Health Effects of Burning Fossil Fuels

Air Pollution

The burning of fossil fuels is the world’s largest contributor to air pollution and is a major global public health concern. It releases a wide array of harmful pollutants, including particulate matter, ozone, nitrogen dioxide, sulfur dioxide, mercury, and other hazardous air pollutants. The health effects of breathing polluted air include reduced lung function, asthma, cardiovascular disease, preterm birth, and premature death.39 Generally, older people are more susceptible to premature death due to air pollution40 while children are especially vulnerable to asthma and impaired lung function development.41 Air pollution, predominantly from burning fossil fuels, reduces worldwide average life expectancy by nearly three years.42 If fossil fuel emissions were completely eliminated, the global average life expectancy would increase by 1.1 years.43 

In the U.S., more than 100 million people live in areas where pollution exceeds national standards.44 Research has shown that reducing pollution and improving air quality has significant positive impacts on health. In Southern California, for example, reductions in nitrogen dioxide and particulate matter (PM) over a 21-year period led to 20 percent fewer asthma diagnoses in children.45 Yet, research has shown that even pollution at levels below national standards adversely affects health, signaling a need for stronger regulation and enforcement. A study of the Medicare population in the U.S. found significant evidence of increased risk of death from exposure to fine PM and ozone at concentrations below the National Ambient Air Quality Standards.46 Another study concluded that as air pollution increases, the rate of mortality increases almost linearly, and that any level of air pollution is harmful to human health.47

Particulate Matter Pollution

PM pollution is a mixture of solid particles and liquid droplets found in the air and is the largest environmental health risk factor in the U.S., accounting for 63 percent of deaths from environmental causes.48 PM pollution varies in size, and is usually classified in two categories — larger particles with diameters up to 10 micrometers and the more deadly49 fine particles with diameters 2.5 micrometers or smaller.50 The majority of PM2.5 is formed through chemical reactions in the air with pollutants emitted from power plants, automobiles, and other sources of fossil fuel emissions.51 

Exposure to PM has been associated with a wide range of health problems, including cardiovascular disease, respiratory issues, lung cancer, and adverse birth outcomes,52 and is associated with up to 45,000 deaths annually.53 PM2.5 pollution has more recently been linked to hospitalizations for common diseases, including those related to blood, skin, and kidneys, even when daily PM2.5 levels are below World Health Organization (WHO) air quality guidelines.54 In fact, researchers have concluded that there is no level of PM2.5 pollution below which the risk of death is negligible, and therefore no “safe” level of PM2.5.55

Improvements in air quality from reducing PM pollution have been shown to have significant positive impacts on health. For example, reducing PM pollution could increase average life expectancy by eight months in the wildfire-prone areas in the Central Valley of California and by two months in the industry-heavy areas of Pittsburgh, Pennsylvania and eastern Ohio.56 Unfortunately, after declining by 24.2 percent from 2009 to 2016, average annual PM pollution in the U.S. increased by 5.5 percent between 2016 and 2018. This increase was associated with 9,700 additional premature deaths in 2018, representing $89 billion in damages.57

Ozone Pollution

Ozone, the main ingredient in forming smog, is another exceptionally dangerous air pollutant that results from burning fossil fuels. Ozone is made up of nitrogen oxides and volatile organic chemicals that develop in the atmosphere after being emitted from tailpipes, power plants, refineries, and other sources.58 Exposure to ground-level ozone is associated with many adverse health effects including premature death, respiratory hospital admissions, cases of aggravated asthma, lost days of school, and reduced productivity among outdoor workers.59 More than one million deaths worldwide60 and 51,000 deaths in the U.S. are associated with ground level ozone pollution every year.61 

