The life-saving urgency of reducing air pollution

January 7th, 2019, Published in Articles: EE Publishers, Articles: Energize

The severity of the impact of climate change on health is increasingly clear. A report tabled by the World Heath Organisation (WHO) following the recent COP24 meeting in Poland, presents important findings and makes vital recommendations.  The drivers of climate change – principally fossil fuel combustion – pose a heavy burden of disease, including a major contribution to the 7-million deaths from air pollution annually.

Climate change is the greatest challenge of the 21st century, threatening all aspects of the society in which we live, and the continuing delay in addressing the scale of the challenge increases the risks to human lives and health.The air pollutants which cause ill-health, and the greenhouse gases (GHGs) which cause climate change, are emitted from many of the same sectors, including energy, housing, transport and agriculture. Short-lived climate pollutants (including black carbon, methane and ozone) have important impacts on both climate and health.

This is a summary of the WHO’s special COP24 report “Health and climate change”.

Click here to download the full report.

If the mitigation commitments in the Paris Agreement are met, millions of lives could be saved through reduced air pollution, by the middle of the century. More stringent mitigation policies would result in greater health benefits. There are important additional opportunities for synergy between health and climate change mitigation in energy, households, food systems, transport and other sectors, particularly in stemming the burden of noncommunicable diseases (NCDs).

Economic valuation of health decisively favours more aggressive climate mitigation. The most recent evidence indicates that the health gains from energy scenarios to meet the Paris climate goals would more than meet the financial cost of mitigation at global level and would exceed that in countries such as China and India by several times.

Climate change has negative health effects and undermines the “right to health” cited in the Paris Agreement. Climate change undermines the social and environmental determinants of health, including people’s access to clean air, safe drinking-water, adequate food and secure shelter. It is affecting health particularly in the poorest, most vulnerable communities such as small-island developing states (SIDS) and least developed countries, thus widening health inequities.

The health impacts of climate change could be greatly reduced by proven interventions in climate-resilient health systems, including climate-resilient health facilities, and through health-determining sectors such as water, sanitation and food systems and disaster risk reduction. At present, however, only 3% of health resources are invested in prevention, and only 0,5% of multilateral climate finance has been specifically for health projects.

City mayors and other subnational authorities are critical actors in reducing carbon emissions, improving health and increasing resilience. Local authorities are often wholly or partly responsible for energy provision, transport, water, sanitation and health. Ongoing urbanisation makes cities important foci of action for climate and health.

The health community is highly trusted, globally connected and increasingly engaged in reducing climate change and air pollution. The World Health Organisation (WHO) is working with leading health professional bodies, nongovernmental organisations, journals and the wider health community to mobilise behind stronger climate mitigation and adaptation. The call to action on climate and health for COP24 was issued by organisations representing over 5-million doctors, nurses and public health professionals and 17 000 hospitals in over 120 countries.

The mobilisation of the health sector is also necessary to reduce the growing contribution of health care to GHG emissions, which currently represents 5 to 8% of the total in high-income countries.

Monitoring of progress in health and climate change is improving, but there are weaknesses in coverage and in stakeholder engagement. The indicators of the sustainable development goals (SDGs) for climate change do not include health, although the situation is being remedied in academic research initiatives, by WHO and by the secretariat of the UN Framework Convention on Climate Change (UNFCCC), in partnership with countries. Such indicators could be used for formal reporting to the UNFCCC, broader outreach to the public and monitoring of the achievement of the SDGs.

The strong linkage between climate change, air pollution and health

The human activities which are destabilising the Earth’s climate also contribute directly to ill health. The most direct link between climate change and ill health is air pollution. The burning fossil fuels for power, transport and industry is the main source of the carbon emissions which are driving climate change and a major contributor to health-damaging air pollution, which kills over 7-million people every year. More than 90% of the urban population of the world breathe air containing levels of air pollutants which exceed WHO’s guidelines. Air pollution is responsible for 26% of deaths from ischaemic heart disease, 24% from strokes, 43% from chronic obstructive pulmonary disease and 29% from lung cancer.

Health gains of climate change mitigation

Meeting the targets of the Paris climate agreement could save over 1-million lives a year from air pollution alone by 2050, according to the most recent assessment. The same analysis shows that the value of the health gains would be approximately twice the cost of the policies. The largest gains would be in China and India, which would generate even larger net benefits by pursuing the 1,5°C target rather than the 2°C target (US$ 0,27 to 2,31-trillion in China and US$ 3,28 to 8,4-trillion in India). The health gains of meeting the 2,0°C target would also significantly offset the costs in other regions, such as the European Union (7 to 84%) and the USA (10 to 41%).

The cost of the use of coal for the generation of electricity

Most of the energy used around the world continues to be from fossil fuels. It has been reported that 15% of the 4,2-million premature deaths caused by the inhalation of fine particulate matter can be linked directly to the burning of coal for the generation of electricity.

