work has ended. In Hokkaido, Japan, former miners with pneumoconiosis were followed from 1985 to 2005. Data remained available for 207 participants after ten years and 85 after twenty. The authors reported disease progression in 62% of those followed in the first decade and 29% in the second. These results cover two follow-up periods with different numbers of remaining participants. [14] In the Czech Republic, researchers followed mortality among former miners during 1992–2013. Among 3,476 men with recognised pneumoconiosis, 122 deaths from respiratory diseases were recorded. After standardisation for age and follow-up period, deaths from these causes were 2.78 times the number expected from rates among men nationwide. For chronic obstructive pulmonary disease — COPD — the ratio was 2.94. [6] A separate group of 6,687 former miners had no pneumoconiosis when they entered the study. There were 77 deaths from respiratory diseases in this group; the corresponding ratio to expected mortality was 1.08. These men had stopped working underground after reaching the prescribed dust exposure limit. [6] A long-term follow-up was also conducted in the United States: workers from 31 underground mines were enrolled in 1969–1971, and their causes of death were traced through the end of 2007. The final analysis included 8,829 people. Researchers reconstructed cumulative exposure to coal dust and silica and accounted for work history and smoking. [15] Within this cohort, among workers who had never smoked, an increase in cumulative coal dust exposure of 64.6 mg·years/m³ corresponded to a hazard ratio for death from COPD of 1.84 (95% CI 1.05–3.22). Among former smokers, the estimate was 1.52 (0.98–2.34). This compares exposure levels within a workforce; it is not the proportion of workers who became ill. It shows why smoking information alone is not enough: a history of occupational dust exposure is also needed. [15] Leaving the mine should therefore not mean the end of medical follow-up. In the Japanese study, the disease continued to change after work had stopped; in the Czech and American studies, outcomes were followed for many years. For the person concerned, this whole history matters, not just the last medical examination before leaving the job. [14] [6] [15] Our collection contains no study of a separate group of coal miners in Appenzell Ausserrhoden. Occupational findings are therefore compared here with other studies of workers, while the health of the canton’s residents is described separately. The same screening programme for miners and their neighbours In Balochistan, Pakistan, 96 outreach tuberculosis screening camps were organised in 2019. The programme covered coal mine workers and people in neighbouring communities across five districts. Participants were asked about symptoms, then sputum was tested; diagnoses were confirmed using Xpert MTB/RIF. [10] The rates among those screened were almost identical: 233 cases per 100,000 workers and 235 per 100,000 residents. In one programme, medical teams found the same disease among people working in the mines and their neighbours. But the near-identical rates in these two groups do not demonstrate an effect of coal: the study included no comparison with people outside coal areas. [10] How often tuberculosis is recorded in Kuzbass, and which Swiss data are available, is discussed below in “Tuberculosis and HIV”. Hearts and lungs in mortality statistics In Appalachia, researchers compared mortality among people living in coal-mining counties with mortality in US counties without mining. They examined 2000–2004, accounting for age and area characteristics, including social conditions and smoking prevalence. [7] In the group of Appalachian counties with the highest coal production, the relative mortality rate for chronic respiratory diseases was 7% higher for men and 11% higher for women. This group of causes included chronic bronchitis, emphysema, asthma and other chronic lower respiratory diseases. For chronic heart disease, the excess was 28% for men and 18% for women. For acute heart disease in men, by contrast, the rate was 11% lower. [7] In the same Appalachian study, the relative mortality rate for kidney-related causes was 19% higher for men and 13% higher for women. A corresponding local rate for Appenzell Ausserrhoden was not obtained from the data checked. [7] In Australia, cardiovascular mortality was studied within a large group of Queensland coal industry workers. The analysis included 161,534 men and 23,967 women whose occupation was known; mortality follow-up continued until November 2020. [8] Among men in the production group — which included miners and operators — the adjusted mortality rate for circulatory diseases was 22% higher than among the other men in the same workforce cohort. Researchers accounted for age, calendar period and smoking. This study compared occupations within the industry. The Appalachian study compared people