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Health effects of coal

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This article is part of the Coal Issues portal on SourceWatch, a project of CoalSwarm and the Center for Media and Democracy. See here for help on adding material to CoalSwarm.

Coal 101: What's Wrong with Coal?

There are a number of negative health effects of coal that occur through its mining, preparation, combustion, waste storage, and transport. Negative health effects from coal use within the U.S. include:[1]

Coal Mining

Health effects from coal mining include:

  • the release of methane (CH4), a potent greenhouse gas estimated to account for 18% of the overall global warming effect triggered by human activities (CO2 is estimated to contribute 50%).[2]
  • the release of carbon monoxide (CO) from explosives, which pollutes the air and poses a health risk for mine workers.[3]
  • coal dust and coal particles stirred up during the mining process, as well as the soot released during coal transport, which can cause severe and potentially deadly respiratory problems.[3]
  • drastic alteration of the landscape, particularly with mountaintop removal, which can render an area unfit for other purposes, even after coal mine reclamation. The clearing of trees, plants, and topsoil from mining areas destroys forests and natural wildlife habitats. It also promotes soil erosion and flooding, and stirs up dust pollution that can lead to respiratory problems in nearby communities.[3]

As of June 2010, no national limits exist on air pollution from coal mines. On June 17, 2010, in a petition presented to Environmental Protection Agency Administrator Lisa Jackson, a coalition of environmental groups called for new controls over coal mine air pollution. The petition states that coal mines should be held to the Clean Air Act standards in force for gravel mines, coal-fired power plants, coal processing plants, and other sources. The petition also calls on Jackson to adopt strict limits on other dangerous air pollutants released from coal mines, including methane, as well as particulate matter, nitrogen oxide gases, and volatile organic compounds — all toxic air pollutants under the Clean Air Act.[4]

Coal Mining Hazards

Chronic exposure to coal dust can lead to black lung disease, or pneumoconiosis, which took the lives of 10,000 miners worldwide over the last decade.[5] Rates of black lung are on the rise, and have almost doubled in the last 10 years. The US National Institute for Occupational Safety and Health (NIOSH) reported that close to 9 percent of miners with 25 years or more experience tested positive for black lung in 2005-2006, compared with 4 percent in the late 1990s.[6]

Miners can also suffer other serious, long-term respiratory ailments: industrial bronchitis is very common among coal workers. In nonsmokers (who are less prone to develop bronchitis than smokers), studies of coal miners have shown a 16%[7] to 17%[8] incidence of industrial bronchitis.

Miners are also at risk of injury and fatality from coal mining disasters, such as the Upper Big Branch mine disaster that occurred on April 5, 2010 at Massey Energy's Upper Big Branch Mine at Montcoal in Raleigh County, West Virginia. Twenty-nine miners were killed.[9]

Mountaintop Removal

In mountaintop removal mining, most common in the Appalachian region of the U.S., mountaintops are literally blown off to reach coal seams, with the waste products deposited into valleys below, causing permanent damage to the landscape and the local ecosystem. According to the Sierra Club, this practice has "damaged or destroyed approximately 1,200 miles of streams, disrupted drinking water supplies, flooded communities, eliminated forests, and destroyed wildlife habitat. Coal companies have created at least 6,800 fills to hold their mining wastes, and the government estimates that if this mining continues unabated in Appalachia it will destroy 1.4 million acres of land by 2020."[3]

Coal Combustion

Coal is the least efficient of the fossil fuels in terms of the amount of energy gained vs. CO2 released. Burning it also releases numerous toxic chemicals and particulates, which can exact a cost on a country's population in terms of reduced life expectancy and increased health costs [10].

Coal combustion releases nitrogen oxides, sulfur dioxide, particulate matter (PM), mercury, and dozens of other substances known to be hazardous to human health.[11]

Coal-fired power plants that sell electricity to the grid produce more hazardous air pollution in the U.S. than any other industrial pollution sources. According to the report details, over 386,000 tons of air pollutants are emitted from over 400 plants in the U.S. per year. Interestingly, while most of the power plants are located in the Midwest and Southeast, the entire nation is threatened by their toxic emissions. An ALA graph shows that while pollutants such as acid gases stay in the local area, metals such as lead and arsenic travel beyond state lines, and fine particulate matter has a global impact. Particle pollution from power plants is estimated to kill approximately 13,000 people a year [12]

According to the Union of Concerned Scientists, in an average year, a typical coal plant (500 megawatts) generates the following amounts of air pollutants:[13]

