# Session Overview This session focuses on energy and health. When you complete this session, you should be able to: · Describe the main pathways to health associated with different energy sources · Estimate the likely magnitude of health impact attributable to different energy sources, in absolute terms as well as per unit of energy produced · Understand how insufficient access to energy adversely affects certain populations and, conversely, how an overabundance of energy can compromise health · Recognize that multiple and sometimes competing interests are weighed during the design of energy policies # 1. Introduction ## Activity 2. Energy matrices **Indonesia** energy matrices based on International Energy Agency (IEA) ![[Indonesia total energy supply 2022.png]] Indonesia's primary energy sources are coal (36.4%) and oil (28.1%) in 2022. The rest are followed by natural gas, biofuels and waste, and a tiny bit of hydro. The trends over time focused on oil and coal, with oil production relatively stable until coal production ramped out around the COVID-19 pandemic time and took over the number one spot. The renewable energy sources were relatively small, only 10%. In 2022, geothermal, solar, wind slowly increased over the years and approaching natural gas's energy supply. The condition happened because Indonesia's coal mines are vast, and thus, one of the world's largest coal producers and exporters. It's low-cost production makes it competitive in the global market. Moreover, coal industry are owned by politicians. The 2020-2022 timeframe especially has been influenced by China's energy crisis (shortages) and restriction on Australian coal imports due to political tensions, so Indonesia became the alternative supplier. This crisis was also exacerbated by Russia-Ukraine conflict's impact on energy supply and demand. In short, it's a combination of political, economic, and geographical factors. >Fossil-fuel producing countries have been known to exert influence in a variety of ways such as by subsidizing domestic oil prices, directing oil proceeds to key constituencies or by leveraging fuel supply or extraction contracts in international trade negotiations. However, these motivations can be counterbalanced by pressure from interest groups which have concerns about the fossil fuel industry for reasons including climate change, indigenous land rights and health risks. In 2023, Indonesia's enery transition began to gain momentum by launching Just Energy Transition Program (JETP). Institute for Essential Services Reform (IESR) published the [Indonesia Energy Transition Outlook 2024](https://iesr.or.id/en/pustaka/indonesia-energy-transition-outlook-ieto-2024/). ## 1.1 Energy and health - a primer On a per unit basis, emissions of particulate matter - a type of air pollution which strongly associated with premature death and disability. Different energy sources have different GHG lifecycle and PM2.5 emissions. Coal and oil has the highest PM2.5 production with the longest GHG lifecycle. # 2. Health profiles of different energy sources ## 2.1 Fossil fuels Includes coal, petroleum (oil) and natural gas. The burning of fossil fuels, mainly for electricity generation, transport and home heating, is one of the major sources of outdoor air pollution and has been the single greatest contributor to anthropogenic climate change. > Not all fossil fuels generate the same amount of pollution; from electricity generation, natural gas is the cleanest in terms of both particulate matter and CO2 emissions while coal produces the greatest emissions. Fossil fuel extraction, distribution and processing also carry substantial risks. For this reason, during policy analysis, it is always necessary to conduct a full **life-cycle assessment** of a fuel – health and environmental impacts may occur at any stage from extraction through to end-use. For example, coal mining has been associated with pneumoconiosis ([[black lung]]) and chronic obstructive pulmonary disease ([[COPD]]), while petroleum refining can release carcinogens such as benzene. The fossil fuel sector is also one of the most dangerous for its workers, contributing to high rates of occupational injury and death in many countries. Fossil fuels are also a key source of non-particle air pollution. Fuel combustion for electricity generation releases sulphur dioxide and oxides of nitrogen, while the transport sector is a major emitter of carbon monoxide, oxides of nitrogen and volatile organic compounds. Coal combustion also releases mercury, which if deposited in water can lead to exposure in humans through the consumption of contaminated fish. Where leaded petrol is still available, its combustion is a source of exposure. ==Mercury and lead exposure are associated with neurological and developmental disorders==. Household use of coal for heating or cooking exposes household members to air pollution that is associated with cardio-respiratory diseases. ## 2.2 Nuclear energy > The primary health concern from nuclear power is the release of radioactive material. Certain radioactive isotopes have a long half-life, sometimes remaining in the environment