''We know people are dying and getting diseases in Lithgow at a rate much higher than elsewhere and it is a legitimate question to ask if the coal industry is contributing to that,'' local doctor Richard Stiles said. The SWAHS 2005-10 Healthcare Services plan showed Lithgow's cancer rate to be 20 per cent greater than the state average. But 2008 figures show a drop. A spokeswoman for the health service explained: ''Over time, rates of some individual cancers have been higher in some years but the number of cases in the small Lithgow population means that rates vary from year to year.'' The earlier figures also showed the rate of heart attacks at almost 50 per cent greater than the rest of NSW. Dr Stiles said: ''What the community needs is an independent health inquiry to see if this environmental pollution, both air- and water-borne, is having an adverse impact on the health of the people living here.'' The figures also show a greater number of smokers and overweight people in the area, but Dr Stiles said: ''It doesn't stack up that these problems are just down to poor lifestyle. From a local doctor's perspective this is a major issue that should not be swept under the carpet.''

He was among a group of doctors who raised questions last year about decontaminated mine discharge water from the Clarence colliery being added to the drinking supply to try to drought-proof the town. Conservationists also raised the alarm about the nearby coal-fired Wallerawang power plant releasing toxic metals and pollutants such as arsenic into the Coxs River, which feeds into Sydney's water supply. There are plans to extend another coal-fired plant at Mount Piper. The area health service recommended it become gas-fired to cut air pollution. ''The location of the peak air pollution impact is on two of the most disadvantaged suburbs in SWAHS, potentially exacerbating existing health inequalities,'' it warned. People living near the power station, at Blackmans Flat and Wallerawang, were regularly exposed to high levels of sulphur dioxide, which the report said was linked to greater levels of respiratory and cardiac disease. Residents regularly complain about talcum-powder-like ash from mines dusting their homes.

Asthma Foundation NSW chief Greg Smith called on the state government to improve air monitoring: "[We are] aware of long-standing concerns about the very high rates of asthma in Lithgow and of the anecdotal evidence that coal dust and pollution from heavy machinery used in mining and the transport of coal may be either causing or exacerbating asthma.'' A spokeswoman for the area health service said: ''Lithgow residents also have higher rates of admission to hospital for asthma than the NSW average. Increased rates of asthma can be caused by a number of factors, especially exposure to tobacco smoke, pollens, dust mite, mould and other types of indoor and outdoor air pollution.'' Kirsty Ruddock, principal solicitor with the Environmental Defenders Office, said the law needed to be reformed to provide greater protection to residents in areas around coal-fired power stations and coal mining. She pointed to American research that found long-term exposure to fine dust particles increased the risk of heart disease and lung cancer. Greens MP Lee Rhiannon has entered a motion in Parliament calling for a health study into mining and power station emissions in the Hunter be extended to Lithgow. And she called for an Environment Protection Agency office to be opened in Lithgow after research showed 22 mines in the area breached their pollution licences 1267 times between 2000 and 2008 (a third of the total incidents reported across NSW).

Many of the breaches were a failure to report results of their own monitoring. There are no EPA staff in the area to provide independent checks. "Coal companies are making huge windfall profits yet the NSW government is failing to enforce the environmental conditions of mine approval,'' Ms Rhiannon said. "Coal companies barely get a slap on the wrist for pollution breaches, so they continue to reoffend. The Springvale colliery in Lidsdale, the state's worst offender, continues to breach its licence every year. ''Communities do not want to breathe coal dust, nor do they want arsenic, nickel, zinc and copper entering the water catchment.'' Bob Miller, from Springvale Colliery's owner Centennial Coal, said the EPL breaches were the result of a broken water monitor.

''This was a minor onsite issue which posed a zero threat to the environment and in actual fact is an environmentally responsible disposal of onsite water … ''However, for each day the equipment was not working and despite continued manual monitoring another individual breach was calculated,'' Mr Miller said. A spokeswoman for Environment Minister Frank Sartor said the department did not consider Springvale discharges had caused significant water pollution issues over the past 10 years And she said there was no need for a new EPA office: ''There is an EPA office located in the Bathurst region - approximately 40 minutes from Lithgow.'' Lithgow mayor Neville Castle said air quality in Lithgow was fine: ''I think people should get their facts straight before they start raising things in Parliament.''

He said the greater mortality rates in Lithgow were similar to those in Holroyd. Loading ''I don't see a lot of power stations there.''