Coal Impacts on Public Health

Burning coal releases a number of harmful pollutants, including particulate matter, sulfur dioxide, nitrogen dioxide, and metals such as mercury, arsenic, chromium, and other known and possible carcinogens. The public health consequences of extracting, processing, and burning coal include respiratory illness, cancer, cardiovascular disease, kidney disease, poor birth outcomes, poor quality of life, mental health problems, and death.62 More than 3,000 deaths every year are attributable to PM2.5 pollution from U.S. coal-fired power plants.63 Exposure to mercury released from power plants has been linked to an increased risk of diabetes and autoimmune dysfunction in adults and permanent neurological damage in children.64

Research has shown that regulation and enforcement efforts aimed at reducing emissions from coal-fired power plants result in positive impacts for public health.65 For example, reductions in sulfur dioxide emissions from coal-fired power plants in Kentucky were associated with fewer local hospitalizations and emergency department visits due to asthma, as well as decreases in people’s use of rescue inhalers.66 Analysis by the Union of Concerned Scientists found that closing Illinois’ coal plants by 2030 and replacing them with clean energy would prevent significant numbers of heart attacks, hospital admissions, incidents of chronic bronchitis, and premature deaths.67

Coal-fired power plants also harm public health by producing immense quantities of coal ash, a byproduct of burning coal that contains numerous toxic metals including mercury, arsenic, lead, chromium, cadmium, nickel, zinc, and others.68 There are at least 737 coal ash dumps in 43 states, nearly all of which are contaminating groundwater with toxins.69 Power plants typically dispose of coal ash in surface impoundments, often unlined, which leak into surrounding soil, groundwater and surface water, and are disproportionately likely to be located near low-income communities. Breathing and ingesting coal ash toxins can cause a multitude of health problems including cancer, cardiovascular problems, and nervous system damage,70 and research has documented increased health problems in children who reside near coal ash impoundments.71 

Oil & Gas Production and Public Health

More than 50 million Americans live near oil and gas operations that have measured air pollution levels exceeding the federal health standard.72 Oil and gas operations are the leading industrial source of smog-forming volatile organic compounds, releasing numerous toxic chemicals, such as hydrogen sulfide, toluene, xylene, benzene, and formaldehyde, that have serious public health impacts.73 Exposure to air pollution released by the oil and gas sector is expected to cause 2,000 premature deaths, 3,600 emergency room visits, 100,000 lost days of work, and over a million asthma exacerbations annually by 2025 and each year thereafter, resulting in annual health damages of $13 to 26 billion.74 Studies have also linked living near oil and gas wells to lower birth weights, preterm births, and other negative birth outcomes in Colorado, Pennsylvania, Oklahoma, and Texas. A study of millions of birth records in California found that pregnant women living near the highest-producing wells in the state were 40 percent more likely to have low birth weight babies than people living farther away or near inactive sites.75

Transportation and Public Health

The transportation sector, which relies almost entirely on fossil fuels, is the largest source of U.S. greenhouse gas emissions and accounts for more than two-thirds of all oil burned in the U.S. every day.76 Pollution emitted by the transportation sector includes particulate matter, volatile organic compounds, nitrogen oxides, carbon monoxide, and sulfur dioxide, and causes a wide array of health impacts ranging from respiratory, cardiovascular, and immune system problems to cancer and premature death.77 In New York City alone, PM2.5 pollution from motor vehicle emissions contributes to 320 deaths and 870 hospitalizations and emergency department visits annually.78 As with nearly all polluting industries, reducing air pollution from the transportation sector would have significant positive impacts on public health. For example, studies have found that implementing clean transportation policies could prevent 120,000 premature deaths by 2030 and 14,000 deaths annually thereafter.79


39Cleaner Air Tied to Healthier Lungs in Kids, Nᴀᴛ. Iɴsᴛs. ᴏꜰ Hᴇᴀʟᴛʜ (Mar. 16, 2015), [hereinafter Cleaner Air].

40Neela Banerjee, Breathing Polluted Air Shortens People’s Lives by an Average of 3 Years, a New Study Finds, Iɴsɪᴅᴇ Cʟɪᴍᴀᴛᴇ Nᴇᴡs (March 3, 2020),

41Cleaner Air, supra note 39.

