In 2016 I wrote about the effect of air pollution on health, and the potential savings in terms of healthcare dollars and preventing premature death from reducing pollution. There have been a number of studies published since then, making an update appropriate. With more thorough analysis, the problem is much bigger than estimated six years ago.
It is challenging to estimate the health-related costs of air pollution because we first have to decide what counts. Early estimates focused entirely on the direct medical costs from emergency room visits and hospital stays, and ignored outpatient care. That problem was fixed with this 2020 study, which used employer data to capture the full range of direct healthcare costs, increasing the estimate by 40% – above the US annual $488 million for respiratory and $809 million for cardiovascular disease from hospital care alone.
Healthcare costs, however, typically also contain an estimate of lost productivity, in order to calculate the full cost to society. Respiratory and cardiovascular disease are major causes of premature death, in addition to disability. They are therefore substantial causes of lost productivity. A 2022 study tried to capture a more complete picture of the full costs to society from fossil-fuel related pollution, and found:
We use EPA’s CO-Benefits Risk Assessment screening tool to estimate health benefits resulting from the removal of PM2.5-related emissions from these energy-related sectors. We find that nationwide efforts to eliminate energy-related emissions could prevent 53,200 (95% CI: 46,900–59,400) premature deaths each year and provide $608 billion ($537–$678 billion) in benefits from avoided PM2.5-related illness and death.
That is more than 50,000 premature deaths per year (in the US alone) and over $600 billion is cost to society – just considering the health care related costs. This study looked at:
In this study, we estimate health benefits resulting from the elimination of emissions of fine particulate matter (PM2.5), sulfur dioxide, and nitrogen oxides from the electric power, transportation, building, and industrial sectors in the contiguous US.
But there is yet another source of negative health outcomes related to fossil fuel-based pollution – resulting from a warming planet. For example, increased risk and severity of heat waves causes heat-related negative health outcomes, including death. Wildfires cause direct harm but also release intense local pollution into the air.
A 2021 analysis found that increased heath care costs from climate change, due to increases in certain vector borne illnesses (from ticks and mosquitoes) and intense weather could add another $20 billion to this annual US cost. And of course, these climate change related healthcare costs are likely to significantly increase as temperatures continue to rise.
But even if, for some reason, you are someone who does not accept the scientific consensus on climate change, it’s important to note that the direct effects of air pollution itself cost the US over $600 billion per year. This means we could invest $3 trillion dollars over the next 20 years to phase out fossil fuel, and this would represent only 25% of the money we would potentially save from reduced healthcare costs. Actually, assuming a linear decrease in pollution and healthcare expense, that would be about 50% of the savings, but then we would save $600 billion every year after that – without even considering climate change. And, of course, we would be preventing 50,000 premature deaths per year.
One of the challenges of air pollution policy (more with climate change, but also pollution in general) is that the costs of mitigation are local and immediate while the benefits are perceived to be global and distant. But this is not true when it comes to the healthcare benefits. There is increasing evidence that the health benefits are immediate and regional.
That same 2022 study found that:
We also find that an average of 69% (range: 32%–95%) of the health benefits from emissions removal remain in the emitting region.
The range is wide because of geographical and weather considerations. In some locations the pollution remains mostly local, while in others it rapidly gets carried away to nearby regions. But in the US, we are still mostly talking about effects in the US – so while an average of 69% of the benefits remain regional, the vast majority remain national. (We don’t have to worry much about China stealing our good air and sending us their bad air.)
This analysis is backed up by other studies. This study, for example, looked at the effect of regional efforts to reduce air pollution in the South East and related that to reduction in ER visits in the Atlanta metropolitan area. They found:
During the final two years of the study (2012-2013), when pollution-control policies were most fully implemented and the associated benefits realized, these policies were estimated to prevent 5.9% of the RD ED visits that would have occurred in the absence of the policies (95% interval estimate: -0.4% to 12.3%); 16.5% of the asthma ED visits (95% interval estimate: 7.5% to 25.1%); 2.3% of the CVD ED visits (95% interval estimate: -1.8% to 6.2%); and -.6% of the CHF ED visits (95% interval estimate: 26.3% to 10.4%).
These are somewhat modest, but in line with the degree of pollution reduction. Essentially the point was to show regional benefits from regional pollution control.
Conclusion: Pollution is a health care issue
Pollution from the burning of fossil fuel is a major health care issue. Anything that causes 50,000 premature deaths per year and an annual cost in direct health care and lost productivity of over $600 billion is a public health issue. Framed entirely in this context, substantial investment in reducing fossil fuel related pollution is justified, especially since the benefits of doing so mostly remain local and are realized fairly quickly. This is messaging we do not hear enough, mainly because it has been lost in the artificial controversy surrounding climate change.
But the science is also becoming more clear, with better methods and more precise estimates getting closer to the true health-related costs of burning fossil fuel. The problem is much bigger than we thought just six years ago. But the good news is we also have better data on the benefits of reducing fossil fuel use and other industrial pollution. We have solutions and they work.