for thousands of years. Exposure may take place via inhalation, external exposure from ground contamination and ingestion of foods from contaminated soils (Ahern et al, 2004). Exposure can lead to cancer and the potential for mutation, resulting in hereditary effects. Other concerns associated with nuclear power are its role in providing material for nuclear weapons, possible terrorism risks, escape of radionuclides into the environment, and risk of reactor melt-down such as occurred at Chernobyl or the more recent incident at the Fukushima Daiichi power plant in Japan in March 2011. Although there were no immediate fatalities from the Fukishima incident, it led to high radiation exposures in some workers, evacuations, and bans on drinking water and food from the area. It will take decades to decontaminate the affected region. ## 2.3 Renewable Energy ### Biomass fuels (biofuels) Biomass refers to energy produced by burning organic matter such as wood, dung or agricultural waste. When clean and efficient stoves are not available, household use biofuels to cook inside the home. Because the biomass burning is inefficient, it leads to high levels of particulate emissions, and expose the women who do the cooking and their children. As a result, WHO ranked biomass fuels in the home as number one environmental risk factor for ill-health. Relatively new liquid biofuels: bioethanol and biodiesel. Bioethanol is produced through a fermentation process that turns starches or sugars, mainly from maize or sugarcane, into ethanol while biodiesel is produced from oil crops such as rapeseed, soya, or oil palm. ### Hydroelectric Can only be produced where there is water and altitude - the electricity comes from harnessing the potential energy of water as it falls in height. It is not without hazard to health though. There is a question about ownership of river/waterfall that harness the electricity, and it requires infrastructure that might disrupt land- and water-use, social disruption, or dislocation. Restricting flows upstream can compromise water security for countries and populations downstream. ## 2.4 'New' renewables Although renewable energy sources still comprise only a small proportion of the world’s energy supply, the sector is growing quickly. The cost of renewables is decreasing with improved technology, while the costs of fossil fuels are increasing due to the depletion of easily accessible reserves and from the externalities associated with pollution and climate change (Figure 4). In 2012, more than half of the net additions to global power capacity was from renewable energy (REN21, 2014). Advantages of renewable energy over fossil fuels: 1) no combustion is required to produce the electricity (biomass excluded), most renewables do not have an adverse impact on air quality. 2) they allow people to contribute to the provision of clean, sustainable energy at the individual level, without major infrastructure investments # 3. Energy Access [[Insights]]: [[Preston Curve]] all over again. At the international level, the amount of energy consumed per capita is strongly correlated with health. However, this correlation only holds up to about 1500 kg of oil equivalent per person per year (Figure 5); above that level, the relationship with life expectancy or infant mortality, for example, is fairly flat, indicating that increasing _per capita_ energy use is not accompanied by a further gain in health. Nonetheless, access to plentiful and affordable energy provides multiple services that can contribute to health, ranging from protection against heat and cold, to enabling the functioning of advanced health care services (and allowing us to access them via transportation). Insufficient access to modern energy, known as [[Energy poverty]], prevents large segments of the world from enjoying these benefits. ![[Energy consumption and health.png]] # 4. Energy and sustainability Energy and sustainability are inextricably linked, in terms of both the sustainability of human populations and the broader environment. We have already discussed the importance of renewable energy and **energy efficiency** in mitigating dangerous climate change and reducing other forms of pollution. Reducing energy demand is a third strategy, and while this is feasible to some extent in richer populations, it must be balanced against the need for more energy in populations facing energy poverty. Specifically, the proposed goals for SDG 7 (Ensure access to affordable, reliable, sustainable and modern energy for all) are to, by 2030: - Ensure universal access to affordable, reliable and modern energy sources - increase substantially the share of renewable energy in the global energy mix - double the rate of improvement in energy efficiency enhance international cooperation to facilitate access to clean energy research and technology, including renewable energy, energy efficiency and advanced and cleaner fossil-fuel technology, and promote investment in energy infrastructure and clean energy technology - expand infrastructure and upgrade technology for supplying modern and sustainable energy services for all in