Living near coal-fired power plants increases risk of death, children particularly vulnerable – study

‘There is nothing more fundamental to our freedom than the freedom to breathe freely,” said Rachel Kyte, the UK Special Representative for Climate and Professor of Practice in Climate Policy at Oxford University.

Kyte was speaking at a workshop hosted by the South African Medical Research Council (SAMRC) in Pretoria on Thursday, 6 March, where the Council’s Climate Change and Health Research Programme presented a first-of-its-kind study on the health impacts faced by people living in district municipalities with coal-fired power stations.

Funded by the British High Commission in Pretoria, the study found that individuals living near coal-fired power stations faced an increased risk of respiratory diseases and premature death, with children under five being particularly vulnerable.

Read more: How climate change will impact us through our lifetime: Part 1 (maternity and newborns)

Key findings:

• Increased mortality: Overall, people living in district municipalities with coal-fired power stations have a 6% higher chance of dying compared with those in districts without such power stations. This difference was statistically significant across all causes of death, as well as deaths from diseases of the arteries and the cardiovascular system, chronic obstructive pulmonary disease, and tuberculosis. Wright noted that while tuberculosis was an infectious disease, exposure to air pollution could exacerbate its symptoms.


• Children vulnerable: Children under the age of five are particularly vulnerable to the effects of pollutants such as nitrogen dioxide (NO2) and sulphur dioxide (SO2), which are commonly emitted by coal-fired power stations. So for every small increase in these pollutants – 10 parts per billion – the study observed a corresponding rise in pneumonia cases among young children. Although some of these findings were not considered statistically significant, and researchers note that we have to think about some other confounders – like HIV and antenatal prevalence – they still suggest a real-world impact on children’s health. Wright explained that statistical significance was a measure used to determine if results were likely due to chance or if they reflected a genuine relationship. Even if findings weren’t statistically significant, they could still be important if they showed a meaningful effect, especially when dealing with small data sets or varied results.


• Prenatal impacts: Statistically significant findings showed higher instances of cleft lip and palate anomalies in babies born in areas with coal-fired power stations. Between 2006 and 2020, the median prevalence of these birth anomalies was higher in districts with coal plants – eight cases per 100,000 births compared with five per 100,000 in areas without coal plants.


• Air quality data from the South African Air Quality Information System showed elevated levels of pollutants in district municipalities with coal-fired power plants.

 

This is in line with research into air pollution that the SAMRC looked at from around the world – Wright noted that, globally, eight million lives are lost every year as a result of exposure to ambient or indoor air pollution.

Data collection

“We sought to answer the question, does living in a district municipality with a coal-fired power station affect people’s health?” said Professor Caradee Wright, the chief specialist scientist leading the Climate Change and Health Research Programme at SAMRC.

“What we did differently, and why we wanted to embark on this study, is we used real, observed data – we didn’t want to model this – making it one of the first of its kind in South Africa and possibly Africa.”

Kendal coal-fired power station, pictured from Phola, eMalahleni Local Municipality, Mpumalanga. (Photo: Julia Evans)

Children at play in the mining town of Phola, situated on Mpumalanga’s coal belt. (Photo: Julia Evans)

The researchers analysed air quality data from the South African Air Quality Information System (SAAQIS), mortality data from death certificates (1997-2018), and morbidity data from primary healthcare facilities, clinics and hospitals.

To assess health impacts, they compared data from a coal-mining district to a control district without coal, but with similar environmental conditions.

Due to South Africa’s limited digital records, morbidity data focused primarily on pneumonia and child fatalities. “The only data we have comes from our district health information system, which records certain variables but does not collect everything digitally,” Wright explained.

What are the recommendations?

• Phasing out coal: The study strongly suggests decommissioning coal-fired power stations and replacing them with renewable energy sources such as solar, wind and hydropower. While acknowledging the challenges of this transition in a country grappling with high poverty levels, the report emphasises the significant health benefits of cleaner energy for children and communities in high-risk areas.


• Strengthening regulations: The report calls for stricter enforcement of South Africa’s National Air Quality Standards to prevent illness and premature deaths. “We recognise that last year, we then put in place a new set of regulations to manage the priority areas, because we were not seeing the improvements fast enough for human health protection,” said Patience Gwaze, the Chief Director for Air Quality Management in the Department of Forestry, Fishery and the Environment (DFFE) at the workshop. The DFFE has signed a memorandum of understanding with the SAMRC to take their research onboard. In August 2024, the DFFE published regulations for implementing and enforcing Priority Area Air Quality Management Plans (AQMPs). This follows the landmark “Deadly Air” court case, which ruled that the government’s failure to address air pollution in Highveld Priority Area (Mpumalanga and Gauteng) violated residents’ constitutional right to an environment not harmful to health. The Constitutional Court upheld this judgment in 2022, mandating the publication of regulations to strengthen AQMPs. Gwaze acknowledged that while AQMPs have been in place since 2007, which included installation of air quality monitoring systems, and issuance of atmospheric emission licences, “… there is still more work to be done”. The new regulations focus on mandatory interventions and set targets for improved air quality by 2030.


• Public awareness: The study emphasises the need for communities near coal-fired power stations to be informed of the severe health risks they face.


• Improved surveillance: Enhanced health surveillance is crucial to monitor pollution-related illnesses in affected regions, ensuring effective tracking and response to health impacts.


• Speaking from experience, as the UK recently became 100% coal free when it closed its last coal-fired power plant in October 2024, Kyte said, “we understand that these transitions are difficult – politics are difficult, vested interests are difficult.

“People are used to what they’re used to, but they don’t know what a cleaner energy future can look like.”

Kyte, a former World Bank Group Vice President, stressed that data such as this not only informed government policy but was also “powerful in helping people understand that the future can be different from the past”.

“I think this is an extremely important dynamic in the just energy transition in South Africa, because it shows that it does matter where you live, and it does matter what you breathe. And that breathing dirty air can exacerbate not only existing health conditions, but be extremely punitive to young children.”

She said that while we thought about the investments in terms of emissions reduction targets, she emphasised that, “actually, the silent costs to health and education of burning dirty fuel and not phasing out of that quickly enough is something that generations in the future will bear”. DM