living in different areas. [8] [7] Heart and respiratory diseases are studied among both workers and residents, but the comparison groups differ. In Australia, production workers were compared with other workers; in the United States, areas were compared with areas. Kidney-related causes add another question for monitoring residents’ health. The studies selected for this article do not provide an equivalent finding on coal workers’ mortality from kidney disease. Data on acute cardiovascular events are available for Appenzell Ausserrhoden. In 2017–2021, the average annual rate of myocardial infarction was 271.8 per 100,000, compared with 227.7 for Switzerland; the corresponding stroke rates were 283.4 and 249.8. All four values use the same age standardisation. For both indicators, the canton was above the national average. [16] [17] Lung cancer The Czech follow-up of former miners with pneumoconiosis recorded 116 deaths from cancer of the trachea, bronchus and lung. The standardised mortality ratio, relative to the number expected among men nationwide, was 1.70. In the group without pneumoconiosis at enrolment, 143 deaths were recorded and the ratio was 0.83. The groups differed in size and length of follow-up. [6] In Spain, researchers analysed cancer deaths in 1997–2006. They separately examined populations in twelve municipalities near open-pit coal mines and thirteen near underground coal operations. These were compared with municipalities that had no registered mining within five kilometres of the municipal centre. [9] Near open-pit mines, the relative lung cancer mortality rate for both sexes was 1.22. For men, it was 29% higher than the comparison rate; for women, 43% lower. Near underground coal operations, the overall relative rate was 1.09, with a 95% Bayesian interval of 0.95–1.26. [9] Coking is a separate industrial process. In Lorraine, France, researchers studied 534 men who had retired from two coke plants. During 1963–1982, 104 deaths were recorded, including 17 from lung cancer. The standardised lung cancer mortality ratio, relative to the number expected from rates in the French male population, was 2.51. The authors did not report a numerical confidence interval in the tables. [18] For all-cause mortality and all cancers combined, the French study found no significant excess. This is an important distinction within cancer research: the result for one cancer site may differ from the result for all cancers together. Lung cancer, other cancers and deaths from all causes are therefore considered separately. [18] The cantonal cancer registry also reports lung cancer separately. In 2017–2021, it recorded 94 new cases among men and 54 among women; in 2016–2020, it recorded 58 and 45 deaths respectively. Using the same age standard, the annual mortality rates were 26.7 per 100,000 men and 17.4 per 100,000 women. [19] Children: breathing and congenital anomalies In the study of schools near the Bootle terminal, the finding for school absence was more pronounced than the findings for individual diagnoses: the OR for missing more than one day because of respiratory symptoms was 1.59 (95% CI 1.23–2.04). For asthma, the OR was 1.25 (0.88–1.76); for wheeze, 1.37 (0.98–1.91). Both of these intervals included 1. The school absence analysis used 1,391 observations. [11] Another question is children’s health from the very beginning of life. A study in four central Appalachian states examined 1,889,071 live births in 1996–2003. In counties with mountaintop removal mining, the rate ratio for recorded congenital anomalies was 1.26 (95% CI 1.21–1.32) compared with counties without coal mining. For the combined group of circulatory and respiratory anomalies, it was 1.93 (1.73–2.15); for chromosomal anomalies, 0.92 (0.72–1.18). [20] A later study in West Virginia examined differences in recording between maternity hospitals. In a comparison covering 44 hospitals, the rate ratio after accounting for the birth hospital was 1.08 (95% CI 0.97–1.20). The authors found no statistically significant difference. The two studies partly overlapped in their areas and years. For local monitoring, this means that counts of anomalies need to be accompanied by information on where and how they were recorded. [21] Annual infant mortality figures are available for Appenzell Ausserrhoden: 5.38 per 1,000 live births in 2019, 1.83 in 2020 and 1.74 in 2021. In Kuzbass, the corresponding figures were 6.2, 5.6 and 5.5. Separate cantonal figures for congenital anomalies, preterm birth and low birth weight were not obtained from the pre-war materials checked. [22] [23] What changes when a coke plant closes In January 2016, the Shenango coke plant near Pittsburgh, Pennsylvania, closed. Researchers followed changes in residents’ use of medical services after the closure. They studied data for 2013–2018 and compared developments near the plant with those in control areas. [24] [25] The analysis found an immediate 41% reduction