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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.


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The Costs of Coal

Posted on April 14, 2011

By Paul Epstein, MD MPH and Molly Rauch, MPH

This essay is in response to: What is the most important achievement we've gained through air pollution management? What remains to be done to safeguard public health from air pollution?

Energy is essential to our daily lives, and is the foundation of our modern, industrial society. But fossil fuels, which feed the energy appetite of our nation and that of most developed nations, cost our society dearly in terms of health, environmental, and economic impacts.

Coal combustion in particular seems cheap. But there are billions of dollars in hidden costs to our annual coal consumption. A full cost accounting of our coal consumption needs to take into account each stage in the life cycle of coal – extraction, transport, processing, and combustion. An analysis of the external costs of this full life cycle reveals multiple hazards for health and the environment, including:

  • Death, illness, and disabilities of miners due to accidents and black lung disease;
  • The environmental destruction and watershed contamination resulting from Mountain Top Removal mining;
  • Spills, toxic exposure, property damage, and injuries due to the thousands of sludge and slurry ponds storing coal combustion waste;
  • Poor health in coal-mining regions, with increased deaths from lung cancer, heart, respiratory, and kidney disease, and higher rates of reproductive disorders;
  • Deaths, air pollution, and the resulting health consequences from rail transport of coal, which accounts for 70% of total US rail traffic;
  • Degraded forests, fisheries, and waterways due to acid rain and “fertilization” of waterways, both of which are in part due to nitrogen emissions from coal combustion;
  • Groundwater contamination due to inadequate reclamation of abandoned mine lands;
  • Coal’s contribution to climate change and the resulting health, environmental, and economic impacts, such as a warming planet, stronger hurricanes, heat waves, flooding, drought, wildfires, food insecurity, and damage to life support systems.

The life cycle effects of coal and the waste stream generated are costing the US public between one third and one half a trillion dollars every year.

Air pollution from coal combustion makes up a significant portion of those hidden costs. Coal combustion releases CO2, methane, particulates and oxides of nitrogen, oxides of sulfur, mercury, heavy metals, and carcinogenic chemicals into the atmosphere. Indeed, coal power is responsible for most of the US power generation-related emissions of PM2.5 (51%), NOx (35%), and SO2 (85%). These and other coal combustion pollutants contribute to respiratory illness, heart arrhythmias, infant mortality, lung cancer, hospitalizations, and asthma exacerbations, among other major health problems.

The Clean Air Act has acted on these emissions, and our air is cleaner, and healthier, than it would be without these important regulations in place. But the EPA air quality standards are not adequately health protective. This is especially evident in the case of PM2.5. The EPA has set the annual particulate concentration standard at 15.0 µg/m3, arguing that there is no evidence for harm below this level. Exposure to these particles has been epidemiologically linked with increases in all-cause premature mortality, cardiovascular and cardiopulmonary mortality, respiratory illnesses, hospitalizations, respiratory and lung function symptoms, and school absences. A reanalysis of the Harvard Six Cities Study, a large US cohort study on the health effects of air pollution, found little support for EPA’s assumption that there is a threshold level of particulate exposure below which there are no health effects. There may be no safe level of exposure to PM2.5. Safeguarding public health from air pollution in the future will mean tightening our air quality standards.

It is time to move away from a coal-powered nation. This will have tremendous health benefits due to preventing and reducing air pollution. It will also yield multiple co-benefits to society, potentially saving our economy billions of dollars annually, as well as reducing environmental pollution and the carbon emissions that are the cause of global warming. It’s a win-win situation, and it can happen through the implementation of smart energy policies, including the following strategies:

  • Conduct comprehensive comparative life-cycle analyses of the costs of all electricity sources including the public health costs of pollution.
  • Implement alternative industrial and farming policies in coal-field regions to support solar, wind, small-scale hydro, and smart grid energy technologies.
  • Phase in cleanly powered smart grids using place-appropriate alternative energy sources.
  • Plug electric vehicles into cleanly powered smart grids.
  • End mountaintop removal (MTR) mining; reclaim MTR sites and abandoned mine lands.

It is time to realign federal and state regulations and incentives to stimulate manufacture of and markets for clean energy systems. This realignment would benefit our health, the environment, our economy, and our planet’s climate.


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