Access to energy has a positive effect on the health

and well-being of people worldwide. However, the

use of coal to generate electricity has negative health

consequences that dwarf those of other energy sources,

making coal by far the least preferable resource for meet-

ing energy needs while protecting human health.

Pollutants generated by coal combustion can have pro-

found effects on the health of communities, especially

vulnerable individuals such as children, the elderly, preg-

nant women, and those suffering from asthma and lung

disease in urban settings. Coal’s harmful effects include

cardiovascular and respiratory diseases, and impairment

of brain and nervous system development. Air pollution

is carcinogenic to humans, and long-term exposure in

particular can increase mortality rates, as evaluated by the

World Health Organization. Coal pollution can travel long

distances, thus affecting populations living far away from

power plants. Moreover, coal combustion contributes to cli-

mate change, which is already having and will continue to

have significant and growing health impacts for hundreds

of millions of people worldwide. The mining and transport

of coal, as well as the disposal of coal waste ash, can also

have significant health effects.

Estimates of the combined health costs of coal-fired

power generation are staggering, greatly increasing its

cost to consumers if fully accounted for. Taken together,

the health effects of coal are simply too burdensome to

ignore, morally and financially. Around the world, in plac-

es like Beijing and Delhi, citizens and communities are

advocating for urgent action to address poor air quality

and other deadly impacts of coal.

COAL FACTSHEET #5

Deadly EnergyThe Health Impacts of Coal

Photo Credit: groundWork/FOE South Africa

HEALTH SECTOR SUPPORTS END TO COAL• The World Federation of Public Health

Associations called for “a rapid phase out of coal for electricity production and greater investment in renewable energy technologies as a significant investment in global health and healthy communities.”1

• Ministers of health gathered at the World Health Assembly in 2015 adopted a landmark resolution on “addressing the health impact of air pollution,” which urges governments to redouble efforts to identify, address, and prevent the health impacts of air pollution through multi-sectoral approaches.2

• The 2015 Lancet Commission on Health and Climate Change (a special report from a prestigious medical journal) calls on governments to “protect cardiovascular and respiratory health by ensuring a rapid phase out of coal from the global energy mix.”3

• The Healthy Energy Initiative – a global network of health professionals, academics, and organizations advocating for a shift away from coal and other fossil fuels towards clean, renewable energy – has become active in several countries and at the global level.4

COAL’S EFFECTS ON THE HUMAN BODY

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RESPIRATORY EFFECTSGases and particles (dust and soot) emitted from coal

power plants enter the body through the mouth and nose,

where some of them cause irritation. Eyes can also be irri-

tated from acute exposure to acidic gases. In the bronchia

and lungs, pollutants lead to inflammation and physiologi-

cal stress, which over the long term causes cell death and

changes the lung tissue. The following pollutants are of

particular concern for respiratory health:

• Particulate Matter (PM) emitted or formed as a result

of coal combustion contains small particles less than

2.5 micrometres in diameter (PM2.5) that travel deep

into the airways and lead to respiratory stress, asthma,

impairments in lung function. This results in increased

numbers of emergency department visits and hospital

admissions for infections and chronic obstructive pul-

monary disease. Long-term exposure to PM2.5 is caus-

ally linked to the development of lung-cancer. Note

that NOx and SO2, whose primary health effects are

described below, are also precursor gases that react

in the atmosphere to form secondary PM, which often

produces a greater health burden than the primary PM

directly produced by coal combustion.

• Sulphur Dioxide (SO2) emitted by coal burning power

plants leads to inflammation and hyper responsiveness

of the airways, aggravates bronchitis, decreases lung

function, and increases hospitalizations and emergen-

cy department visits for asthma and other respiratory

conditions, particularly among children and adults over

65. Even low concentrations of SO2 are associated with

increased risk of death from heart and lung conditions.

• Oxides of Nitrogen (NOx) are byproducts of fossil

fuel combustion and react with chemicals in the at-

mosphere to create ground-level ozone (smog) and

nitrogen dioxide (NO2). NO2 exposure among asth-

matic children can increase wheezing, cough, and dec-

rements in lung function. It increases susceptibility to

viral and bacterial infections, increases hospital admis-

sions and emergency department visits for respiratory

causes, and at high concentrations can cause airway

inflammation.

CARDIOVASCULAR EFFECTSInhalation of PM2.5 has been linked to cardiovascular

disease and death. The World Health Organization esti-

mates that worldwide, 5% of cardiopulmonary deaths are

due to particulate matter pollution. Long term exposure to

PM2.5 can accelerate the buildup of plaque inside arteries

and increase emergency department visits and hospital

admissions for heart disease and congestive heart failure.