in the rate of children’s emergency department visits for asthma. In a separate study of the same closure, cardiovascular visits fell by 42%. The confidence intervals for these estimates were 14–60% and 33–51% respectively. [24] [25] Here, change can be observed over time: medical visits before and after the plant stopped operating. Childhood asthma and cardiovascular visits are covered in two publications about the same plant closure. They examine one local experience of reduced industrial exposure through different health outcomes. [24] [25] Mental health At two coal mines in West Bengal, India, researchers studied mental health between December 2016 and March 2019 among workers who used alcohol, tobacco or cannabis. The analysis of depressive symptoms included 131 people: 31, or 23.7%, screened positive on the HADS scale. The analysis of anxiety symptoms included 132 people; 38, or 28.8%, screened positive. [26] In Appenzell Ausserrhoden, the 2017 population survey found moderate or more severe depressive symptoms in 7.8% of participants aged 15 and over; for Switzerland, the figure was 8.6%. The 95% confidence interval was 5.2–10.3% for the canton and 8.1–9.1% for the country. The PHQ-9 questionnaire was used to assess the two weeks preceding the survey. [27] The Indian miners were a deliberately selected subgroup; the canton’s residents were a population sample. These are different groups of people assessed with different questionnaires, so the percentages cannot be compared directly. The sources collected contain no comparable pre-war estimate of depressive symptoms for the population of Kuzbass. Suicide: workers, coal regions and the canton In the Queensland coal worker cohort, 614 deaths by suicide among men and 18 among women were recorded by November 2020. After accounting for age, male mortality was 18% higher than expected from Australian rates; the female measure was 96 against an expected level of 100. When men were compared with the population of Queensland itself, the authors found no overall increase. [28] For Appalachia’s population in 2021, the US regional commission reports 21.0 deaths by suicide per 100,000 people aged 15–64, compared with 17.4 in the rest of the United States. These are age-standardised rates for a large region that includes both coal-mining and other counties. [29] Russian regions also differ. In 2021, recorded deaths by suicide per 100,000 residents were 19.09 in Kuzbass, 21.31 in Khakassia, 32.93 in Buryatia, 21.42 in Tuva and 4.56 in Rostov Region. The Russian rate was 10.71. A five-year series shows how the rates changed. [30] Between 2017 and 2021, the rate in Kuzbass fell from 25.61 to 19.09, in Khakassia from 32.37 to 21.31, and in Russia from 13.81 to 10.71 per 100,000. Data for each year and region are provided in the appendix. In Appenzell Ausserrhoden over the same five years, the average annual rate excluding assisted suicide was 17.00 per 100,000; for Switzerland, it was 11.75. The canton was above its national average. Assisted suicide is recorded separately; its rates are provided in the appendix. [31] Alcohol and drugs: separate health indicators In Kuzbass, mortality from accidental alcohol poisoning fell from 17.95 per 100,000 in 2017 to 11.72 in 2021. The corresponding figures for Russia were 8.36 and 6.36; for Khakassia, 10.42 and 9.05. These are deaths from a specific cause, recorded separately from diagnoses of dependence. [30] The materials checked contain no separate series for Appenzell Ausserrhoden on deaths from accidental alcohol poisoning and drug overdoses in 2017–2021. Surveys of alcohol and cannabis use answer a different question: they describe use, not the number of deaths. All-cause mortality and individual causes of death In the large Australian cohort of Queensland coal workers — 189,011 people — all-cause mortality through November 2020 was lower than expected from rates in the Australian population. The standardised mortality ratio was 81 for men and 75 for women, on a scale with a baseline of 100. These figures were 19% and 25% below the expected level respectively. [28] The authors discuss the “healthy worker effect”: industrial workers and the general population already differ in health when people enter employment. In a later analysis of this same cohort, they compared occupations and individual causes of death — the finding on cardiovascular mortality in the production group comes from that study. [28] [8] For residents of former coal-mining areas in England and Wales, there is also a long series of all-cause mortality data, covering 1981–2019. The main analysis compared 54 coal districts with districts matched on social characteristics but without a coal-mining history. In 1981, the gap in age-standardised rates was 122.6 deaths per 100,000 for men and 66.49 for women. By 2019, the gap had narrowed by 91% and 70% respectively. [32] This study shows why it is worth following not only today’s rate, but also