Fossil fuels – coal, oil and gas – are often described as the silent architects of suffering because they take a toll on human lives and health, and not just at the moment they are burned. Their entire life cycle, from initial extraction, through refining, transporting and disposing of waste, leaves a toxic footprint on human health, social well-being and ecosystems. A message “Cradle to Grave: The Health Toll of Fossil Fuels and the Imperative for a Just Transition” provides a comprehensive global overview of these consequences.

Fossil fuels are the main source of greenhouse gas emissions that are driving the climate crisis. This crisis is exacerbating existing health risks, with extreme heat exacerbating air pollution and increasing the risk of mortality, especially when combined with smoke from wildfires.

Health impacts across ages

Exposure to pollutants related to fossil fuels affects every stage of life. Even before birth Prenatal exposure is associated with an increased risk of low birth weight, premature birth, miscarriage, and birth defects that can harm the baby throughout life.

Children are particularly vulnerable, because they breathe faster and inhale more pollutants relative to their body weight. In children, exposure is linked to impaired lung function, increased risk of cancer, especially leukemia, and worsening of asthma and other respiratory diseases. A study from Richmond, California, showed that children in areas near refineries visited emergency rooms for asthma three times more often than children nationwide.

U adults Pollution impairs cognitive function and mental health, increases the risk of cardiovascular disease and cancer. Older adults face greater vulnerability due to cumulative exposure and existing chronic diseases that are exacerbated by air pollution, contributing to premature mortality and an increased risk of dementia and Parkinson's disease.

Unfair distribution of damages

The health damage caused by fossil fuels is unevenly distributed. Marginalized groups (including indigenous peoples, racial minorities, and low-income populations) disproportionately live near polluting infrastructure—in so-called “victim zones.” These communities experience increased rates of illness, disability, and premature death. For example, in Louisiana, USA, an area nicknamed “Cancer Alley” is known for high rates of cancer and respiratory diseases, which disproportionately affect black residents.

Workers in the oil, gas and coal industries face an increased risk of cancer (including mesothelioma and leukemia) and serious respiratory diseases such as pneumoconiosis (black lung) and COPD.

Toxic impact life cycle

Every stage of the fossil fuel life cycle releases harmful substances:

• Extraction: For example, fracking and coal mining release benzene, heavy metals (mercury, lead), and radioactive materials, which increase rates of respiratory and cardiovascular diseases. Accidents at mining sites, such as the Jharia coal seam fires in India (burning since 1916), release a toxic mix of gases that lead to respiratory diseases.
• Processing and Refining: These processes emit carcinogenic chemicals such as benzene, toluene, and volatile organic compounds (VOCs), which endanger workers and nearby residents.
• Combustion: Combustion is the main source fine particulate matter (PM2.5) and nitrogen dioxide (NO2), which penetrate deep into the lungs and bloodstream, increasing the risk of premature mortality, asthma, heart disease, and stroke. For example, coal-fired power plants have been linked to premature deaths and adverse birth outcomes, and the closure of three power plants in Chicago led to a decrease in emergency room visits for asthma in young children.
• Waste: Gas flaring (burning excess gas) and coal ash expose communities to heavy metals and toxins. Benzene exposure from daily flaring has been linked to altered liver enzymes and blood cells in children.

The imperative for a healthy and just transition

The transition from fossil fuels to clean and renewable energy is economically beneficial and ethically necessary. The costs of inaction are rising: global fossil fuel subsidies were estimated to reach $7 trillion in 2022, of which $5.7 trillion were implicit costs (indirect social costs, including health and climate damage). Redirecting subsidies to clean energy and health could free up $4 trillion in public revenues and prevent millions of premature deaths.

Key policy recommendations for a healthy and just transition include:

1. Halting new fossil fuel extraction and development: This is essential to meet global climate goals (Paris Agreement 1.5°C).
2. Ending fossil fuel subsidies: The saved funds must be redirected to resilient infrastructure and pollution reduction.
3. Cleaning up existing production: Immediate action is needed to reduce emissions of methane and toxic chemicals, with the aim of improving public health and the climate.
4. Internalizing health costs using the “Polluter Pays” principle: This will ensure that polluters bear the costs of environmental and health damage, instead of these costs falling on public health systems.
5. Regulating the influence and disinformation of the fossil fuel industry: Fossil fuel advertising and sponsorship needs to be banned, building on successful tobacco control campaigns.

Transitioning to a healthier and more equitable future is not just an environmental imperative, but a moral imperative. The science is clear.: our dependence on fossil fuels is costing lives and livelihoods today. Action must be urgent. JRi