Impacto del carbón mineral en la salud humana

Impact of coal on human health

[Article originally published in País Dominicano Temático]

1. Introduction

Climate change is a reality that threatens all living beings on the planet. For years, scientists from all over the world have provided evidence of its existence and the damage it causes, pointing to human activity as one of its main causes. Therefore, it is necessary and urgent to take action to keep the average temperature increase below 1.5ºC with respect to pre-industrial levels in accordance with the objective of the Paris Agreement. In fact, the Intergovernmental Panel on Climate Change (IPCC) in its report last February, 2022 revealed that without an immediate reduction of emissions in all sectors, it will be impossible to limit global warming to 1.5ºC. To achieve this, global greenhouse gas emissions must peak by 2025 at the latest and be reduced by 43% by 2030[1].

At the same time, it is essential to address air pollution caused by greenhouse gases and other pollutants such as particulate matter (PM10 and PM2.5), nitrogen oxides (NOx) and sulfur dioxide (SO2). These cause serious impacts on health and the environment, and therefore on the economy. The main sources of pollution include the transport sector, industrial activities and the energy sector. The pollution caused by the latter is mainly due to the burning of fossil fuels such as coal. Despite the fact that since the signing of the Paris Agreement, around 20 countries have already agreed to abandon this type of fuel as part of their energy and climate policies, it continues to be the main source of electricity generation worldwide[2]. 2] Moreover, it is still expected to play an important role in the electricity production of many countries. However, International Energy Agency scenarios show that it needs to be abandoned by 2040[3] if we are to achieve climate neutrality by the middle of this century.

This article focuses on the repercussions on our health and our economy due to the air pollution generated by the production of electricity from fossil fuels, particularly coal. To do so, it first briefly examines air pollution due to human activity and the impacts on health, and then analyzes the recommendations of the World Health Organization (WHO) to ensure good air quality, thus safeguarding people’s health. The consequences of coal burning are then examined. In particular, its pollutant emissions and their consequences, including health impacts.

This analysis allows us to conclude that:

  • A more sustainable energy model based on energy efficiency and greater use of renewable energy sources is needed.
  • It is necessary that energy companies internalize the negative impacts they generate on health and the environment through the burning of fossil fuels, as well as that governments and electricity companies continue to adopt commitments to phase out fossil fuels worldwide, the first being coal as it is the most harmful. This must go hand in hand with a commitment by governments to take urgent action to reduce air pollution levels in accordance with WHO guidelines.
  • The process towards a more sustainable and low-carbon energy model must be supported by transition measures.
2. Atmospheric pollution

Air pollution is a direct consequence of air emissions of gases, particulate matter and liquids from multiple sources, which are concentrated in the atmosphere. The main sources of pollution include the transportation sector, the burning of waste and fuels in homes, power plants and industrial activities. Despite the progress made in recent decades to improve air quality, air pollution is still a global problem. At present, there are still situations of risk that can negatively affect our health depending on the concentrations to which we are subjected and the duration of exposure. Thus, the World Health Organization (WHO) estimates that 99% of the world’s population lives in places where air pollution exceeds its recommended emission levels[4]. Air pollution is associated with the onset and development of various types of diseases, increasing morbidity and mortality, as well as lost workdays. It also carries high economic costs. Its impact is greatest on people who are already ill, as well as on the most vulnerable groups, such as children, the elderly, and low-income families with limited access to medical care.  The physical nature and composition of atmospheric chemical pollutants is varied. In addition to their natural or anthropogenic origin, they can be classified on the basis of the transformation they undergo in the atmosphere into primary[5] and secondary[6] pollutants.

TABLE 1.- Main atmospheric pollutants

Carbon monoxide (CO)

It is produced by the incomplete combustion of organic fuels. The main anthropogenic sources are the transportation sector, domestic appliances burning fossil fuels, the metallurgical and paper industry and formaldehyde-producing plants.

Inhalation in small concentrations can cause mental confusion, dizziness, headaches, nausea, weakness and loss of consciousness. With prolonged exposure, the nervous system and cardiovascular system may be affected.

Carbon dioxide (CO2)

Its main anthropogenic emissions come from the burning of fossil fuels. The transportation and industrial sectors are its main sources. Inhalation of high concentrations can cause hyperventilation, loss of consciousness, tachycardia and headaches. Prolonged or repeated exposure may cause alterations in a person’s metabolism.

Nitrogen Dioxide (NO2)

Inhalation of high concentrations of this pollutant for a short period of time can cause pulmonary edema. Prolonged exposure can affect the immune system and the lungs, resulting in reduced resistance to infection and causing irreversible changes in lung tissue.

