# Abstract The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health—eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required. # Key messages - Increased access to clean energy services for poorest populations of world is current high priority for public health - Reducing public-health effects of current fossil fuel use is also a priority - With careful planning, appropriate incentives, and development and spread of advanced technologies, these goals can be met in ways that also help to reduce risk of climate change, the biggest long-term challenge in relation to energy use - Society needs to find ways to limit global warming to around 2°C, thereby reducing the risk of most serious consequences of climate change. Policies to achieve this should be political priority, especially in industrialised countries - The needed transformations in patterns of power generation and energy use are very great (eg, around 90% reduction in carbon dioxide emissions in UK), and they will require major policy initiatives and legal, fiscal, economic, and other measures to achieve. Policies to reduce human population growth and livestock production could also have an important role in reducing greenhouse-gas emissions - There are imperatives to transfer technology to less developed countries to ensure their urgent health and development needs can be met without further contributing to adverse health and environmental effects at local and global levels - The challenge faced by society in moving to cleaner, healthier, more sustainable patterns of energy use is comparable to great public-health challenges of earlier generations, and its successful achievement will require bold and visionary leadership, which we predict would result in substantial benefits to global health both in the short and long terms > [!NOTE] Panel: Technology and policy options for mitigation of greenhouse-gas emissions from electricity generation and use of energy in different sectors > 1. Energy efficiency in homes, industry, transport, and commerce: vehicle fuel economy (hybrid vehicle/electric vehicle),buildings (space heating, cooling, water heating, lighting, and appliances such as air conditioning and refrigeration), industry and commerce, use of combined heat and power "cogeneration", smart grids with distributed, regional and central power generation, and technologies to reduce demand and optimise distribution. > 2. Substitution of natural gas for coal in power generation > 3. Use of coal and natural gas for electricity generation, with carbon dioxide being captured and stored in geological formations and oceans (carbon capture and storage) > 4. [[Nuclear power]] for electricity generation. This is controversial because of risks of proliferation, terrorist attack, and waste storage, as well as large upfront capital costs. > 5. Production of hydrogen from gas and coal, with CO2 being captured and stored. > 6. Renewable energy: > 1. Onshore and offshore wind. > 2. Wave and tidal energy > 3. Solar photovoltaics are especially promising in developing regions, where incident solar energy is two to three times greater than in the UK and energy is more uniformly distributed throughout year > 4. Solar thermal technologies, both for heating and for power generation. > 5. Combustion of landfill gas, a natural byproduct of decomposition of solid waste in landfills, comprised mainly of carbon dioxide and methane. > 6. Biomass combustion for heat and power, liquid fuels for transport, and methane for electricity generation. > 7. Geothermal energy, which could become a substantial resource given progress in the oil and gas industry with deep drilling technologies. In some countries (eg, Iceland) it is the predominant energy source for centralised power generation; geothermal heat-pumps using sub-surface temperature differentials can be used for individual buildings or building complexes > 8. Production of hydrogen by electrolysis from renewable energy and nuclear power, again for use as fuel for homes, commerce, industry, and transport # Notes [[OECD]] proposed three policies to improve the cashflow of private investments for energy policies (low-carbon altternatives to fossil fuels). 1. Pricing carbon directly, either through a [[carbon tax]], as in the Nordic countries, or through a marketable permit or so-called [[cap and trade]] system, as with the EU permit-trading scheme. 2. Raising the prices paid for the outputs of low-carbon energy technologies, exemplified by the Renewables Obligation in the UK, the feed-in tariffs in several EU countries, and the renewable energy portfolio standards in a growing number of US States. 3. Reducing the private costs of investment through tax credits; government finance for R&D and demonstration projects; tax credits for the incremental costs of commercialising the technologies; financial rewards for technological developments, and subsidising the costs of providing supporting infrastructure.