To protect health and the climate, there is a need for a health energy transition to ensure access to affordable, reliable, sustainable and modern energy, with zero emissions of GHGs and health-damaging air pollutants. The cost of renewable energy generation is falling quickly, and investment in and deployment of these source are growing rapidly; however, they still comprise only 25% of global electricity production. In order to meet the goal of maintaining the global temperature rise to less than 2°C above pre-industrial levels, renewable energy must account for a least 65% of the global primary energy supply by 2050. The most important choices for energy policies are therefore based on the fastest means of scaling up renewable energy while maximising the health benefits. The case for rapidly phasing out some forms of fossil fuels is clear. Coal is a particularly polluting form of energy and contributes to premature mortality worldwide. Coal emits 40% more CO2 than natural gas and thus contributes proportionally more to climate change. Policies should therefore be designed to phase out coal use as quickly as possible while ensuring a just transition for populations and economies that depend heavily on its production. The Powering Past Coal Alliance of over 20 countries is committed to phasing out coal-fired power generation by 2030, in view of the contribution of coal to climate change and premature deaths worldwide. To keep global temperatures from rising above 1,5 or even 2°C, coal must be phased out by 2030 in the countries of the Organisation for Economic Co-operation and Development (OECD) and the European Union; by 2040 in China and by no later than 2050 in the rest of the world. Current plans for coal use are, however, inconsistent with the targets of the Paris Agreement, with plans for 1082 new coal plants globally. If these are built, the world will be locked onto a carbon-intensive pathway, still heavily reliant on coal, for the next 40 years, with severe implications for human health.

Health economics and climate change

Health can contribute significantly to the three economic drivers necessary to address climate change:

  • Resource efficiency, including carbon pricing and reform of subsidies
  • Investment in low-carbon, resilient infrastructure with existing technologies
  • Innovation in low-carbon technology

Exposure to air pollution causes as many as one in eight deaths worldwide, resulting in US$5,11-trillion in welfare losses globally, nearly doubling the losses in 1990. In the 15 countries which emit the most GHGs, the health impacts of air pollution are estimated to cost more than 4% of their GDP.

It is increasingly recognised that both the costs to health of climate change and the benefits for health of action against climate change are substantial and should therefore be included in cost–benefit analyses and the design of economic policy instruments. Full accounting for the value of health and other social gains that result from mitigation and adaptation demonstrates in many cases that it is in countries’ best interests to invest in cleaner technologies and sustainable development.

Governments can obtain more realistic estimates of the overall effects of climate change mitigation by accounting for the numbers of lives saved and improvements in health with better air quality. The extent to which the health benefits of mitigation would compensate for the cost of achieving the targets of the Paris Agreement has been estimated for various scenarios. In all scenarios, the health benefits of meeting climate goals substantially outweighed the costs of action. The benefits were particularly large in China and India, where they compensated the costs of mitigation entirely.

Evidence on health impacts contributes to the evidence that low-carbon, climate-resilient development results in more sustainable, equitable economies. For example, it is estimated that creating more sustainable, healthy cities would reduce the capital required for urban infrastructure over the next 15 years by $15-trillion. Furthermore, the low-carbon investment necessary to meet the targets of the Paris Agreement is estimated to be $270-billion a year for the next 15 years, while continuing along a high-carbon pathway would cost an estimated $90-trillion per year in infrastructure investment and maintenance.

Carbon pricing

Carbon pricing mechanisms are designed to capture the true cost of carbon, including external costs, which are often omitted. Health is the largest external cost, as the costs on health of both climate change and the polluting energy sources that cause climate change are borne by the public and not by the emitters.

Work at the International Monetary Fund has shown that the un-costed damage to health caused by air-polluting fuels accounts for approximately half of the negative externalities of fossil fuel use. Inclusion of health gains in estimates of the optimal, locally beneficial carbon price for each country should incentivise cleaner investment that would reduce deaths due to air pollution by 50%, reduce CO2 emissions by approximately 20% and result in over $3-trillion/year in revenues, which could be reinvested in socially beneficial objectives. Investment of the revenues in health has important social benefits and generally strong public support. For example, Chile introduced a number of such taxes and used the revenues to reduce the environmental and health impacts of burning fossil fuels.

It has been estimated that, in order to meet the goals of the Paris Agreement, carbon would have to be priced at $40 to 80/t of CO2 equivalent by 2020 and $50 to 100/t of CO2 equivalent by 2030. Health should therefore be an important component of the economic and political rationale for carbon pricing and a major beneficiary of its implementation.

Presently, 24 carbon tax systems operate globally. An important consideration in applying carbon taxation is making such schemes non-regressive, in order to ensure that low-income groups are not disproportionately affected by their implementation, thus exacerbating existing inequity. It is also important to establish mechanisms to ensure that companies do not leave areas with a carbon price to establish themselves in countries that do not have such schemes (“pollution havens”). This is also an important consideration regarding air pollution policies, as companies might relocate to areas with less stringent air quality regulations and hence continue to expose populations to air pollution.