changes over decades. For residents, the question is whether an area’s health disadvantage diminishes after mines close. For workers, it is whether health changes after dust exposure ends. These questions require years of follow-up of people and places. [32] [14] In 2021, life expectancy at birth was 67.54 years in Kuzbass and 83.43 in Appenzell Ausserrhoden: a difference of 15.89 years. For men, the published values were 62.69 and 80.82; for women, 72.31 and 86.23. The table also retains the pre-pandemic figures for 2019. [23] [33] Life expectancy at birth, years Group and year | Kuzbass | Russia | Appenzell Ausserrhoden | Switzerland Both sexes, 2019 | 69.69 | 73.34 | 83.20 | 83.72 Both sexes, 2020 | 68.44 | 71.58 | 82.77 | 82.97 Both sexes, 2021 | 67.54 | 70.15 | 83.43 | 83.58 Men, 2021 | 62.69 | 65.69 | 80.82 | 81.55 Women, 2021 | 72.31 | 74.50 | 86.23 | 85.53 Period life expectancy at birth. Russian values: the published series in the regional report, Table 75, p. 96; Swiss values: BFS / Obsan, category_id=1. [23] [33] Kuzbass: occupational diseases and population health In Kuzbass in 2021, 425 new diagnoses of occupational disease were recorded in coal mining — 50.30 per 10,000 workers. In 2019, there were 524 diagnoses and a rate of 56.25 per 10,000; in 2020, there were 421 and a rate of 50.63. These are diagnoses recorded in the industry. Figures for the region’s residents are presented separately. [23] First, the overall, or “crude”, mortality rates. These do not account for differences in the population’s age structure: mortality may be higher where older people make up a larger share of the population. The following figures therefore show recorded mortality levels, rather than directly comparing risk for people of the same age. In 2021, the all-cause mortality rate was 1,817.2 per 100,000 residents in Kuzbass, 1,608.1 in Khakassia, 1,673.9 in Russia and 910.78 in Appenzell Ausserrhoden. For circulatory diseases, malignant neoplasms and respiratory diseases, Kuzbass was also above the Russian rate that year. [30] [34] Mortality from circulatory diseases in Kuzbass in 2021 was 896.93 per 100,000, compared with 640.32 for Russia. For malignant neoplasms, the rates were 237.44 and 191.30; for respiratory diseases, 102.07 and 78.65. Separate comparable cantonal rates for these three groups of causes are not yet available in the collected materials. [30] The canton has its own data on myocardial infarction, stroke, respiratory diseases and lung cancer, presented in the relevant sections. For all-cause mortality in 2021, Appenzell Ausserrhoden was above the Swiss average: 910.78 versus 817.87 per 100,000. With the same age standardisation applied to both, the pattern remained: 895.0 versus 821.2. [34] Tuberculosis and HIV Newly registered active tuberculosis in Kuzbass in 2021 amounted to 70 cases per 100,000 residents, compared with 30.71 for Russia. A year earlier, the figures were 72.28 and 32.07. Each pair comes from the same federal tables. [35] [36] The materials collected contain no separate public tuberculosis rate for coal industry workers in Kuzbass. Nor does our collection contain a local series for Appenzell Ausserrhoden; the Swiss national rate for 2021 was 3.90 per 100,000. [37] In Kuzbass, the recorded number of people living with HIV rose from 1,934.9 per 100,000 population at the end of 2019 to 2,069.7 at the end of 2021. This count includes people with AIDS. New diagnoses in a single year are a different indicator: in 2021, Kuzbass recorded 79.49 new cases per 100,000, while Russia recorded 41.72. [38] [35] [36] The cantonal report states that Appenzell Ausserrhoden recorded one new HIV case in each year from 2016 to 2019. Its permanent population at the end of 2019 was 55,445: with that denominator, one recorded case corresponds to approximately 1.8 per 100,000. In 2019, Kuzbass recorded 179.5 new cases per 100,000, and Russia 64.5. The canton’s figure of 1.8 is calculated here from one case and the year-end population. It is not a published annual rate from the Swiss Federal Office of Public Health (BAG). [39] [38] For 2021, BAG reports 3.47 new HIV cases per 100,000 for Switzerland. A separate prevalence figure — the number of people living with HIV — for Appenzell Ausserrhoden was not obtained from the sources checked. [40] These data describe the health of the region’s population. On their own, they do not establish a link between the spread of infections and coal mining. Comparing the canton across the article’s health themes Appenzell Ausserrhoden offers several different answers. Life expectancy here is considerably higher than in Kuzbass. Infant mortality was also lower in 2020 and 2021. Yet for myocardial infarction, stroke, all-cause mortality and suicide, the canton was above the Swiss average. The same place can do well on some measures and have higher rates on others. Appenzell Ausserrhoden was chosen because it is home to the office of MIR Trade, a