  • 3.7 million tons of carbon dioxide (CO2), an amount equivalent to chopping down 161 million trees. CO2 pollution is the principal human cause of global warming and climate change.
  • 10,000 tons of sulfur dioxide (SO2), which causes acid rain and forms small airborne particles that can cause lung damage, heart disease, and other illnesses.
  • 10,200 tons of nitrogen oxide (NOx), equivalent to half a million late-model cars. NOx leads to formation of smog, which inflames lung tissue and increases susceptibility to respiratory illness.
  • 500 tons of small airborne particles (particulate matter), which can cause bronchitis, reductions in lung function, increased hospital and emergency room admissions, and premature death.[14]
  • 220 tons of hydrocarbons, which contribute to smog formation.
  • 720 tons of carbon monoxide (CO), which causes headaches and places additional stress on people with heart disease.
  • 170 pounds of mercury. 1/70th of a teaspoon of mercury deposited in a 25-acre lake can make the fish unsafe to eat. Mercury also causes learning disabilities, brain damage, and neurological disorders.[15]
  • 225 pounds of arsenic, which leads to cancer in 1 out of 100 people who drink water containing 50 parts per billion.
  • 114 pounds of lead, 4 pounds of cadmium, and other toxic heavy metals. These toxic metals can accumulate in human and animal tissue and cause serious health problems, including mental retardation, developmental disorders, and damage to the nervous system.[16]

Coal ash, the hazardous waste that remains after coal is burned, can also contain: chromium, which can cause stomach ulcers, anemia, and stomach and lung cancers; selenium, which in excess can cause impaired vision or paralysis; and boron, which can cause eye, nose, and throat irritation, or in large amounts damage to testes, intestines, liver, kidney, and brain. All effects can eventually lead to death. [17]

Aging coal plants "grandfathered" in after passage of the Clean Air Act have been particularly linked to large quantities of harmful emissions.[18][19]

Emissions from coal power plants in Europe contribute significantly to the burden of disease from environmental pollution. The brand-new figures published in this report show that European Union-wide impacts amount to more than 18,200 premature deaths, about 8,500 new cases of chronic bronchitis, and over 4 million lost working days each year. The economic costs of the health impacts from coal combustion in Europe are estimated at up to €42.8 billion per year. Adding emissions from coal power plants in Croatia, Serbia and Turkey, the figures for mortality increase to 23,300 premature deaths, or 250,600 life years lost, while the total costs are up to €54.7 billion annually.These costs are mainly associated with respiratory and cardiovascular conditions, which are two important groups of leading chronic diseases in Europe [20].

Physical Effects

A November 2009 report on the effects of coal by the Physicians for Social Responsibility (PSR) found that coal combustion affects not only the human respiratory system, but also the cardiovascular and nervous system.[21]

Respiratory Effects

  • Coal combustion contributes to smog through the release of oxides of nitrogen, which react with volatile organic compounds in the presence of sunlight to produce ground-level ozone, the primary ingredient in smog. Air pollutants such as nitrogen dioxide (NO 2) and fine particulate matter adversely affect lung development.[21]
  • Air pollution triggers attacks of asthma, which now affects more than 9% of all U.S. children, who are particularly susceptible to the development of pollution-related asthma attacks. There are now tens of thousands of hospital visits and asthma attacks each year.[21]
  • Coal pollutants also plays a role in the development of chronic obstructive pulmonary disease (COPD), a lung disease characterized by permanent narrowing of airways.[21]
  • Exposures to ozone and PM are also correlated with the development of and mortality from lung cancer, the leading cancer killer in both men and women.[21]

Cardiovascular Effects

  • Air pollution is known to negatively impact cardiovascular health. The mechanisms have not been definitively identified, but studies in both animals and humans suggest they are the same as those for respiratory disease: pulmonary inflammation and oxidative stress. Pollutants produced by coal combustion can lead to cardiovascular disease, such as artery blockages leading to heart attacks, and tissue death and heart damage due to oxygen deprivation. It is estimated that soot pollution from power plants contributes to 38,200 non-fatal heart attacks each year.[22]
  • Recent research suggests that nitrogen oxides and PM2.5, along with other pollutants, are associated with hospital admissions for potentially fatal cardiac rhythm disturbances. Cities with high NO 2 concentrations have death rates four times higher than those with low NO 2 concentrations, suggesting a potential correlation.[21]
  • There are also cardiovascular effects from long-term air pollution exposure. Exposure to chronic air pollution over many years increases cardiovascular mortality, a correlation that remains significant even while controlling for other risk factors like smoking. Conversely, long-term improvements in air pollution reduce mortality rates: reductions in PM2.5 concentration in 51 metropolitan areas, due to the Clean Air Act, were correlated with significant increases in life expectancy.[21]
  • A 2012 Journal of the American Medical Association article looked at 34 studies comparing the risk of suffering a heart attack at various levels of inhaling industrial and traffic-related air pollutants including carbon monoxide, nitrogen dioxide, and particulate matter. The researchers conclude that: "All the main air pollutants, with the exception of ozone, were significantly associated with a near-term increase in [heart attack] risk."