42Jos Lelieveld et al., Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective, 116 Cᴀʀᴅɪᴏᴠᴀsᴄᴜʟᴀʀ Rᴇsᴇᴀʀᴄʜ 1910 (2020),


44Christopher G. Nolte et al., Air Quality, in Iᴍᴘᴀᴄᴛs, Rɪsᴋs, ᴀɴᴅ Aᴅᴀᴘᴛᴀᴛɪᴏɴ ɪɴ ᴛʜᴇ Uɴɪᴛᴇᴅ Sᴛᴀᴛᴇs: Fᴏᴜʀᴛʜ Nᴀᴛɪᴏɴᴀʟ Cʟɪᴍᴀᴛᴇ Assᴇssᴍᴇɴᴛ, Vᴏʟᴜᴍᴇ II 13 (2018),

45Asthma cases dropped when air pollution declined, Nᴀᴛ. Iɴsᴛs. ᴏꜰ Hᴇᴀʟᴛʜ (June 18, 2019),

46Qian Di et al., Air Pollution and Mortality in the Medicare Population, 376 N. Eɴɢʟ. J. Mᴇᴅ. 2513 (2017),

47Air pollution linked to risk of premature death, Nᴀᴛ. Iɴsᴛs. ᴏꜰ Hᴇᴀʟᴛʜ (Jan. 9, 2018),

48Inequitable Exposure to Air Pollution from Vehicles in the Northeast and Mid-Atlantic, Uɴɪᴏɴ ᴏꜰ Cᴏɴᴄᴇʀɴᴇᴅ Sᴄɪᴇɴᴛɪsᴛs (June 21, 2019),

49The Weight of Numbers: Air Pollution and PM2.5, Uɴᴅᴀʀᴋ (2018),

50Cleaner Air, supra note 39.

51Particulate Matter (PM) Basics, U.S. Eɴᴠᴛʟ. Pʀᴏᴛ. Aɢᴇɴᴄʏ, (last visited Sept. 14, 2020).

52Particle Pollution, U.S. Cᴛʀ. ꜰᴏʀ Dɪsᴇᴀsᴇ Cᴏɴᴛʀᴏʟ ᴀɴᴅ Pʀᴇᴠᴇɴᴛɪᴏɴ (last updated Sept. 4, 2020).

53U.S. Eɴᴠᴛʟ. Pʀᴏᴛ. Aɢᴇɴᴄʏ, Pᴏʟɪᴄʏ Assᴇssᴍᴇɴᴛ ꜰᴏʀ ᴛʜᴇ Rᴇᴠɪᴇᴡ ᴏꜰ ᴛʜᴇ Nᴀᴛɪᴏɴᴀʟ Aᴍʙɪᴇɴᴛ Aɪʀ Qᴜᴀʟɪᴛʏ Sᴛᴀɴᴅᴀʀᴅs ꜰᴏʀ Pᴀʀᴛɪᴄᴜʟᴀᴛᴇ Mᴀᴛᴛᴇʀ (2020),

54Short-term exposure to air pollution linked with hospital admissions, substantial costs, Tʜᴇ Hᴀʀᴠᴀʀᴅ Gᴀᴢᴇᴛᴛᴇ (Dec. 23, 2019),

55Di et al., supra note 46.

56Michael Greenstone & Claire Fan, Air Quality Life Index Annual Update, Eɴᴇʀɢʏ Pᴏʟɪᴄʏ Iɴsᴛ. ᴀᴛ ᴛʜᴇ Uɴɪᴠ. ᴏꜰ Cʜɪᴄᴀɢᴏ (July 2020),

57Karen Clay & Nicholas Z. Muller, Recent Increases in Air Pollution: Evidence and Implications for Mortality, Nᴀᴛ. Bᴜʀᴇᴀᴜ ᴏꜰ Eᴄᴏɴᴏᴍɪᴄ Rᴇsᴇᴀʀᴄʜ (2019),

58Ozone, Aᴍ. Lᴜɴɢ Assɴ., (last updated Apr. 20, 2020).