developing countries, in particular least developed countries, small island developing States, and land-locked developing countries, in accordance with their respective programmes of support. # 5. Activity 4 _New drilling techniques have only recently enabled energy companies to profitably extract natural gas trapped in rock crevices situated thousands of feet underground. The process, called hydraulic fracturing, or ‘fracking’, entails drilling a well shaft into the rock and pumping in water and chemicals to open cracks that will release the gas. An average well uses millions of gallons of water and tens of thousands of gallons of chemicals. After injection, the water (and any chemicals in it) is returned to the surface for treatment or re-use. Whether to allow fracking has become a hotly debated topic in many parts of the world, with particularly vocal protests in parts of the USA, UK, Australia and a dry region of South Africa called the Karoo, amongst others. _Note some potential advantages and disadvantages of this technique in terms of impacts to_ human health and the environment. ## Feedback Many of the issues around fracking are still under investigation, but key concerns include: - ==Contamination of ground and surface water== with fracking chemicals or methane released from the rock. Although fracking normally occurs far below aquifers used for drinking water, there is concern that pollutants can migrate upwards through cracks in the rock, or more likely, through poorly sealed or previously decommissioned wells. Moreover, the injected fluid is brought back to the surface after use, where it is often stored in open pits which risk overflow during heavy rains. Although many of the chemicals are unknown and protected as trade secrets, some are known or suspected human carcinogens. - ==Depletion of local water supplies==. The quantity of water necessary is large and in arid areas such as South Africa’s Karoo, residents worry about the loss of water entitlements for household or agricultural uses. Reduced water supply can affect aquatic ecosystems. - Air (and GHG) emissions from methane leaks and machinery. VOCs present in gas reservoirs can also enter the fluid and be released into the air during evaporation from surface pits. - Occupational accidents. Potential advantages include: - Burning natural gas for electricity releases fewer particle emissions than many other fuels. This is most important in areas where the prevailing fuel used is dirty, such as coal or solid biomass. South Africa for example, a country where fracking is under consideration, relies heavily on both. - Burning natural gas releases fewer greenhouse gases than other fossil fuels. # 6. Summary Energy is essential for human activity. As populations increase and there is greater prosperity, the demand for energy also increases. This session has demonstrated that a consistent supply of energy offers many benefits, including household energy for cooking and heating and the ability to provide modern healthcare. However, not all populations have equal access to energy; high-income countries generally use more and cleaner energy than low-income countries, and therefore energy-related health impacts can differ substantially between populations. Currently, the world depends on fossil fuels for most of its energy, but as these reserves have depleted, and with increasing concerns about environmental impacts, including climate change, there is a trend towards renewable energy sources which have very different profiles of health impact. Due to the wide reaching impacts of decisions taken in the energy sector however, it is important to balance health considerations with those in other areas, particularly the environmental, social and economic impacts. # 7. References ## 7.1 [[Essential readings]] [[@wilkinsonGlobalPerspectiveEnergy2007]] **Wilkinson, P., K. R. Smith, et al. (2007). "A global perspective on energy: health effects and injustices." The Lancet 370 (9591): 965-978.** An excellent overview of energy issues as related to health and development. Issues are explored at various scales and for different populations. The paper emphasizes the point that access to a sufficient supply of modern energy is health-promoting for many populations, but when dirty energy sources are used, certain risks are heightened, such as from air pollution and global climate change. There are also sections on the public health implications of energy policies and how institutions can facilitate the transition toward a sustainable and secure energy future. [[@hainesPoliciesAcceleratingAccess2007]] **Haines A, Smith KR, Anderson D, et al. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change. The Lancet. 2007; 370(9594): 1264-81.