company that traded Russian coal. It is a place where coal was traded, rather than a control area specifically matched to Kuzbass. The comparison shows how health and living conditions differ on the two sides of the coal economy. It does not determine how much of the gap is due to coal: age, income, smoking and access to treatment also affect these indicators. [1] [3] Health needs to be visible in the reports There is already a concrete answer to the question of what official reporting shows. In Kuzbass in 2021, 425 new diagnoses of occupational disease were recorded in coal mining. Separate series show population mortality, new tuberculosis and HIV cases, the number of people living with HIV, and life expectancy. These are different indicators: occupational diagnoses concern workers, while regional statistics concern the whole population. [23] [30] [36] [33] In this article, most territorial indicators refer to the region as a whole. Assessing the health of people living near particular operations requires more detailed local data. A regional average does not, by itself, describe life beside an individual underground mine, open-pit mine or processing plant. This is a boundary of the present comparison, not a claim that city-level data or studies do not exist. In studies of occupational and environmental exposure, the respiratory theme recurs most clearly: cough, chronic lung diseases, medical visits and deaths from respiratory causes. The period after employment matters too: pneumoconiosis can progress in former miners. Studies of people living near industrial operations add cardiovascular outcomes, lung cancer, children’s respiratory symptoms and birth outcomes; findings depend on the type of operation and the way comparisons are made. [14] [6] [7] [9] [11] [20] [21] The Shenango coke plant closure shows that changes after industrial exposure falls can also be observed: researchers recorded fewer childhood asthma visits and fewer cardiovascular visits. Follow-up of former miners, in turn, shows why a person’s health history does not end on the day they leave work. [24] [25] [14] The overall picture of population health is a different level of description. Suicide, infections, poisoning, life expectancy and all-cause mortality matter for understanding life in a region, but that does not make them a list of established consequences of coal. Exposure studies and regional statistics need to be read alongside one another, while keeping the distinction between them. I want people to be visible alongside the tonnes of coal mined and sold. The people who worked in the mine. Those whose homes ended up beside an open pit or processing plant. And those who live where coal is traded. That means looking beyond production volumes to workers’ health after they leave the company, their neighbours’ health, and how it changes over time. There are already specific studies, places, years and figures on which to base this conversation. Sources [1] MIR Trade AG. About company / Impressum. Page undated. https://mirtrade.ch/about-company/ About company; address in the Impressum: Alte Haslenstrasse 5, CH-9053 Teufen AR. Snapshot dated 21 October 2026. [2] MIR Trade AG. Sales structure. Page undated. https://mirtrade.ch/sales-structure/ Baltic region section: almost 1,000,000 mts monthly. A company statement about shipments, not an independent measurement; the period to which this volume refers is not specified. [3] Hargreaves Services plc. Interim results. 2011. Issuer announcement published by Investegate. https://www.investegate.co.uk/announcement/rns/hargreaves-services--hsp/interim-results/2019077 Section on European trading and the joint venture with MIR Trade AG: supplier of Russian coal. [4] Mamuya SH, Bråtveit M, Mashalla Y, Moen BE. High prevalence of respiratory symptoms among workers in the development section of a manually operated coal mine in a developing country: a cross sectional study. BMC public health. 7. 17. 2007. https://doi.org/10.1186/1471-2458-7-17 Table 4; Methods. [5] Masto RE, Rout TK, Srivastava NK, Ram LC. Health status of communities living around Jharia coalfield area. Bhartiya Vaigyanik evam Audyogik Anusandhan Patrika. 2015;23(2):87–92. https://nopr.niscpr.res.in/handle/123456789/33774 Printed pp. 88–89; Table 1, PDF p. 3. [6] Tomášková H, Šplíchalová A, Šlachtová H, Urban P, Hajduková Z, Landecká I, Gromnica R, Brhel P, Pelclová D, Jirák Z. Mortality in Miners with Coal-Workers' Pneumoconiosis in the Czech Republic in the Period 1992-2013. International journal of environmental research and public health. 14(3). E269. 2017. https://doi.org/10.3390/ijerph14030269 Table 3; Results; Methods. Table 3, row “Malignant neoplasm of lung (C33–C34)”. [7] Hendryx M. Mortality from heart, respiratory, and kidney disease in coal mining areas of Appalachia. International archives of occupational and environmental health. 82(2). 243-249. 