Transitioning away from fossil fuels saves lives

Replacing fossil fuels with clean renewable energy is critical to meeting legally binding greenhouse gas (GHG) emission targets and averting the accelerating health impacts of climate change. Placing health at the centre of the transition to net-zero emissions has the potential to deliver large public health benefits almost immediately. This narrative examines the benefits and potential trade-offs for health of transitioning away from fossil fuels in the EU.

Improving air quality saves lives

An estimated 308,000 (95% CI 187,000 to 432,000) deaths would be avoided in the EU-27 annually due to improved air quality by phasing out fossil fuels (Lelieveld et al., 2023).

Although air quality in Europe has improved considerably in recent decades, it remains the greatest environmental risk to health in Europe (European Environment Agency, 2022) contributing to poor health and lower life expectancy.

According to the Lancet Countdown in Europe 2026 report, deaths due to air pollution from the power sector decreased by 84% in the EU between 2000 and 2022, while CO2 emissions in the sector reduced by 34% due to switching away from dirty fuels like coal.

308,000An estimated deaths would be avoided in the EU-27 due to improved air quality by phasing out fossil fuels.

The highest levels of air pollution are largely located in Eastern Europe, due to high reliance on fossil fuels for electricity production and residential heating. The region also has some of the lowest levels of income per capita in the EU. Phasing out fossil fuel use could deliver the largest health benefits on a per population basis in Eastern Europe, while also reducing socio-economic inequalities across the EU in the health burden due to air pollution. Despite these potential health benefits, political barriers to transitioning away from fossil fuels in the region remain significant. CATALYSE explores these issues in a case study focused on the politics and actors at the centre of the debate to phase out coal in Poland.

The CATALYSE Poland case study

Poland is one of the countries with the highest air pollution levels in the EU. Poland also relies more on coal power generation than any other member state, with 72% of electricity produced from coal combustion. Poland is also home to the single largest carbon polluter in the EU, the Bełchatów lignite-fired power plant, which has remained the biggest emitter in the EU for more than a decade (statista, 2023). It is the only country in the EU that still has not set an official date to phase out coal and has not committed to climate neutrality by 2050 (Mathiesen, 2019).

Despite clear health and economic arguments in favour of phasing out coal as soon as 2030 and growing awareness in the media that coal combustion is a health issue, the Polish government continues to protect the coal industry, partly because a significant share of the industry is still state owned. Government arguments to protect coal burning and mining have focused on economic interests, concerns over job losses, and energy security without adequately considering the large economic benefits from coal phase out through reduced health care costs.

Polish health professionals have played an important role in drawing attention to the health impacts of coal combustion, air pollution, and climate change. Through work coordinated by the Health and Environment Alliance (HEAL), a European not-for-profit organisation, health professionals have been drawing attention to the health impacts of coal-related air pollution for more than a decade. In 2013, HEAL published the first assessment of the health costs from coal power generation in Poland (the Unpaid Health Bill), which was followed up by a more recent report in 2023 outlining what a coal phase out by 2030 would mean for health. The report shows phasing out coal power generation by 2030 compared to 2049 would avoid 71% of premature air pollution related deaths and save 65% of the health cost from coal burning.

Buildings, climate, and health: benefits and trade-offs

Buildings in the EU are responsible for approximately 40% of energy consumption and 36% of GHG emissions (EC, 2022). The EU has set ambitious targets to reduce GHG emissions by 55% in buildings by 2030 compared to 1990 levels. Between 2015 and 2021, energy consumption in EU buildings decreased by 12% due to efficiency gains from building improvements and stricter energy performance standards (Gonzaléz-Torres, 2022). Improving the energy performance of buildings has direct and indirect benefits for the physical and mental health of occupants. Energy-efficient buildings typically have better air quality, healthier temperatures, and reduced noise levels, all of which contribute to better health outcomes.

Energy- efficient buildings reduce the costs to households of high energy bills and buffer households against short-term price spikes related to geopolitical instability affecting fossil fuel prices. They can play an important role in reducing energy poverty- the inability of households to maintain healthy indoor temperatures (between 18ºC and 22ºC) and enough energy for cooking and lighting.

