Imagine if we could save over 8 million lives per year globally through public policy. Many of these preventable deaths are in younger people and fall disproportionately on the poor and disadvantaged. This is the estimate of a recent observational and modelling study on the effects of air pollution (fine particulate and ozone pollution). Of these death, over 5 million could be prevented by phasing out fossil fuel use.
This information is not new. There are studies going back decades, like this one from 1997, showing health benefits from improved air quality. In addition the research shows that these benefit are mostly linear – which means that, to whatever degree we decrease air pollution, there is a corresponding improvement in health. Benefits are also both global and local, so when a local community invests in improved air quality, they benefit.
The health benefits are not limited to preventing excess deaths. Air pollution, mostly from the combustion of fossil fuels, contributes significant to disease burden. This includes (but is not limited to) many forms of heart disease, asthma and other pulmonary diseases.
Of course, phasing out fossil fuel use will not be cheap or easy. It involves a massive change in many industries, and a huge corresponding investment in infrastructure. A full transition will take decades, and the stated goal of doing so by 2050, while possible, is considered ambitious. This is why it is also important to consider the healthcare costs of fossil-fuel caused air pollution.
One recent review of the published evidence by the Natural Resources Defense Council estimated the annual cost in the US alone of fossil fuel induced air pollution at over $820 billion. Estimate vary, however, with a 2023 study putting the figure at $77 billion. Another estimate put the global costs at $2.9 trillion. But we need to drill down on what we consider to be “costs”. There are direct costs and indirect costs.
The direct costs are mainly for healthcare for those affected, including medications, hospitalization, physical therapy, and other costs. This represents about $8 billion per year. The rest is indirect costs, mostly those due to premature deaths and lost productivity. Indirect costs include something called a VSL – value of a statistical life. This estimates the economic impact of a premature death.
There is no objective correct answer as to what the best method is to use – they just give different information. It is helpful to understand both direct costs and the likely total economic impact.
Most of the studies also emphasize that these numbers are likely to be an underestimate, because they only include the effects of air pollution itself. If you then also include the downstream effects of global climate change, the figures can climb much higher. For example, excess forest fires also release a lot of particulate matter into the air, worsening air pollution with all the downstream economic health costs.
There is also a quality of life issue that is difficult to model economically. What is the value, to us individually and collectively, of the improved quality of life from not having to deal with the negative health effects of air pollution? How much is avoiding a premature death, or not having to take a child to the ER for an asthma attack, worth?
The precise numbers and methods used to derive them can be endlessly debated, but across many studies it is clear that the direct healthcare costs of fossil fuel use is in the billions annually, for any large industrialized nation, and the hundreds of billions globally. The indirect costs are harder to objectively estimate, but even at the low end approach $100 billion nationally and trillions globally.
And again, I must emphasize, this is just considering the healthcare costs, not the costs of climate change, which also run into the trillions globally.
All this means at least two things, when considering the big picture. First, fossil fuel use is a clear public health issue. This means the medical profession should be, at least in general terms, advocating for policies that improve air quality, which should include phasing out fossil fuel use.
Second, phasing out fossil fuels is a good economic investment. We should not think of measures that reduce fossil fuel use as an expense, they are an investment. Any money spent which effectively reduces fossil fuel use is likely to be repaid many times over. As a side benefit, we have improved health and quality of life.