Coal’s Assault on Human Health

Physicians for Social Responsibility has released a groundbreaking medical report, “Coal’s Assault on Human Health,” which takes a new look at the devastating impacts of coal on the human body. Coal combustion releases mercury, particulate matter, nitrogen oxides, sulfur dioxide, and dozens of other substances known to be hazardous to human health. This report looks at the cumulative harm inflicted by those pollutants on three major body organ systems: the respiratory system, the cardiovascular system, and the nervous system. The report also considers coal’s contribution to global warming, and the health implications of global warming.

1. Introduction

Almost half of the energy used to generate
electricity in the United States
comes from burning coal, as shown in
Figure 1.1. Coal is a major component
of the economy and forms the center around which
political, economic, health, and environmental
considerations coalesce. The U.S. holds extensive
coal reserves, although how much of that coal is
accessible at a commercially viable cost is subject
to debate. The high-end estimate 491 billion tons,
which would be enough to last as much as 250 years
at the current rate of consumption, earned the U.S.
the title of the “Saudi Arabia of Coal.”1 In 2006,
the electric power industry burned 1.026 billion
tons of coal (see Figure 1.2). The electric industry
currently plans to build as many as 100 new coal
plants, adding to the approximately 600 large coal-
burning power plants already in existence.

Using coal has a variety of major adverse impacts
on health. Mining, transporting, burning,
and disposing of the products of coal combustion
all place human health at risk. With the passage of
time, more and more adverse health effects have
been attributed to the increasing reliance on coal.
Studies of the health effects of hazardous air pollutants
date clearly to 1872 with the publication of
Air and Rain: the Beginning of Chemical Climatology
by Robert Angus Smith. Since then, there have
been a number of sentinel events that link episodes
of severe air pollution to a variety of illnesses.2 In
October, 1948, almost half of the 14,000 residents
of Donora, Pennsylvania were sickened when
atmospheric conditions trapped toxic emissions
from a nearby smelter: 20 died and 400 required
hospitalization. In 1952, the infamous “killer fog”
in London, lasting four days, sent death rates
and hospital admissions soaring. Overall hospital
admissions increased by 43%; those due to respiratory
diseases rose by 163%. Almost 12,000 deaths
were attributed to this environmental disaster
caused, in part, by burning coal.

The link between burning coal and adverse
health was made strikingly clear
in Dublin, Ireland in the 1990s.3
Because of increases in the cost
of fuel oil in the 1980s, Dubliners
switched from oil to bituminous
coal to heat their homes and provide
hot water. Subsequent increases
in air pollution were associated with
an increase in in-hospital deaths
due to respiratory diseases. This
led the Irish government to ban the
marketing, sale, and distribution of
bituminous coal on September 1,
1990. In the year that followed, black smoke
concentrations declined by 70%

Sources of energy used for
generation of electricity:
Natural gas
Other gases
pumped storage
Source: U.S. Energy Information Administration. Available from

For each TerraWatt
hour of electricity
generated by coal,
24.5 deaths are
expected in addition
to 225 serious illnesses
and 13,288 minor

Physicians for Social Responsibility

(35.6 µg/m3), respiratory deaths fell by 15.5%, and
cardiovascular deaths fell by 10.3%. Approximately
450 lives were calculated to be saved that year by
this measure, and hundreds of acute
illnesses were prevented. Although
burning coal was not the only cause
of these illnesses, burning coal was
clearly a major factor in the production
of the complex mixture of airborne
pollutants that had protean
adverse effects on human health.

Many of coal’s pollutants were
identified by the U.S. Environmental
Protection Agency in its 1998 report
Report to Congress.4 This report
identified as many as 67 different haz

ardous air pollutants (HAPS) emitted from coal
plants, but did not address particulates or oxides of
nitrogen and sulfur (NOx and SO x), now referred
to as criteria pollutants. Particulates, mercury,
NO x, SOx, and the pollutants they give rise to, such
as ozone, are now recognized as posing the greatest
threats to health, and are the focus of much of
this report.