Nervous System Effects

  • According to the PSR report, the nervous system is also a target for coal pollution’s health effects, as the same mechanisms thought to mediate the effect of air pollutants on coronary arteries also apply to the arteries that nourish the brain. These include stimulation of the inflammatory response and oxidative stress, which can lead to stroke and other cerebral vascular disease.[21]
  • Several studies have shown a correlation between coal-related air pollutants and stroke. In Medicare patients, ambient levels of PM2.5 have been correlated with cerebrovascular disease, and PM10 with hospital admission for ischemic stroke, which accounts for eighty-seven percent of all strokes.[21]
  • Coal contains trace amounts of mercury that, when burned, enter the environment and can act on the nervous system to cause loss of intellectual capacity. Coal-fired power plants are responsible for approximately one-third of all mercury emissions attributable to human activity. Researchers have estimated that between 300,000 and 630,000 children are born in the U.S. each year with blood mercury levels high enough to impair performance on neurodevelopmental tests and cause lifelong loss of intelligence.[21]

Researchers from Harvard University’s School of Public Health found that pregnant women exposed to high levels of diesel particulates or mercury were twice as likely to have an autistic child compared with peers in low-pollution areas. The findings were published in a 2013 issue of Environmental Health Perspectives, and is the largest U.S. study to examine the ties between air pollution and autism.[23]

Climate change

Coal-fired power plants are responsible for one-third of America’s carbon dioxide (CO2) emissions—about the same amount as all transportation sources (cars, SUVs, trucks, buses, planes, ships, and trains) combined.[24] A 1000 megawatt (MW) coal-fired power plant produces approximately the same amount of global warming as 1.2 million cars.[25]

SO2 emissions have roughly paralleled the increase in coal consumption, reflecting heavy coal burning and inadequate sulfur control measures. Coal burning, the primary source of China’s high SO2 emissions, accounts for more than three quarters of the country’s commercial energy needs, compared with 17 percent in Japan and a world average of 27 percent [20]. China’s consumption of raw coal increased annually by 2 percent between 1989 and 1993. Meanwhile, SO2 emissions increased by more than 20 percent and TSP increased by approximately 10 percent. The country is expected to burn 1.5 billion metric tons of coal annually by the year 2000, up from 0.99 billion metric tons in 1990. Without even more dramatic measures to control emissions than are currently in place, the deterioration of air quality seems inevitable [26].

Health costs from climate change

A November 2011 analysis published in the journal Health Affairs by NRDC scientists estimated that climate change-related events in the United States during the last decade added up to health costs exceeding $14 billion dollars and over 760,000 interactions with the health care system. The analysis looked at cases in six specific categories in the U.S. occurring between 2002 through 2009, including: Florida hurricanes, North Dakota floods, California heat waves and wild fires, nationwide ozone air pollution, and Louisiana West Nile virus outbreaks. The group of events resulted in an estimated 1,689 premature deaths, 8,992 hospitalizations, 21,113 emergency room visits, and 734,398 outpatient visits, totaling over 760,000 encounters with the health care system.[27]

Coal Waste

Coal sludge from mining and coal ash from combustion are stored throughout the U.S. in coal waste sites. As of October 2010, coal waste is not regulated by the federal government, even though New York Times analysis of EPA data found power plants are the nation’s biggest producer of toxic waste, surpassing industries like plastic, paint manufacturing, and chemical plants.[28]