Sulfur dioxide (SO2)

Mainly affects mucous membranes and lungs causing coughing fits. Exposure to high concentrations for short periods of time can irritate the respiratory tract, cause bronchitis, asthmatic reactions, respiratory arrest, and bronchial congestion in asthmatics.


Particles with an aerodynamic diameter of ≤10 μm. They are formed by inorganic compounds such as silicates, aluminates, and heavy metals, among others, as well as organic material associated with carbon particles. In the industrial setting, the burning of fossil fuels is the main source of primary particulate matter, especially coal combustion. Prolonged or repeated exposure can cause harmful effects on the respiratory system.


Particles with an aerodynamic diameter of ≤2.5 μm. They are mainly composed of secondary particles formed in the atmosphere from precursor gases-particularly NOx, SO2, VOCs, NH3-through chemical processes or by liquid-phase reactions. They can cause respiratory morbidity, impaired lung function, and lung cancer.

2.1.  World Health Organization Air Quality Guidelines

WHO air quality guidelines are intended to support measures aimed at achieving air quality that protects the health of citizens. These guidelines are based on a large body of scientific evidence concerning air pollution and its health consequences.[7]

Since 1987, WHO has periodically published air quality guidelines. In 2021, information on particulate matter, ozone (O3), NO2, SO2 and CO was updated with revised guideline values for each. These, however, cannot fully protect human health since, as the WHO itself states, epidemiological evidence indicates that the potential for adverse health effects persists even when guideline values are attained. Therefore, some countries may decide to adopt stricter national air quality standards that set lower concentration values. Despite this, most air quality objectives set in national contexts are more permissive than those recommended by WHO. 

TABLE 2.- Guideline values – WHO


WHO Guideline Value [μg/m3]

Middle Period





24 hours





24 hours



8 hours





24 hours



24 hours



24 hours

3. Coal: emissions and health impacts

For decades, the main source of electricity generation worldwide has been coal. Currently, there are 2,074,732 MW[8] of coal installed in the world. The countries with the largest installed capacity of active coal-fired power plants are China (1,064,401 MW), India (231,947 MW) and the USA (226,978 MW).

Coal accounts for three quarters of SO2 emissions from the power sector, 70% of NOx emissions and more than 90% of PM2.5 emissions[9], pollutants that, as discussed above, have been mainly associated with adverse health effects. The main health impacts associated with these pollutants are as follows:

  • Exposure to PM5 is associated with the progression of cardiovascular diseases as a whole and has been associated with an increase in total mortality. In particular, an increase in cardiorespiratory mortality[10] and lung cancer mortality[11]. It is also associated with respiratory diseases[12].
  • NO2 is a highly reactive pollutant and equally hazardous to health. Prolonged exposure to NO2 can cause damage to the respiratory system and is associated with increased symptoms of bronchitis and asthma, impaired lung function and lung cancer[13]. It is also associated with increased mortality.
  • SO2 has been associated with increased asthma and chronic bronchitis, as well as decreased lung function and bronchial inflammation. Hospital admissions for heart disease, as well as mortality, increase on days when SO2 levels are highest[14].

In addition, several studies have also been published on the impact of carbon emissions on health.

In 2013, a study was conducted on the contribution of coal-fired power plants to PM2.5 pollution in China[15]. The study covered more than 2,000 power plants. That study attributed 9,900 premature deaths to 192 coal-fired power plants within the Jingjinji region, including an estimated 850 lung cancer deaths within the region in 2011, with 2,000 deaths in Beijing, 1,200 in Tianjin, and 6,700 in Hebei. These health impacts also included 11,110 cases of asthma, 12,100 cases of chronic bronchitis, 1,010 cases of hospital admissions and 59,500 outpatient visits[16].

A year earlier, a study on the health effects of coal-fired power plants for electricity generation in India was also published[17]. It attributed more than 41,000 premature deaths to pollutant emissions in 2008 from 63 coal-fired power plants. Most of these deaths were due to SO2 and NOx emissions, as the plants did not have desulfurization and denitrification systems in place at the time.

In June 2016, another study was published analyzing the impacts caused by emissions from 257 coal-fired power plants in the European Union in 2013[18]. It shows that more than 22,900 premature deaths can be associated with these emissions, as well as 21,000 hospital admissions, 11,800 cases of chronic bronchitis in adults, 51,700 cases of bronchitis in children, as well as 23,502,800 days of restricted activity and 6,575,800 working days lost. The plants that caused the most damage were located in Poland, Germany, the United Kingdom, Romania, Bulgaria, Spain, and the Czech Republic.

