Coal mining is one of the most hazardous industries globally, exposing workers to a wide range of occupational risks, including dust inhalation, noise pollution, toxic gases, and physical strain. This study presents a comprehensive assessment of occupational health risks and disease prevalence among coal mine workers in India. A cross-sectional analytical approach was adopted using both primary and secondary data from selected coalfields. The results indicate that respiratory diseases, particularly pneumoconiosis and chronic obstructive pulmonary disease (COPD), are the most prevalent health issues, followed by hearing loss, musculoskeletal disorders, and cardiovascular conditions. The study also highlights the combined effects of environmental exposure, work duration, and lifestyle factors on worker health. Despite advancements in mining technology and safety regulations, occupational diseases remain a significant concern. The paper proposes integrated mitigation strategies including technological interventions, enhanced health surveillance, and improved safety culture. This research contributes to sustainable mining practices and provides actionable insights for policymakers and industry stakeholders.