Coal Sludge

After mining, coal is crushed and washed to remove the surrounding soil and rock. Coal sludge, also known as slurry, is the liquid coal waste produced by mining activities. The washing process generates huge amounts of liquid waste. Another form of liquid coal waste is acidic mine runoff, as sulfuric acid forms when coal is exposed to air and water. Each year coal preparation creates waste water containing an estimated 13 tons of mercury, 3236 tons of arsenic, 189 tons of beryllium, 251 tons of cadmium, and 2754 tons of nickel, and 1098 tons of selenium. The mining process also produces millions of tons of solid coal waste each year from dredging up land and its natural elements, including heavy metals.[11] Coal companies usually dispose of sludge by constructing dams from the solid mining refuse to store the liquid waste. These impoundments are often located in valleys near their coal processing plants, and are at risk from breaking open and spilling onto residential areas (see Coal waste Spills below), or leaching into and contaminating groundwater supplies.[29]

Coal Ash and Toxic Waste

Burning coal produces airborne compounds, known as fly ash and bottom ash (collectively referred to as coal ash), which can contain large quantities of heavy metals that settle or wash out of the atmosphere into oceans, streams, and land.[30][11] The amount of fly ash is going up: in 2006, coal plants in the United States produced almost 72 million tons, up 50 percent since 1993.[13]

The large quantities of toxic metals in coal ash include lead, mercury, nickel, tin, cadmium, antimony, and arsenic, as well as radio isotopes of thorium and strontium.[11] Small amounts of heavy metals can be necessary for health, but too much may cause acute or chronic toxicity (poisoning). Many of the heavy metals released in the mining and burning of coal are environmentally and biologically toxic elements, stored in federally unregulated coal waste sites.[30]

Sulfur dioxide scrubbers also create coal waste. The flue-gas desulfurization (FGD) process creates a wet solid residue containing calcium sulfite (CaSO3) and calcium sulfate (CaSO4). Often dry material such as fly ash is added to stabilize the sludge for transport and landfill storage.[31]

A power plant that operates for 40 years will leave behind 9.6 million tons of toxic waste.[11] This coal waste constitutes the nation's second largest waste stream after municipal solid waste.[32]

Soil and Water Pollution

Most often coal waste is disposed of in landfills or "surface impoundments," which are lined with compacted clay soil, a plastic sheet, or both. As rain filters through the toxic ash pits year after year, the toxic metals are leached out and pushed downward by gravity towards the lining and the soil below. An EPA study found that all liners eventually degrade, crack or tear, meaning that all landfills eventually leak and release their toxins into the local environment.[33][34] In a best case scenario, the EPA study determined that a 10-acre landfill would leak 0.2 to 10 gallons per day, or between 730 and 36,500 gallons over a ten-year period, an amount guaranteed to infiltrate the drinking water supply.[33]

In January 2009, an Associate Press study found that 156 coal-fired power plants store ash in surface ponds similar to one that ruptured at Kingston Fossil Plant. The states with the most storage in coal ash in ponds are Indiana, Ohio, Kentucky, Georgia and Alabama. The AP's analysis found that in 2005, 721 power plants generating at least 100 MW of electricity produced 95.8 million tons of coal ash, about 20 percent of which - or almost 20 million tons - ended up in surface ponds. The rest of the ash winds up in landfills or is sold for other uses.[35]

In October 2009, Appalachian Voices released an analysis of monitoring data from coal waste ponds at 13 coal plants in North Carolina. The study revealed that all of them are contaminating ground water with toxic pollutants, in some cases with over 350 times the allowable levels according to state standards. The contaminants include the toxic metals arsenic, cadmium, chromium, and lead, which can cause cancer and neurological disorders. The study was based on data submitted by Duke Energy and Progress Energy to state regulators.[36]

High hazard coal ash dumps

In response to demands from environmentalists as well as Senator Barbara Boxer (D-California), chair of the Senate Committee on the Environment and Public Works, the EPA made public its list of 44 "high hazard potential" coal waste dumps. The rating applies to sites at which a dam failure would most likely cause loss of human life, but does not include an assessment of the likelihood of such an event. The list includes sites in 10 states, including 12 in North Carolina, 9 in Arizona, 6 in Kentucky, 6 in Ohio, and 4 in West Virginia. Eleven of the sites belong to American Electric Power, 10 to Duke Energy. No Tennessee Valley Authority sites were included on the list. EPA relied on self-reporting by utilities to rank the facilities, and TVA classied all of its dump sites - including Kingston Fossil Plant - as "low hazard."[37]

Coal Waste "Spills"

TVA ash spill in Harriman, TN on December 25, 2008. Photo courtesy of United Mountain Defense.