An 8-18% increase in cardiovascular deaths is estimated to

occur per 10 µg/m3 increase in average PM2.5 concentra-

tion. Furthermore, the arteries nourishing the brain can be

affected, leading to an increased risk of stroke.

CANCER AND OTHER CHRONIC DISEASESNot only has air pollution been classified as a known can-

cer-causing substance for humans, but also coal mining

dust emissions can increase the risk for lung cancers. Heavy

metals (such as arsenic and cadmium) and organic toxicants

(such as PAHs and dioxins) are present in high concentra-

tions in coal fly ash and coal sludge, and are also emitted

directly from smoke stacks. They can harm the liver and

kidneys as well as other vital organs, and can cause cancer.

REPRODUCTIVE HEALTHEvidence is sufficient to conclude that exposure to air

pollution (containing SO2, PM, NO2, and ozone) during

pregnancy can cause low birth weight,9 pre-term birth

and complications during pregnancy.10 Infant mortality

was shown to increase with increased coal consumption

in countries that had mid to low infant mortality rate at

baseline (in 1965) such as Chile, China, Mexico, Thailand,

Germany, and Australia.

NEUROLOGICAL EFFECTSCoal power plants are the second largest source of mercury

releases to the environment globally, due to their emissions

of gaseous mercury as well as mercury in their waste water.

Mercury is known to accumulate in sediments and organic

tissue, thus increasing in concentration while making its way

up the food chain. Human exposure occurs mostly through

the consumption of contaminated fish and shellfish. Con-

sumption of methyl mercury-contaminated food by young

children and pregnant women can cause developmental

effects in these children and in the foetus. Effects include

lower intelligence levels, delayed development of the brain

and central nervous system,11 attention deficit disorders,12

and subtle changes in vision, memory, and language.

MENTAL HEALTH AND SOCIAL HARMSCoal projects can also impact mental health (which also

affects physical health) and damage the social and eco-

nomic well-being of communities. These mental health

and social harms may include: distress related to concerns

about adverse health impacts; costs associated with en-

vironmental damage and declining land values; concerns

regarding noise and air pollution; social divisions and in-

equalities between those benefiting from the coal industry

and those who do not; and distress and disempowerment

resulting from asymmetries of power, influence, and ac-

cess to information and resources.13

E N D C O A L | 3Infograhic courtesy of Greenpeace

COST OF THE HEALTH BURDEN FROM THE USE OF COAL

The monetary value of the damage to public health and the environment has been

estimated to be 18-45 US cents per kWh for US power plants, which would at least

triple its cost to consumers. An EU-wide cost estimate arrived at 5.3 c€ per kWh,

ranging between 0.4 and 29.5 c€ per kWh for individual countries. In the EU alone,

coal is responsible for 18,000 premature deaths and four million lost working days

each year, costing up to €43 billion annually.7 The costs of coal pollution are esti-

mates of direct health costs such as medication and hospital visits from the higher

rates of disease, lost productivity as people are sick and remain absent from work, as

well as societal costs from premature mortality.

Additionally, researchers at the International Monetary Fund recently estimated that

fossil fuels are subsidized by US $5.3 trillion in 2015, 6.5% of global GDP, greater than

the health spending of all the world’s governments. Ending these subsidies, which

include the health and other costs imposed on governments for dealing with air

pollution, would slash premature deaths from outdoor air pollution by 55% – about 1.6

million lives a year – with coal accounting for a 93% share of this reduction.14

COAL KILLSWhile a global estimate is

not yet available, an aggre-

gation of estimates from

different countries suggest

that at least 800,000 people

die prematurely each year

as a consequence of coal :

• 670,000 premature

deaths per year in China5

• 80,000 to 115,000 pre-

mature deaths per year

in India6

• 13,000 premature

deaths per year in the

United States7

• 23,300 premature

deaths per year in

Europe8

HEALTH IMPACTS OF COAL THROUGH ITS LIFE CYCLEEach step in the coal life cycle generates pollution that has repercussions for

human health. To learn more, refer to Coal Factsheet #1, available at http://

endcoal.org/resources/end-coal-fact-sheets/.

