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Regulating Power Plants Is a Health Issue


The recent Supreme Court decision in the case known as West Virginia v. EPA weakened the Environmental Protection Agency’s ability to regulate carbon emissions from power plants. At the heart of this ruling is the capacity of the U.S. federal government to regulate the release of substances that can be harmful to American people.

The EPA had been using the Clean Air Act to assist utilities and power companies in the transition from fossil fuel–based electricity generation to less carbon-intensive sources, such as wind or solar power. The burning of fossil fuels like coal, oil and natural gas harms human health directly through the inhalation of microscopic particulate matter into the lungs and indirectly through climate change.

We can measure the public health effect of carbon pollution through something called the mortality cost. The mortality cost of carbon estimates how many tons of carbon must be emitted into the atmosphere to cause one death that would otherwise not have occurred. It is calculated by using a climate model and analyzing the impact of carbon emissions overtime on human mortality. The mortality cost can be used to quantitatively consider the impact of carbon emitting choices upon human life.  

For every 4,434 tons of carbon dioxide emitted, one additional death is predicted. Using U.S. Energy Information Agency data for carbon emissions from coal-generated electricity in the U.S., I have calculated that 200,000 lives will be lost for each year the U.S. continues to use coal instead of a non-carbon dioxide emitting alternative to generate electricity.

As an intensive care doctor, I may spend weeks focused on saving a single life. The opportunity to save 200,000 lives each year is so incredibly precious; it would be like preventing all deaths from Alzheimer’s disease and influenza in the U.S. for an entire year. The Supreme Court could have made a tremendously positive impact on human health, but in this case, the majority did the opposite. 

Since it seems to me that the Supreme Court has narrowed the scope of the federal government’s ability to protect its citizens’ health , then it is incumbent upon clinicians to speak up on behalf of our patients. 

As we have done with the public health crises of tobacco and opioid misuse, clinicians should take a more prominent role in the public health crises that climate change portends and pollution creates right now. Clinicians have powerful voices, as well as the science and evidence to back up their claims. These voices can rise above the din of marketing, lobbying and shareholder profits to speak for the young, the sick and the poor, whose lives will be harmed by climate change first.

The combustion of fossil fuels like coal, gas and diesel creates fine particulate matter (we classify these particles by size: PM2.5 and PM10), which, once airborne, can be inhaled into our lungs. The larger particles (PM10) generally get lodged in the upper airway resulting in inflammation and irritation, which can lead to COPD and asthma exacerbations. The smaller particles (PM2.5) can be drawn into the lower airways and even absorbed into the bloodstream. PM2.5 exposure is associated with increased rates of many different diseases including heart attacks, heart failure, strokes, blood clots, lung cancer and Parkinson’s. Inhaling fossil fuel emissions contributes to 10 million premature deaths each year worldwide.

Fossil fuel combustion further harms human life through its contribution to climate change. Climate change is associated with pathology affecting most organ systems, mental health and even the well-being of newborns. Applying the mortality cost of carbon to the 33 billion tons of carbon dioxide emitted each year from oil, natural gas and coal yields 7.4 million deaths.

The fossil fuel industry has been aware of the connection between fossil fuel emissions and harm to global public health since the 1960s. In the 1990s, industry sought to delegitimize climate science and created the “Global Climate Science Team” with the intention of undermining climate-focused regulatory efforts. Notably, the messages disseminated by the “Global Climate Science Team” were in direct contradiction to actual global climate scientists’ at that time and today.


The efforts of the fossil fuel industry were so successful at stigmatizing the public health crisis of climate change in the United States, that the words “climate change” were eliminated from certain federal documentation. The residual impacts are still present: despite climate change being identified in over 200 medical journals as the most pressing global public health crisis of this century, only $23 million (0.05 percent of the total National Institutes of Health budget) was allocated to research the effects of climate change on health in 2021.

West Virginia is the second-leading producer of coal in the U.S. and employs around 11,000 coal miners. The Supreme Courtdecision will almost certainly prolong the usage of coal for electricity production in the U.S., which in turn will prolong coal mining. Mining is associated with asthma-related hospitalizations. By choosing coal, the justices in the majority have chosen against the nation-leading 12.4 percent (175,011) of adult West Virginians who have asthma. 

I take care of patients from West Virginia, and for an anesthesiologist, asthma and asthma-related complications can turn a routine procedure into a risky one. As a physician, I will not stand idle as my patients suffer from fossil fuel combustion. Fossil fuel emissions need to be reduced to the least amount necessary. While I am disappointed by the Supreme Court’s decision to undermine the executive branch’s ability to protect public health, the movement to minimize fossil fuel emissions must continue.

Today, it is possible to link approximately 17 million deaths to fossil fuel emissions each year. This is 25 percent of global deaths. The harm from climate change is expected to accelerate in the next decade if there is not a marked reduction in emissions.

The damage from the fossil fuel industry prioritizing profits above human life will exist long after the mea culpashave been made and the courts have adjudicated. Clinicians, in defense of our future patients’ lives, need to proactively address the misinformation and empower patients, citizens, politicians and judges to focus on the most unalienable of human rights: the right to live a healthy life.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.

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