59Nolte et al., supra note 44, at 518.

60Andy Haines & Kristie Ebi, The Imperative for Climate Action to Protect Health, 380 N. Eɴɢʟ. J. Mᴇᴅ. 263 (2019),

61Health and Economic Benefits of 2°C Climate Policy: Hearing on “The Devastating Impacts of Climate Change on Health” before the H. Comm. on Oversight and Reform, 116th Cong. (2020) (testimony of Drew Shindell, Distinguished Professor of Earth Sciences, Nicholas School of the Environment),

62Michael Hendryx et al., Impacts of Coal Use on Health, 41 Aɴɴᴜᴀʟ Rᴇᴠɪᴇᴡs 397 (2020)

63Raising Awareness of the Health Impacts of Coal Plant Pollution, Cʟᴇᴀɴ Aɪʀ Tᴀsᴋ Fᴏʀᴄᴇ (last visited Sept. 14, 2020) [hereinafter Raising Awareness].

64Massachusetts et al., Comment Letter on Proposed National Emission Standards for Hazardous Air Pollutants Coal- and Oil-Fired Electric Utility Steam Generating Units–Reconsideration of Supplemental Finding and Residual Risk and Technology Review (Apr. 17, 2019) (state comments in opposition to proposed reversing of the finding in the MATS rule).

65Raising Awareness, supra note 63.

66Drop in coal power plant emissions associated with asthma improvements, Nᴀᴛ. Iɴsᴛs. ᴏꜰ Hᴇᴀʟᴛʜ (Apr. 21, 2020),

67Soot to Solar: Illinois’ Clean Energy Transition, Uɴɪᴏɴ ᴏꜰ Cᴏɴᴄᴇʀɴᴇᴅ Sᴄɪᴇɴᴛɪsᴛs (Oct. 24, 2018),

68Hendryx et al., supra note 62, at 404.

69Mapping the Coal Ash Contamination, Eᴀʀᴛʜᴊᴜsᴛɪᴄᴇ (Nov. 6, 2019),

70Harm to Human Health from Breathing and Ingesting Coal Ash Toxicants, Eᴀʀᴛʜᴊᴜsᴛɪᴄᴇ, (last visited Sept. 14, 2020).

71Hendryx et al., supra note 62, at 405.

72Methane Pollution from the Oil & Gas Industry Harms Public Health, Eɴᴠᴛʟ. Dᴇꜰᴇɴsᴇ Fᴜɴᴅ, (last visited Sept. 14, 2020) [hereinafter Methane Pollution].


74Methane Leaks from Oil & Gas Exploration: A Health Nightmare, Nᴀᴛᴜʀᴀʟ Rᴇsᴏᴜʀᴄᴇs Dᴇꜰᴇɴsᴇ Cᴏᴜɴᴄɪʟ (Dec. 04, 2018),

75Emily Dooley, California Study Finds Lower Birth Weights Near Oil, Gas Wells, Bʟᴏᴏᴍʙᴇʀɢ Lᴀᴡ Nᴇᴡs (Jan. 27, 2020),

76The Impacts of Oil, Uɴɪᴏɴ ᴏꜰ Cᴏɴᴄᴇʀɴᴇᴅ Sᴄɪᴇɴᴛɪsᴛs, (last visited Sept. 14, 2020).

77Cars, Trucks, Buses and Air Pollution, Uɴɪᴏɴ ᴏꜰ Cᴏɴᴄᴇʀɴᴇᴅ Sᴄɪᴇɴᴛɪsᴛs, (last updated July 19, 2018).

78Iyad Kheirbek, The contribution of motor vehicle emissions to ambient fine particulate matter public health impacts in New York City: a health burden assessment, 15 Eɴᴠᴛʟ. Hᴇᴀʟᴛʜ 89 (2016)

79Haines & Ebi, supra note 60.