Recent peer-reviewed reports provide estimates
of the morbidity and mortality associated
with burning coal. European data reported by
Markandaya and Wilkinson show that for each
TerraWatt hour of electricity generated (1 TWh =
1012 Watt hours), 24.5 deaths are expected
(95% CI = 6.1–98) in addition to 225 serious illnesses
(95% CI = 56.2–899) and 13,288 minor illnesses
(95% CI = 3,322–53,150).5 Burning lignite,
a softer form of coal that yields more pollutants
than bituminous coal, raises these numbers to 32.6
deaths (95% CI = 8.2–130), 298 serious illnesses
(95% CI = 74.6–1,193), and 17,676 minor illnesses
(95% CI = 4,419–70,704). To give these data perspective,
consider the fact that nearly half of the
4,160 TWh of electricity generated in the United
States in 2007 came from coal-fired power plants.6
If these estimates are applied to the U.S., as many
as 50,000 deaths per year may be attributable to
burning coal. Although differences in population
density between Europe and the U.S. are substantial
and there are large boundaries on the 95% con

Coal’s assault on Human Health

Source: U.S. Energy Information Administration. Available from:

It is clear that burning coal has major adverse health effects.

In seeking to describe relationships between
health and any single pollutant or any single
source of the pollutant, notably burning coal, difficulties
arise due to multiple sources of the pollutant
in question and multiple health impacts. This
is a particular issue with regard to SOx, NOx, and
particulates, as there are many important sources
of these pollutants in addition to burning coal.
This is less of a problem in regard to mercury,
where coal is the acknowledged largest single
source of emissions. Thus, in this report we draw
on literature that goes beyond that in which authors
limit themselves to coal as the sole source of
the pollutant in question.

In describing the health effects of coal combustion,
this report utilizes an organ-system approach
rather than a pollutant-based review. By considering
coal’s impact on the respiratory system, the
cardiovascular system, and the central nervous
system, we replace a piecemeal approach with a
fuller and more integrated assessment of coal’s
overall effect on human health. To the best of our
knowledge, this approach has not been taken in
previous reviews of coal’s health implications. To
minimize bias, whenever possible we cite contemporary
peer-reviewed medical literature and reports
published by governmental agencies such as
the U.S. Environmental Protection Agency and the
Department of Energy. We hope that this report
will provide physicians, other healthcare providers,

1 Goodell J. Big coal: the dirty secret behind America’s energy
future. Boston: Houghton Mifflin; 2006.
2 Simkhovich BZ, Kleinman MT, Kloner RA. Air pollution

Physicians for Social Responsibility

and cardiovascular injury epidemiology, toxicology, and
mechanisms. J Am Coll Cardiol 2008; 52(9):719–726.

Clancy L, Goodman P, Sinclair H, Dockery DW. Effect of
air-pollution control on death rates in Dublin, Ireland: an
intervention study. Lancet 2002; 360(9341):1210–1214.

EPA. Study of Hazardous Air Pollutant Emissions from Electric
Utility Steam Generating Units -Final Report to Congress. 1998:

Markandaya A, Wilkinson P. Energy and Health 2: Electricity
Generation. Lancet 2007; 370:979–990.

Energy Information Administration. Electric power industry
2007: year in review. Available from:

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2 Responses to Coal’s Assault on Human Health

  1. Maxine says:

    Thanks for the info. I just know from this article that coal can cause so many disadvantages for our health.

  2. Randall Maggard says:

    I really think that the article was very misleading and one sided. It fails to take into account the advantages of affordable electricity and it’s impacts on the quality if life and also life expectentancy. When one examines third world countries and their lack of ANY electricity the options are few. When people heat and cook indoors with wood, charcoal , and even coal without proper ventilation the adverse heath affects are much more severe. How would ” Maxine ” feel if her electricity bill increased four fold . How would that affect her lifestyle? Even better yet what if she just gave up electricity altogether and went back to oil lamps and candles, no air conditioning and burned wood for heating and cooking. What would her life expectancy be then ?

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