Carbon can also be priced through emissions trading schemes, which reduce GHG emissions by capping the total. Sectors can reduce their GHG emissions to a desired level and either sell their extra GHG allowances or purchase additional allowances to enable them to emit more than their allocation, while keeping within the total emissions cap. This creates a market for GHG emission allowances, thus establishing a price for carbon based on supply and demand.

Currently, 24 regional, national and subnational emissions trading schemes have been established globally, representing 9,9% of global GHG emissions in 36 countries. The largest scheme is that established in the European Union, which covers approximately 45% of its GHG emissions, with the aim of reducing emissions in this area by 43%, compared to 2005 levels, by 2030. Since the 2008 economic recession, however, the price of allocated permits fell to a level that was no longer an incentive to reduce emissions. If such lessons are learnt, the expanding coverage of emissions trading schemes globally is positive. Importantly, China plans to introduce an emissions trading system in 2019.

Subsidy reform

The burning of fossil fuels has severe consequences for human health, due to both climate-related risks and air pollution. Yet, fossil fuels are still heavily subsidised, which artificially lowers their cost and promotes overconsumption. If only direct financial subsidies are considered (i.e. omitting the much higher estimates of the un-costed externalities of health and other environmental costs of fossil fuel use), global fossil fuel subsidies comprise $600-billion annually, while subsidies for clean energy represent only $100-billion annually. Furthermore, these subsidies divert funding that could be used for the public benefit, such as health spending.

Some fossil fuel subsidies may benefit health. For example, lowering the prices of clean-burning liquid petroleum gas for household use can reduce consumption of highly polluting solid fuels and therefore exposure to indoor air pollution. There is still scope for reform, however, as most of the benefits accrue to richer rather than poorer populations, and care must be taken to ensure that they facilitate rather than slow the long transition to renewable fuels. As currently implemented, fossil fuel subsidies hinder sustainable development, by using up government budgets and resources that could be better used elsewhere; reducing industrial competition, especially for low-carbon businesses by discouraging investment in renewable energy and energy efficiency; increasing the risk of “stranded assets” if fossil fuels are regulated by encouraging exploration for and production of unusable fossil fuels; putting energy security at risk; exposing the public to air pollution; and negating carbon price signals.

Reform of fossil fuel subsidies is recognised as an integral part of achieving the SDGs and meeting the goals of the Paris Agreement. Although such reforms are often opposed by both energy providers and consumers, well-designed, carefully planned policies, with full risk assessments can be successful, particularly when the savings are reinvested in visible, socially beneficial goals such as health and education. By 2014, nearly 30 countries had successfully reformed their policies on fossil fuel subsidies. For such reforms to have the greatest benefit for health and ensure public support, the resources saved by reducing perverse incentives should be directed to health programmes, such as increasing the resilience of the health sector to climate change and reducing air pollution.


  • Identify and promote actions to reduce both carbon emissions and air pollution, with specific commitments to reduce emissions of short-lived climate pollutants in nationally determined contributions (NDCs) to the Paris Agreement.
  • Include the commitments to safeguard health from the UNFCCC and Paris Agreement, in the rulebook for the Paris Agreement; and systematically include health in NDCs, national adaptation plans and national communications to the UNFCCC.
  • Include the health implications of mitigation and adaptation measures in the design of economic and fiscal policies, including carbon pricing and the reform of fossil fuel subsidies.
  • Remove existing barriers to investment in health adaptation to climate change, especially for climate-resilient health systems and “climate-smart” health care facilities.
  • Facilitate and promote the engagement of the health community as trusted, connected and committed advocates for climate action.
  • Mobilise city mayors and other subnational leaders, as champions of intersectoral action to cut carbon emissions, increase resilience, and promote health.
  • Systematically track progress in health resulting from climate change mitigation and adaption, and report to the UNFCCC, global health governance processes and the monitoring system for the SDGs.


The drivers of climate change, principally fossil fuel combustion, result in a large burden of disease and make a major contribution to the 7-million annual deaths due to air pollution. Emissions which pollute the air and GHG emissions which cause climate change are often emitted by the same sectors: energy, households, transport and agriculture. Short-lived climate pollutants such as black carbon, methane and ozone are important drivers of both climate change and ill health.

Meeting the commitments of the Paris Agreement for mitigation would save millions of lives by the middle of the century. More stringent mitigation policies would reduce air pollution further and thus offer better health benefits. Additional opportunities for synergy between health and reduced climate change can be found in the energy, food, transport and other sectors, particularly for stemming the rising burden of NCDs.

This is a summary of the WHO’s special COP24 report “Health and climate change”.

Click here to download the full report.

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