On December 22, 2008, a retention pond wall collapsed at TVA's Kingston plant in Harriman, TN, releasing a combination of water and fly ash that flooded 12 homes, spilled into nearby Watts Bar Lake, contaminated the Emory River, and caused a train wreck. Officials said 4 to 6 feet of material escaped from the pond to cover an estimated 400 acres of adjacent land. A train bringing coal to the plant became stuck when it was unable to stop before reaching the flooded tracks.[38] Hundreds of fish were floating dead downstream from the plant.[39] Water tests showed elevated levels of lead and thallium.[40]

Originally TVA estimated that 1.7 million cubic yards of waste had burst through the storage facility. Company officials said the pond had contained a total of about 2.6 million cubic yards of sludge. However, the company revised its estimates on December 26, when it released an aerial survey showing that 5.4 million cubic yards (1.09 billion gallons) of fly ash was released from the storage facility.[39] Several days later, the estimate was increased to over 1 billion gallons spilled.[41] The TVA spill was 100 times larger than the Exxon Valdez spill in Alaska, which released 10.9 million gallons of crude oil.[42] Cleanup was expected to take weeks and cost tens of millions of dollars.[43]

Drinking water contaminated with hexavalent chromium from coal may cause cancer

A report released by EarthJustice and the Sierra Club in early February 2011 stated that there are many health threats associated a toxic cancer-causing chemical found in coal ash waste called hexavalent chromium. The report specifically cited 29 sites in 17 states where the contamination was found. The information was gathered from existing EPA data on coal ash and included locations in Alabama, Arkansas, Delaware, Florida, Illinois, Indiana, Minnesota, Massachusetts, North Carolina, North Dakota, Nevada, Ohio, Oklahoma, Pennsylvania, Tennessee, Virgina and Wisconsin.

As a press release about the report read:

Hexavalent chromium first made headlines after Erin Brockovich sued Pacific Gas & Electric because of poisoned drinking water from hexavalent chromium. Now new information indicates that the chemical has readily leaked from coal ash sites across the U.S. This is likely the tip of the iceberg because most coal ash dump sites are not adequately monitored.[44]

Coal Transport

Raw Video: Oil Leak Threatens Great Barrier Reef

18% of hard coal production is traded on the world coal market.[45] In 2007, the United States exported almost 60 million tons of coal.[46]

Coal is often transported via trucks, railroads, and large cargo ships, which release air pollution such as soot and can lead to accidents. On April 3, 2010, Chinese-owned bulk coal carrier named Shen Neng 1 rammed into the Great Barrier Reef in Australia, the planet's largest coral reef and selected as a World Heritage Site in 1981. The fuel oil is a byproduct of oil production that is used by many cargo ships because it is cheap, but also full of contaminants and very gooey, making it dangerous for animals and hard to clean up. A light aircraft was seen spraying a chemical dispersant on the spilled oil. [47]

The Australian Transport Safety Bureau said it would be conducting a full investigation of the incident.[47] The Chinese freighter was in a no-shipping zone, and the owners of the ship could face a fine of $1 million if found to have violated Australia's shipping laws. It is possible that the Captain was attempting to make his voyage shorter by taking a short cut through the reef. Critics say commercial ships are supposed to be monitored by Australian authorities, but the monitoring is weak. The Australian group World Wide Fund for Nature (Australia) claims the Chinese company that owns the ship, Shenzhen Energy, a subsidiary of the COSCO Group, has had three similar incidents occur during the past four years.[48]

Health costs from US coal plants

2010 Clean Air Task Force Report

A 2010 report from the Clean Air Task Force, The Toll From Coal found that, in the United States, particle pollution from existing coal power plants is expected to cause some 13,200 premature deaths in 2010, as well as 9,700 additional hospitalizations and 20,000 heart attacks.[49]

Estimated mortality figures for 2010 have Pennsylvania leading the nation with 1,359 premature deaths, 1,016 people admitted to the hospital, and 2,298 additional heart attacks. Ohio comes in second with 1,221 additional premature deaths; New York takes third with 945 dead from coal pollution. Per capita, the figures change slightly: West Virginia is first in the nation, with an estimated 14.7 coal-related deaths per 100,000 adults. Pennsylvania and Ohio tie for second, with 13.9; Kentucky comes in third at 12.6.[49]

The report found that the total monetized value of these adverse health impacts amounts to more than $100 billion per year. This burden is not distributed evenly across the population. Adverse impacts are especially severe for the elderly, children, and those with respiratory disease. In addition, the poor, minority groups, and people who live in areas downwind of multiple power plants are likely to be disproportionately exposed to the health risks and costs of fine particle pollution.[49]