2009. https://doi.org/10.1007/s00420-008-0328-y Table 1: causes of death included; Tables 2–3: models for men and women. Printed pp. 245–247, PDF pp. 3–5. [8] Glass DC, Gwini SM, Monaco AD, Fritschi L, Abramson MJ, Sim MR, Walker-Bone K. Are mortality rates similar between jobs in the Queensland coal mine workers' cohort?. BMC public health. 25(1). 3004. 2025. https://doi.org/10.1186/s12889-025-24163-4 Abstract; Results, comparisons of occupational groups by cause of death. [9] Fernández-Navarro P, García-Pérez J, Ramis R, Boldo E, López-Abente G. Proximity to mining industry and cancer mortality. The Science of the total environment. 435-436. 66-73. 2012. https://doi.org/10.1016/j.scitotenv.2012.07.019 Table 2, author manuscript PDF pp. 41–44; numerical results on p. 42. Methods, PDF pp. 14–20. [10] Eman KU, Kazi GN, Qin ZZ, Creswell J, Raisani SA, Lodhi UR, Vasquez NA, John S. Improving TB care services among coal mine workers and their associated communities in Pakistan. Public Health Action. 2025;15(3):129–134. https://doi.org/10.5588/pha.25.0011 Methods; Results; Table 1. [11] Brabin B, Smith M, Milligan P, Benjamin C, Dunne E, Pearson M. Respiratory morbidity in Merseyside schoolchildren exposed to coal dust and air pollution. Archives of disease in childhood. 70(4). 305-312. 1994. https://doi.org/10.1136/adc.70.4.305 Methods, pp. 306–307; results and regression, pp. 307–310; Table 7, p. 310 (PDF p. 6); Discussion, pp. 310–312. [12] Obsan. Atemwegserkrankungen [Respiratory diseases]. Official dataset downloaded in 2026; observations before 2022 used. https://ind.obsan.admin.ch/api/_131/kg/json data: kanton_nr=15/0; sex_id=0; year=2017; category_id=1 (asthma), 2 (chronic bronchitis / COPD / emphysema). Field: value; percentages, not standardised. Residents aged 15+ in private households reporting a doctor’s diagnosis. [13] Torres Rey CH, Ibañez Pinilla M, Briceño Ayala L, Checa Guerrero DM, Morgan Torres G, Groot de Restrepo H, Varona Uribe M. Underground Coal Mining: Relationship between Coal Dust Levels and Pneumoconiosis, in Two Regions of Colombia, 2014. BioMed research international. 2015. 647878. 2015. https://doi.org/10.1155/2015/647878 Methods; Table 5. [14] Kimura K, Ohtsuka Y, Kaji H, Nakano I, Sakai I, Itabashi K, Igarashi T, Okamoto K. Progression of pneumoconiosis in coal miners after cessation of dust exposure: a longitudinal study based on periodic chest X-ray examinations in Hokkaido, Japan. Internal medicine (Tokyo, Japan). 49(18). 1949-1956. 2010. https://doi.org/10.2169/internalmedicine.49.2990 Methods, pp. 1949–1950; Table 2 and Figures 1–2, pp. 1951–1952; Discussion, pp. 1954–1955. PDF pp. 1–7. [15] Graber JM, Stayner LT, Cohen RA, Conroy LM, Attfield MD.. Respiratory disease mortality among US coal miners; results after 37 years of follow-up.. Occupational and environmental medicine. 71(1). 30-39. 2014. https://doi.org/10.1136/oemed-2013-101597 Methods, Results, Tables 1–4 and the note to Table 2; CDC author manuscript, 23 PDF pages. Corrigendum: Occup Environ Med 2014;71:738, https://oem.bmj.com/content/71/10/738. [16] Obsan. Akuter Myokardinfarkt [Acute myocardial infarction]. Official dataset downloaded in 2026; observations before 2022 used. https://ind.obsan.admin.ch/api/_011/kg/json data: kanton_nr=15/0; sex_id=0; category_id=1; year=2017-21. standardised_rate and 95% CI limits. Hospitalisations minus in-hospital deaths, plus all deaths from myocardial infarction; ESP2010 (Eurostat 2013). [17] Obsan. Hirnschlag [Stroke]. Official dataset downloaded in 2026; observations before 2022 used. https://ind.obsan.admin.ch/api/_013/kg/json data: kanton_nr=15/0; sex_id=0; category_id=1; year=2017-21. standardised_rate and 95% CI limits. Hospitalisations minus in-hospital deaths, plus all deaths from stroke; ESP2010 (Eurostat 2013). [18] Bertrand JP, Chau N, Patris A, Mur JM, Pham QT, Moulin JJ, Morviller P, Auburtin G, Figueredo A, Martin J.. Mortality due to respiratory cancers in the coke oven plants of the Lorraine coalmining industry (Houillères du Bassin de Lorraine).. British journal of industrial medicine. 44(8). 559-565. 1987. https://doi.org/10.1136/oem.44.8.559 Methods, pp. 560–561; Tables 4–6, p. 562; case-control analysis and Discussion, pp. 563–564. Saved scan, PDF pp. 1–7. [19] Krebsregister Ostschweiz. Jahresbericht 2022 [Annual report 2022]. Cantonal tables for Appenzell Ausserrhoden. https://ostschweiz.krebsliga.ch/krebsregister-ostschweiz-forschung/publikationen/jahresberichte/-dl-/fileadmin/krebsliga_ostschweiz/downloads/jahresberichte/kr_JB_KROCH_2022_OCHFL.pdf PDF p. 111: incidence, 2017–2021; p. 112: mortality, 2016–2020. C33–C34: lung/trachea; all sites excluding C44. P. 25: European standard population, Waterhouse et al., 1976. [20] Ahern MM, Hendryx M, Conley J, Fedorko E, Ducatman A, Zullig KJ.. The association between mountaintop mining and birth defects among live births in central Appalachia, 1996-2003.. Environmental research. 111(6). 838-846. 