COAL, CLIMATE CHANGE, AND HEALTH

ENDNOTES

1 World Federation of Public Health Associations (2015): Kolkata Call to Action. http://www.wfpha.org/images/declarations/150216_Kolkata_Call_to_Action_FINAL.pdf

2 World Health Organization (2014) : Health and the environment : addressing the health impact of air pollution. http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R8-en.pdf

3 Watt N, et al. (2015) : “Health and climate change: policy responses to protect public health.” Lancet http://climatehealthcommission.org/the-report/

4 Healthy Energy Initiative. www.healthyenergyinitiative.org .

5 Li J (2014) : 670,000 smog-related deaths a year : the cost of China’s reliance on coal. South China Morning Post http://endcoal.org/2014/11/670000-smog-related-deaths-a-year-the-cost-of-chinas-reliance-on-coal/

6 Conservation Action Trust, Urban Emissions, and Greenpeace (2013): http://www.greenpeace.org/india/Global/india/report/Coal_Kills.pdf

7 Clean Air Task Force (2010) : The Toll from Coal : An Updated Assessment of Death and Disease from America’s Dirtiest Energy Source. http://www.catf.us/resources/publications/view/138

8 Health and Environment Alliance (2013) : The Unpaid Health Bill : How coal power plants make us sick http://www.env-health.org/IMG/pdf/heal_report_the_unpaid_health_bill_how_coal_power_plants_make_us_sick_final.pdf

9 Dadvand P, Parker J, Bell ML, et al. (2013): Maternal Exposure to Particulate Air Pollution and Term Birth Weight: A Multi-Country Evaluation of Effect and Heterogeneity. Environmental Health Perspectives Online. http://dx.doi.org/10.1289/ehp.1205575

10 Olsson D, Mogren I, Forsberg B (2013): Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study. British Medical Journal BMJ Open. http://bmjopen.bmj.com/content/3/2/e001955.abstract

11 Grandjean P, Weihe P, White RF, et al. (1997): Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicology and Teratology, 1997, 19:417–428

12 Boucher O, Jacobson SW, Plusquellec P, et al. (2012): Prenatal Methylmercury, Postnatal Lead Exposure, and Evidence of Attention Deficit/Hyperactivity Disorder among Inuit Children in Arctic Québec. Environmental Health Perspectives, 2012, 120:1456–1461. http://ehp.niehs.nih.gov/2012/10/1204976/ ; Sagiv SK, Thurston SW, Bellinger DC, et al. (2012): Prenatal exposure to mercury and fish consumption during pregnancy and attention-deficit/hyperactivity disorder-related behavior in children. Archives of Pediatrics & Adolescent Medicine, 2012 December, 166(12):1123-31. doi: 10.1001/archpediatrics.2012.1286

13 Climate and Health Alliance (2014) : Health and Energy Choices : Background Briefing Paper. http://caha.org.au/health-and-energy-background-briefing-paper/

14 Coady D, Parry IWH, Sears L, Shang B (2015): How large are global energy subsidies? The International Monetary Fund https://www.imf.org/external/pubs/cat/longres.aspx?sk=42940.0

15 International Energy Agency (2014) : CO2 emissions from fossil fuel combustion, 2014 edition. https://www.iea.org/publications/freepublications/publication/CO2Emissions FromFuelCombustionHighlights2014.pdf

ENDCOAL.ORG

The Lancet Commission on Health and Climate Change

states that “climate change is the biggest global health

threat of the 21st century,” and that “responding to climate

change could be the greatest global health opportunity of

the 21st century.”3

Two of the major greenhouse gases contributing to

climate change, carbon dioxide and nitrous oxide, are

products of coal combustion. In fact, coal is responsible

for 44% of global CO2 emissions.15 Coal mining releases

methane, a potent greenhouse gas.

Public health will be affected by climate change as a

result of:

• extreme weather events such as floods, hurricanes,

and droughts that in turn, increase disease and injury,

and adversely affect water quality and food security;

• changing precipitation patterns and higher tempera-

tures with adverse effects on food security, leading to

malnutrition of large population groups;

• an increase in the growing ranges of some weeds,

grasses, and trees that may increase the severity and

prevalence of allergies;

• the spread of climate-sensitive diseases such as tick- and

mosquito-borne diseases and food- and water-borne

pathogens an increase in ground-level ozone and smog

which aggravate asthma and increase hospital visits; and

an increase in the number of extremely hot days and

tropical nights which leads to heat-related mortality.

Coal is a deadly and costly source of energy that must

be phased out of the global energy mix in order to

protect the lives, health, and well-being of current and

future generations.

NOTE: Unless specifically cited, the source for information in this fact sheet is: Burt E, Orris P, and

Buchanan S. (2013): Scientific Evidence of Health Effects from Coal Use in Energy Generation.

University of Illinois at Chicago and Health Care Without Harm.

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