In the previous version of this study, done in 2004, it was estimated that coal pollution would caused about 24,000 premature deaths annually. The authors cited EPA action in 2005 under the Clean Air Interstate Rule (CAIR) as resulting in the declining mortality figures. Though CAIR was struck down in Federal court in 2008, the pollution reduction requirements remain in effect until a replacement is established. In making their projections, the authors of the study assume similarly stringent requirements will be in place for the remainder of 2010.[49]

Even with much decreased numbers, the report says sulfur dioxide and nitrogen oxide emissions from coal power plants will "continue to take a significant toll on the health and longevity of millions of Americans." Overall, the report says "among all industrial sources of air pollution, none poses greater risks to human health and the environment than coal-fired power plants."[49]

2011 Harvard report: external costs of coal up to $500 billion annually

A Feb. 2011 report, "Mining Coal, Mounting Costs: the Life Cycle Consequences of Coal," led by associate director of the Center for Health and the Global Environment at Harvard Medical School Dr. Paul Epstein, found that accounting for the full costs of coal would double or triple its price. The study, which was released in the Annals of the New York Academy of Sciences, tallied the economic, health and environmental costs associated with each stage in the life cycle of coal – extraction, transportation, processing, and combustion - and estimated those costs, which are borne by the public at large, to be between $175 billion and $500 billion dollars annually.[50]

In terms of human health, the report estimated $74.6 billion a year in public health burdens in Appalachian communities, with a majority of the impact resulting from increased healthcare costs, injury and death. Air pollutants from combustion accounted for $187.5 billion, mercury impacts as much as $29.3 billion, and climate contributions from combustion between $61.7 and $205.8 billion. The study discussed a number of other impacts that are not easily quantified, including effects of heavy metal toxins and carcinogens released into water supplies as part of coal mining and processing; the death and injury of workers mining coal; and the social impacts in mining communities.[50]

Table 1: Estimates of external costs of coal in cents/kWh of electricity (2008 US$)[51]

Type of impact Low Best High
Land disturbance 0.00 0.01 0.34
Methane emissions from mines 0.03 0.08 0.34
Public health burden in Appalachia 4.36 4.36 4.36
Fatalities due to coal transport 0.09 0.09 0.09
Air pollutants from combustion 3.23 9.31 9.31
Lost productivity from mercury emissions 0.01 0.10 0.48
Excess mental retardation from mercury emissions 0.00 0.02 0.19
Excess cardiovascular disease from mercury emissions 0.01 0.21 1.05
Climate damage from combustion emissions of CO2 and N2O 1.02 3.06 10.20
Climate damage from combustion emissions of black carbon 0.00 0.00 0.01
Subsidies 0.16 0.16 0.27
Abandoned mine lands 0.44 0.44 0.44
Total 9.36 17.84 26.89


The study concluded:

"Our comprehensive review finds that the best estimate for the total economically quantifiable costs, based on a conservative weighting of many of the study findings, amount to some $345.3 billion, adding close to 17.8¢/kWh of electricity generated from coal. The low estimate is $175 billion, or over 9¢/kWh, while the true monetizable costs could be as much as the upper bounds of $523.3 billion, adding close to 26.89¢/kWh. These and the more difficult to quantify externalities are borne by the general public." The average residential price of electricity at the time of the report is 12¢/kWh.[50]

Skeptical Science notes that when the coal externalities of the study are included in coal's price, it increases the levalized costs to approximately 28 cents per kWh, which is more than the 2009 U.S. Energy Information Administration cost of hydroelectric, wind (onshore and offshore), geothermal, biomass, nuclear, natural gas, and solar photovoltaics, and is on par with solar thermal, although the costs of solar thermal are falling.[52]

The study noted that its estimates did not include the full cost of coal:[50]

"Still these figures do not represent the full societal and environmental burden of coal. In quantifying the damages, we have omitted the impacts of toxic chemicals and heavy metals on ecological systems and diverse plants and animals; some ill-health endpoints (morbidity) aside from mortality related to air pollutants released through coal combustion that are still not captured; the direct risks and hazards posed by coal sludge, coal slurry, and coal waste impoundments; the full contributions of nitrogen deposition to eutrophication of fresh and coastal sea water; the prolonged impacts of acid rain and acid mine drainage; many of the long-term impacts on the physical and mental health of those living in coal-field regions and nearby MTR sites; some of the health impacts and climate forcing due to increased tropospheric ozone formation; and the full assessment of impacts due to an increasingly unstable climate."[50]

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