2011. https://doi.org/10.1016/j.envres.2011.05.019 Methods, PDF pp. 2–4; Tables 2–4, PDF p. 5; limitations, §4.2, PDF p. 7. The saved publisher’s proof has its own pagination, pp. 1–9. [21] Lamm SH, Li J, Robbins SA, Dissen E, Chen R, Feinleib M.. Are residents of mountain-top mining counties more likely to have infants with birth defects? The West Virginia experience.. Birth defects research. Part A, Clinical and molecular teratology. 103(2). 76-84. 2015. https://doi.org/10.1002/bdra.23322 Pp. 76–81 (PDF pp. 1–6): Methods, Table 1, Results and Discussion. P. 76 notes the version correction dated 15 December 2014. [22] BFS. Säuglingssterblichkeit nach Kanton [Infant mortality by canton]. Historical annual rates. https://dam-api.bfs.admin.ch/hub/api/dam/assets/36837706/master Table: rows Schweiz (4) and Appenzell Ausserrhoden (19), columns 2019, 2020, 2021. Deaths before age one per 1,000 live births; based on small numbers. [23] Rospotrebnadzor Directorate for Kemerovo Region — Kuzbass. On the state of sanitary and epidemiological well-being of the population in Kemerovo Region — Kuzbass in 2024. 2024 (year on the title page). [In Russian.] https://42.rospotrebnadzor.ru/content/813/ PDF p. 91 / printed p. 90, Table 72: infant mortality, 2019–2021 — 6.2; 5.6; 5.5 per 1,000 live births. PDF p. 97 / printed p. 96, Table 75: life expectancy in Russia and Kuzbass, 2019–2021. PDF p. 164 / printed p. 163, Table 108: occupational disease rates, B05 coal mining, 2019–2021 — 56.25; 50.63; 50.30 per 10,000 workers. PDF p. 165 / printed p. 164, Table 109: 524; 421; 425 new occupational diseases. [24] Yu W, Thurston GD. Reductions in Respiratory Hospital Visits after a Coal Coking Plant Closure: A Natural Experiment. American journal of respiratory and critical care medicine. 211(11). 2072-2085. 2025. https://doi.org/10.1164/rccm.202410-2005oc Results; Table 4; Figure 5. [25] Yu W, Thurston GD. An interrupted time series analysis of the cardiovascular health benefits of a coal coking operation closure. Environmental Research: Health. 1. 045002. 2023. https://doi.org/10.1088/2752-5309/ace4ea PDF p. 2, Abstract; Methods 2; Results and limitations. [26] Chakrabarti A, Saha I, Kalita M, Bhattacharya D, Haque B, Nagraj A, Mukherjee S, Benegal V. High prevalence of alcohol use disorder & psychiatric comorbidity among coal mine workers: Observations from a cross-sectional study in West Bengal. The Indian journal of medical research. 160(1). 95-101. 2024. https://doi.org/10.25259/ijmr_2407_23 Methods, inclusion criteria; Table I and Table II. [27] Obsan. Gesundheit im Kanton Appenzell Ausserrhoden. Ergebnisse aus der Schweizerischen Gesundheitsbefragung 2017 [Health in the canton of Appenzell Ausserrhoden: results of the 2017 Swiss Health Survey]. Report 02/2019. https://www.obsan.admin.ch/sites/default/files/obsan_bericht_02-2019-appenzell_ausserrhoden.pdf PDF p. 38 / printed p. 36, Table 2.19: moderate and severe symptoms on PHQ-9; AR 7.8% (95% CI 5.2–10.3), n=601; CH 8.6% (8.1–9.1), n=18,230. Residents aged 15+ in private households. [28] Glass DC, Gwini SM, Del Monaco A, Fritschi L, Abramson MJ, Sim MR, Walker-Bone K. Mortality and cancer incidence among Queensland coal mine workers: a retrospective cohort. Occupational and environmental medicine. 82(3). 120-127. 2025. https://doi.org/10.1136/oemed-2024-109549 Methods; Tables 2–3. Suicide: Table 2; Results: 2016–2020 and the comparison with Queensland. [29] Appalachian Regional Commission / NORC / East Tennessee State University. Appalachian Diseases of Despair. Update 2025. July 2025. https://www.arc.gov/wp-content/uploads/2025/07/Appalachian-Diseases-of-Despair-Update-2025.pdf PDF p. 14 / printed p. 10, Exhibit 6: 2021, ages 15–64, standardised suicide mortality of 21.0 in Appalachia and 17.4 outside Appalachia per 100,000. Only 2021 used; this large region includes different types of areas. [30] Rosstat / EMISS. Population mortality by cause of death, indicator No. 31270. Saved download from the open NSED mirror. [In Russian.] https://www.fedstat.ru/indicator/31270 Mirror: https://repository.nsedc.ru/dataset/emiss_31270; area code, cause of death, “whole population”, columns 2017–2021. Suicide: X60–X84; other rows follow the table codes. Unit: per 100,000 population. Direct EMISS download returned 403 when checked; provenance and version are retained in the metadata. [31] Obsan. Suizid [Suicide]. Official cantonal dataset. https://ind.obsan.admin.ch/indicator/obsan/_010 API https://ind.obsan.admin.ch/api/_010/kg/json; data: year=2017-21; kanton_nr=15/0; sex_id=0; category_id=1: suicide excluding assisted suicide; 2: assisted suicide. n: average annual count; crude_rate and standardised_rate: per 100,000. Full period: five years. [32] Shaikh M.. The health legacy of coal mining: Analysis of mortality rates over time in England and Wales (1981-2019).. SSM - population health. 27. 101706. 