As of 2022, approximately 9.3% of the EU population was unable to keep their homes adequately warm, up from 6.9% in 2021 (EuroStat, 2022). Although global warming is likely to reduce cold-related deaths in winter, annual excess deaths attributed to cold is still several times the number of deaths attributed to heat. Buildings in Europe have largely been designed to maintain warmth during the winter, which exacerbates the risk of indoor overheating, especially during heatwaves and in dense urban environments, requiring energy-intensive air conditioning. The EU's policies to improve the energy efficiency of buildings can significantly lower energy bills related to maintaining healthy indoor temperatures (EC, 2022) and reduce energy poverty.+

While many climate policies promote health, there are exceptions, highlighting the need for putting health at the centre of the transition from fossil fuels. Past efforts to shift to renewable energy for domestic heating focused on solid biomass fuels (i.e. wood burning). Wood burning for home heating increased by more than 44% (from 58.4 Mtoe to 84.3 Mtoe) between 2004 and 2022 at the EU level. While biomass is technically considered a renewable energy source, wood burning in homes is a major contributor to particulate air pollution and has potential negative impacts on carbon sequestration in trees and biodiversity. Cleaner renewable options like heat pumps and solar thermal collectors are increasing rapidly and should be prioritised as mitigation actions without negative unintended consequences for health.

Health benefits of shifting from fossil fuel powered cars to public and active travel

Transport is responsible for almost 25% of GHG emissions in the EU, most of which are from cars. While overall GHG emissions in the EU have been decreasing, emissions from transport have stagnated- cars are getting more efficient, but people are driving more, overwhelming these gains. Making cars cleaner by improving fuel efficiency and switching from fossil to cleaner fuels can decrease GHG emissions as well as air pollution related health impacts. However, placing health at the centre of sustainable transport shows that actions that get people out of vehicles altogether and into public transport and walking and cycling are even better. Increased physical activity through public and active transport provides large health benefits. Fewer cars on the roads mean more available public space that can be dedicated to other uses, including better infrastructure for pedestrians and cyclists, and expanding tree cover providing shade and cooling to make walking and cycling more comfortable in the heat. Fewer cars and better infrastructure for walking and cycling also mean reduced road traffic injury.

Most trips in Europe are overwhelmingly made in cars, with fairly small numbers made by public transport, walking, and cycling. Not all car trips are equally likely to be substitutable by public transport and walking and cycling. Short trips in urban areas under 7km could realistically be switched to public transport (8.9%), while those under 3km could be made by walking and cycling (10.2% and 5.7%, respectively). About 8% of total car trips in European urban areas could be replaced by public transport, cycling and walking.

The economics of transitioning away from fossil fuels

Powerful financial disincentives for meeting net-zero emission targets in 2050 continue to slow efforts to decarbonise the EU economy. During the period of 2015-2021, EU fossil fuel subsidies remained relatively stable, about €56 bn in 2022 prices, but increased to €123 bn in 2022, in response to high energy prices resulting from the Russian invasion of Ukraine. While many EU states have the ambition to reduce fossil fuel use, few have actually developed plans for phasing out fossil fuel subsidies, i.e., Denmark, Germany, Ireland, Italy and Sweden. More than 60% of all fossil fuel subsidies in 2022 were used in three countries, Germany (€21 bn), Italy (€25 bn) and France (€30 bn), while countries that spent the least on subsidies in 2022 (below €0.5 bn) included Czechia, Bulgaria, Latvia, Slovakia, Croatia, Slovenia, Cyprus, Luxembourg, Malta and Estonia. The figure below depicts fossil fuel subsidies in EU states, by comparing 2015 and 2022 figures. While subsidising fossil fuels perpetuates the substantial health burden due to resulting air pollution, subsidies to promote renewable energy, public and active transport, and energy efficient and thermally comfortable dwellings can instead yield important health dividends.

Negative impacts of fossil fuel use borne by society can be addressed in part by ensuring adequate carbon pricing mechanisms to better reflect the true social cost of carbon. However, such mechanisms are still not present in many European countries. Out of 53 countries in the WHO European region analysed as part of the Europe report of the Lancet Countdown (2024), (van Daalen et al., 2024) 32 (60.3%) had such mechanisms in place in 2020 with only 14 countries (26%) having net-positive carbon prices which encourage phasing out of fossil fuel use. Progress towards phasing out fossil fuel subsidies differs across Europe, with net fossil fuel subsidies declining in 33 countries, but increasing in ten others between 2010 and 2020. Financing from carbon pricing can be redirected to increase affordability of clean renewable energy, ensuring that the transition away from fossil fuels does not increase energy poverty.

Key solutions

Remove fossil fuel subsidies and use financing to make clean renewable energy more accessible and affordable.

Retrofit housing to improve energy efficiency, reduce energy poverty, and protect public health.

Scale up renewable energy infrastructure for solar and wind, keeping in mind the potential negative health impacts of shifting to biomass due to increased air pollution.

Promote public transport, walking and cycling in urban areas reallocating public space to improve infrastructure for active travel and adaptation to climate change.