# Key messages 1. Although exploitation of fossil fuels has delivered many benefits to mankind, their use is the main cause of impending [[climate change]], which demands urgent and widespread action to reduce CO₂ and other greenhouse-gas emissions 2. 1.6 billion people are exposed to adverse health risks because of lack of access to electricity 3. Reliance on (unclean) burning of household coal and biomass fuels is responsible for much ill health in the poorest countries 4. Over-dependence on energy contributes to unhealthy lifestyles in relation to diet and levels of physical activity 5. Insecurity of energy supplies and volatile prices can have adverse consequences on health, especially for low-income countries, because of their effects on affordability and continuity of energy supplies; internationally, the need to safeguard supplies is a potential source of tension and conflict 6. Energy use causes substantial health burdens through outdoor air pollution and injury risks 7. Current and future effects on human health associated with points (1) to (6) are serious challenges to public health worldwide 8. Formidable social, political, economic, and technological barriers obstruct a more equitable and sustainable use of energy, but the potential health benefits of overcoming these barriers are high # Key indicators related to health effects - Proportions of people without access to electricity - Greenhouse gas emissions per person per year - Proportion of households relying on unprocessed coal and biomass fuels # Notes [[Does energy security problem alter foreign policy in ways that damage health?]] > Energy security is an international problem that affects all energy-importing countries and could alter foreign policy in ways that damage health. The way that energy is generated and used is clearly moving the world into global climate change. Health consequences will mainly affect people who are already impoverished—eg, making rainfall even more precarious in parts of Africa, changing the patterns of vector-borne diseases, flooding low-lying areas such as Bangladesh, destroying glaciers in the Andes and the Himalayas on which large populations depend for irrigation, and increasing the frequency of extreme weather events such as hurricanes. These consequences are already beginning to happen, and they have serious health effects, both directly and indirectly—eg, through the mass displacement of populations. The current health risks associated with human use of energy are linked with the current patterns of extracting, transporting, and burning of carbonaceous (fossil plus biomass) fuels. The technologies used [on biomass fuels] are not clean enough to protect health, and because of the scale of use nearly all humanity is affected. The extraction of fuels—such as oil drilling, coal mining, and wood harvesting—create substantial environmental effects globally. The direct public health effects are relatively compared with those due to other parts of the fuel cycles. [[Insights]] As noted in [[@kovatsHealthImplicationsFracking2014]], the health impact assessment from fracking need to be studied not only at the moment or related to occupational hazard, but also to the extend of its long-term emissions effect. Fossil-fuel cycles are responsible for most pollutant emissions to the environment, but the source of greatest human pollution exposure is probably biomass fuels. [[Harnessing innovative technologies as investment in health]] The link between energy use and the economy is neither simple nor fixed, but continuing technological and economic advancement is important for health. [[Energy poverty]] is also important in overall poverty in nearly all poor populations. Examination of past trends has shown that, largely because of the deployment of improved technology, rich populations tend to have reduced exposure to energy-related pollution, and over time the dissemination of technology means that pollution for a specific level of wealth and industrial production is also reduced. ## (1) Improvement of access to affordable, clean energy for poor countries Lack of access to modern energy affects every aspect of life, including transport, agriculture, and health care. Access to clean energy would also bring benefits other than reduction in indoor air pollution and environmental degradation, which are difficult to quantify but still important, such as increased light for security, social interaction and study, reduced burns from household fi res, and the provision of energy to pump and purify water. ## (2) Reduced exposure to outdoor pollution Increasingly, outdoor pollution is becoming an international problem, as transboundary transport of air masses carry pollutants across continents and oceans. Improved technology has much to contribute to the efficiency and cleanliness of combustion processes. However, the highest exposures tend to occur in low-income and middle-income countries, where industrial development is driving rapid growth in emissions without the most advanced technology and legislation for emissions control. Even in high-income countries, pollution in most urban environments is still undesirably high. Substantial reduction in those levels could require a switch away from fossil fuels towards cleaner, perhaps even so-called zero-emissions, primary and secondary fuels. At present, this goal seems distant, but the potential health dividends are substantial. ## (3) Reduced greenhouse-gas emissions ## Institutional responses > Meeting the climate change challenge should be based on principles of shared responsibility. These principles are that (1) global CO₂ emissions should be reduced to an internationally agreed level (contraction); and (2) global governance should be based on justice and fairness with convergence towards equitable shares of per person carbon emission. The most direct statement of this goal was enshrined in the principle of contraction and convergence, as proposed by the [[Global Commons Institute]]. The [[World Bank (WB)]] is incorporating climate change considerations into its development operations The imperatives and opportunities of responding to climate change are increasingly recognised by national governments and international agencies such as WHO, which has led debate on the links between climate change and health and the needed policy responses.46 It is gratifying also that the World Bank has publicly recognised that “increased variability and volatility in weather patterns are expected to have a significant and disproportionate impact in the developing world, where the world’s poor remain most susceptible to the potential damages and uncertainties inherent in a changing climate”.47 As a result, the World Bank is incorporating climate-change considerations into its development operations and “seeking sectoral efficiency and clean energy alternatives”. Similarly, despite not having a specific mandate on climate change, the Food and Agriculture Organization (FAO) has established an Interdepartmental Working Group on Climate Change (IDWG-CC) for “mainstreaming and coordinating climate change related work among all FAO’s technical departments [with the] main objectives to develop normative and methodological approaches integrating forestry, agricultural, cultural, and economic issues in the context of climate change; and to open new channels of financing and other support measures for mitigating and adapting to climate change... ## Conclusion In addition to access to electricity and reduced greenhouse-gas emissions, the most important health related energy indicator would seem to be reduction in the number of households using highly unhealthy unprocessed solid fuels (biomass and coal) or, equivalently, an increase in the proportion using clean fuels. In this regard, it is parallel to the oldest of the major environmental health indicators; access to clean water. In this Series, we consider the specific health implications of energy systems in four key sectorspower generation, transport, the built environment, and food production. Connections with health occur at all stages of the cycle of energy generation, distribution, and use, and arise through emissions to the local and global environment, through influence on health-related behaviours and risks (including those causing injuries), and through influence on access to several social, environmental, and health-care services (figure 8). Overarching all these factors is the need to reconcile energy needs, particularly for the world’s poorest individuals, with the imperative to reduce environmental effects relating to local and increasing global emissions. The major challenges for energy and health policy will be discussed in the final paper of the Series, but the recurring message is that energy-use patterns are of central importance for future health and wellbeing. Despite formidable challenges ahead, a shift towards an equitable distribution of energy based increasingly on renewable resources has the potential for major health dividends. Progress along that path is measurable.