2024. https://doi.org/10.1016/j.ssmph.2024.101706 Methods 2; Table 3, models 1 and 7. [33] Obsan. Lebenserwartung [Life expectancy]. Official dataset downloaded in 2026; observations before 2022 used. https://ind.obsan.admin.ch/api/_001/kg/json data: kanton_nr=15 (AR), 0 (CH); category_id=1; sex_id=0/1/2; year=2019–2021. Life expectancy at birth, years. [34] Obsan. Sterblichkeit [Mortality]. Official dataset downloaded in 2026; observations before 2022 used. https://ind.obsan.admin.ch/api/_007/kg/json data: kanton_nr=15/0; sex_id=0; year=2021. crude_rate: crude mortality rate; standardised_rate: European age standard ESP2010 (Eurostat 2013); n: deaths. [35] Rospotrebnadzor. State report: On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2020. Moscow, 2021. [In Russian.] https://t-j.ru/media/gd-seb_0206-_s-podpisyu_.pdf P. 137, Table 48: tuberculosis, Kuzbass 72.28, Russia 32.07. P. 140, Table 50: registered HIV prevalence, Kuzbass 1,998.6. All rates per 100,000. [36] Rospotrebnadzor. State report: On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2021. Moscow, 2022. [In Russian.] https://xn--80aaoiec5a4aa9czf.xn--p1ai/documents/280/%D0%93%D0%BE%D1%81._%D0%B4%D0%BE%D0%BA%D0%BB%D0%B0%D0%B4_%D0%9E_%D1%81%D0%BE%D1%81%D1%82%D0%BE%D1%8F%D0%BD%D0%B8%D0%B8_%D1%81%D0%B0%D0%BD%D0%B8%D1%82%D0%B0%D1%80%D0%BD%D0%BE-%D1%8D%D0%BF%D0%B8%D0%B4%D0%B5%D0%BC%D0%B8%D0%BE%D0%BB%D0%BE%D0%B3%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%BE%D0%B3%D0%BE_%D0%B1%D0%BB%D0%B0%D0%B3._%D0%BD%D0%B0%D1%81%D0%B5%D0%BB%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B2_%D0%A0%D0%A4_%D0%B2_2021_%D0%B3%D0%BE%D0%B4%D1%83.pdf Pp. 182–183, Table 1.50: tuberculosis, Kuzbass 70.0, Russia 30.71. P. 184, Table 1.52: new HIV cases and registered HIV prevalence, Kuzbass / Khakassia / Russia. Coverage of the Federal Penitentiary Service is not separately specified in the tuberculosis table. [37] BAG. Informationsportal übertragbare Krankheiten [Communicable diseases information portal]: tuberculosis. Mandatory reporting, annual incidence. https://www.idd.bag.admin.ch/en/diseases/tuberculosis/data Saved POST request and API response: /api/v1/data/tuberculosis/cases/incValue/year. country=CH, all sex/age groups. Years selected: 2019–2021; source: mandatory_reporting_system. Available breakdowns checked using metadata/value-metadata: this API contains no separate AR series. [38] Federal Scientific and Methodological Centre for AIDS Prevention and Control, Central Research Institute of Epidemiology, Rospotrebnadzor. HIV infection in the Russian Federation in 2019. [In Russian.] https://forum.hiv.plus/assets/uploads/files/1583139023176-vich-infektsiya-v-rossijskoj-federatsii-na-31.12.2019.pdf P. 1: new cases, Kuzbass 179.5, Russia 64.5; people living with HIV in Kuzbass, 1,934.9 per 100,000. The data are described as preliminary. [39] Obsan / Kanton Appenzell Ausserrhoden. Gesundheitsbericht Appenzell Ausserrhoden 2021 [Appenzell Ausserrhoden health report 2021]. Obsan Report 02/2021. https://www.obsan.admin.ch/sites/default/files/obsan_02_2021_bericht_ar_1.pdf PDF p. 43, G12: 55,445 permanent residents at the end of 2019; PDF p. 102, section 7.6: one new HIV notification in each year from 2016 to 2019. 1 / 55,445 × 100,000 = 1.8036: calculation for this article. [40] BAG. Informationsportal übertragbare Krankheiten [Communicable diseases information portal]: HIV. Mandatory reporting, annual incidence. https://www.idd.bag.admin.ch/en/diseases/hiv/data Saved POST request and API response: /api/v1/data/hiv/cases/incValue/year. country=CH, all sex/age groups. Years selected: 2019–2021; source: mandatory_reporting_system. Available breakdowns checked using metadata/value-metadata: this API contains no separate AR series. [41] Ministry of Health of the Republic of Tuva. Report on activities in 2017. [In Russian.] https://minzdravtuva.ru/images/2017%D0%B3pdf.pdf PDF p. 9 / printed p. 6: comment on the classification of deaths of undetermined intent; PDF p. 10, Table 7. Suicide in 2017: 5.6 per 100,000; injuries of undetermined intent: 90.3. [42] Federal Scientific and Methodological Centre for AIDS Prevention and Control. HIV infection. Information Bulletin No. 47. Data for 2021. 2023. [In Russian.] https://hivhub.ru/wp-content/uploads/2023/05/byulleten-47-vich-infektsiya-za-2021-g.pdf Table, PDF pp. 70–71 / printed pp. 69–70: alternative registered HIV prevalence figures for Kuzbass, 2,003.6 (2020) and 2,027.3 (2021); 52,796 people and a population of 2,604,272. Does not replace the published federal report values; retained for comparison between versions. Photographs An industrial site, coal stockpiles and a strip of greenery in front of them. 29 July 2019. Photo: Smogman archive. A residential street in summer. 14 July 2019. Photo: Smogman archive. Exposed rock layers in the wall of an open excavation. 29 July 2019. Photo: Smogman archive. Water between rocky slopes, with a path and vegetation along the banks. 18 July 2019. Photo: Smogman archive. Kiselyovsk railway station, tracks and a pedestrian bridge. 8 March 2019. Photo: Smogman archive.