** From the same Lancet Series as the previous article, this is complementary in that it deals specifically with policy options available to increase access to clean energy while promoting health and sustainability goals. The paper discusses a variety of potential policies ranging from technological fixes to economic levers. Health is more of a central feature than the IPCC report below, which has similarities but emphasizes climate mitigation. [[@unitedstatesDeepWaterGulf2011]]**National Commission on the BP Deepwater Horizon Oil Spill and Offshore Drilling.Chapter 1: The path to tragedy. Deep Water: The Gulf oil disaster and the future of offshore drilling; 2011. p. 1-19**. Accessed 15 September 2019. A narrative of the moments leading up to the Deepwater Horizon explosion on April 20th 2010 which lead to a catastrophic oil spill in the Gulf of Mexico. Highly engaging, the chapter recreates the morning’s events while also providing background into the key players (individuals and institutions) that had an involvement in and/or responsibility for the disaster. The aim of the reading is to provide students with a description of the occupational hazards facing workers in the extractive industries and to outline how even when using the most modern technologies, there is still a risk of high impact events. Low risk, high impact events can be difficult to conceptualize and integrate into energy planning scenarios, but they are hugely important, both in terms of impact and public perception. Bruckner T., I.A. Bashmakov, Y. Mulugetta, et al. Chapter 7: Energy systems. In: Edenhofer O, Pichs-Madruga R, Sokona Y, Farahani E, Kadner S, Seyboth K, et al., editors. Climate Change 2014: Mitigation of Climate Change Contribution of Working Group III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge and New York: Cambridge University Press; 2014. p. 511-597. Accessed 15 September 2019. This is the IPCC AR5 chapter on climate change mitigation opportunities in the energy sector. The reading outlines trends in energy supply and technologies and behaviors that are available to reduce emissions in the sector. Policies are discussed for the range of potential energy supply technologies, from fossil fuels to renewable energy sources. ==Students need only read the Executive Summary and the short section Environmental and Health Effects==. Many of the policies will be familiar after reading the second article listed above (Haines et al.), but the focus here is more on climate change mitigation and it is also a more recent publication. ## 7.2 [[Recommended reading]] Epstein PR, Buonocore JJ, Eckerle K, et al. Full cost accounting for the life cycle of coal. Annals of the New York Academy of Sciences. 2011; 1219(1): 73-98. A study quantifying impacts and associated costs to health and the environment of coal use in the United States. The authors take a lifecycle approach and try to include all relevant externalities. A difficult and long paper, but students should read the abstract and browse the remainder. Smith K. In praise of power. Science. 2014; 345(6197): 603. A short editorial discussing household solid fuel use that argues for enhanced electricity supply to low income areas. Roberts I, Edwards P. The energy glut: the politics of fatness in an overheating world: Zed Books Limited; 2010. An easy-to-read book exploring relationships between energy and health. The book takes a holistic perspective to include impacts related to food systems, physical activity and road traffic injuries. It provides an integrated view of the many interrelationships between energy, society and health. Ross, A., Why is Ecuador selling its economic and environmental future to China? The Nation, 18 December 2014. Accessed 15 September 2019. A recent magazine article describing how the oil industry impacts Ecuadorian society and politics. Topics covered include the role of oil in the economy as a whole, how the proceeds are utilized domestically and how the industry shapes Ecuadorian-Chinese relations. The article also briefly discusses the history of environmental damage in the Amazon region attributed to oil companies and how that legacy is shaping the current oil extraction debate. The reading does not go in-depth about the potential health issues of oil-related environmental contamination, but Amazonian Ecuador was the site of important epidemiological studies on cancer clusters and birth defects that students should pursue if interested. It is also the site of the long-lasting and highly contentious court case between Chevron/Texaco and Ecuador which has been covered extensively in the media. IIASA/GEA. 2012. Global Energy Assessment: Towards a sustainable future. Cambridge University Press. Accessed 15 September 2019. The Global Energy Assessment is a good resource for all things energy. It looks in-depth at many energy-related issues and includes a primer on energy systems, chapters on different energy resources, issues of equity and development, and health. One advantage over some of the other readings is that the GEA is purposefully future-oriented with an aim of laying out a roadmap of how to achieve a sustainable energy system. The above is the summary document, but students should feel free to explore different chapters according to their interests. Kovats S, Depledge M, Haines A, et al. The health implications of fracking. Lancet. 2014; 383(9919): 757-8. This is a very short commentary article discussing what we know and what we don’t know about fracking. It is complementary to Activity 4 above.