A report by the International Institute for Law and Environment (IIDMA) was published in 2019 focusing on the health impacts of coal-fired power plants in Spain during 2015 and 2016. Coal emissions in Spain are linked to 1,529 premature deaths and 914 hospitalizations for cardiovascular and respiratory diseases between the years of 2015 and 2016. In addition, the study points out the close relationship between coal emissions and their impacts through comparative analysis: between 2015 and 2016 there was a 30% reduction in coal energy production. This reduction was associated with a 40.5% decrease in associated impacts and savings of between €499 million and €952 million.

The health costs associated with health impacts are known as external costs or negative externalities. However, these costs are not covered by the energy companies, which should be entirely responsible for the negative effects derived from the atmospheric pollution generated by their power plants.  Today it is society that covers them, through expenses such as medicines, consultations with specialists, hospitalizations, and laboratory tests.

4. Conclusions

One of the main pillars of economic development has been based on the growing consumption of fossil fuels for energy (mainly coal, oil, and natural gas)  which has led to an increase in GHG emissions and other pollutants responsible for climate change and air pollution.

However, the global energy sector is now in a process of transition. In the 21st century, an energy model based on burning fossil fuels cannot be the basis for economic development, as it must be environmentally friendly and compatible with improving the quality of life. Therefore, one of the main challenges facing our society today in the fight against climate change and atmospheric pollution is the necessary decoupling of fossil fuels and economic growth. To this end, it is necessary to opt for a more sustainable energy model based on energy efficiency -through the application of measures such as improving building insulation or lighting systems- and greater use of renewable energy sources.

At the same time, it is necessary for energy companies to internalize the externalities associated with the generation of electricity produced by burning fossil fuels, and for governments and electric utilities to adopt commitments to phase out fossil fuels worldwide, the first of which is coal because it is the most harmful.  The elimination of coal undoubtedly offers a unique opportunity to reduce polluting emissions and mitigate climate change. In addition, improving air quality would mean a higher level of human health protection, preventing the premature deaths of thousands of people each year. This must be linked to the commitment of governments to take urgent action to reduce air pollution levels in accordance with WHO guidelines.

The process towards a more sustainable and low-carbon energy model must be supported by just transition measures. Both governments and companies must carry out an orderly process of dismantling the fossil fuel industry and ensure new employment opportunities for all affected workers.  At the same time, greater use of renewable energies would lead to less dependence on foreign energy since renewables are indigenous energy sources and would favor job creation.

[1] IPCC, “Climate Change 2022. Mitigation of Climate Change”, (IPCC AR6 WG III), February 2022.

[2] International Energy Agency, “Fuels and technologies: coal”, 2022.

[3] Ibid.

[4] World Health Organization (WHO). For more information see:

[5] Those that are discharged directly into the atmosphere from sources, whether natural or anthropogenic, without having been previously subjected to any type of transformation.

[6] They originate as a consequence of the chemical and photochemical transformations and reactions that primary pollutants undergo in the atmosphere.

[7] WHO, WHO air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide. Guidance summary of the 2005 global update.

[8] Includes units from 30 MW and above. Source: End Coal, Global Coal Plant Tracker.

[9] AIE, Energy and Air Pollution, World Energy Outlook Special Report (2016), p. 43

[10] WHO – Regional Office for Europe, Methods and tools for assessing the health risks of air pollution at local, national and international level, 2014.

[11] Ghassan B. Hamra, Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Met-Analysis, Environmental Health Perspectives, Vol. 122, N. 9, 2014.

[12] WHO – Regional Office for Europe, Health risks of air pollution in Europe – HRAPIE project, 2013.

[13] WHO – Regional Office for Europe, WHO Expert Consultation: Available evidence for the future update of the WHO Global Air Quality Guidelines, 2016, p. 17.

[14] WHO, Ambient (outdoor) air quality and health, September 2016. Available at:

[15] Disponible en:

[16] Greenpeace, Ibid.

[17] M. Cropper et al., The Health Effects of Coal Electricity Generation in India, June 2012. Available at:

[18]Europe’s Dark Cloud – How coal-burning countries are making their neighbours sick”  WWF, Climate Action Network (CAN) Europe, Health and Environment Alliance (HEAL), Sandbag. Disponible en:

Carlota Ruiz-Bautista

Carlota Ruiz-Bautista is a lawyer specialized in environmental and energy law. She holds a double degree in Law and Political Science from the Universidad Autónoma de Madrid, and specialized in Environmental Law at the School of Legal Practice of the Universidad Complutense de Madrid.