Ontario’s Coal Plant Phase-out Produced Many Health and Environmental Benefits

On January 17, 2017, industry think-tank the Fraser Institute released a new report, Did the Coal Phase-out Reduce Ontario Air Pollution? which suggests that coal plants across Canada should not be phased out based on its assertion that Ontario’s phase-out did not significantly reduce air pollution (Fraser Institute, 2017). This report includes a number of statements about pollution, health care benefits, and coal plants that are incorrect or misleading.

The Fraser report focuses on the air pollution benefits of the Ontario coal plant phase-out while ignoring the many co-benefits associated with this action. In 2002, the five coal-fired power plants in Ontario were responsible for

  • nearly one quarter (23%) of the sulphur dioxide (SO2) emissions and one seventh (14%) of the nitrogen oxide (NOx) emissions in Ontario that contributed to air pollution and acid rain,
  • nearly one quarter (23%) of the airborne mercury emissions which contributed to the contamination of fish with a persistent toxic that is harmful to the brains of humans, and
  • one fifth (20%) of Ontario’s greenhouse gases emissions that were contributing to climate change (OPHA, 2002).
Figure 1: Annual SO2 Emissons by Sector, Ontario (OMOECC)
Figure 1: Annual Emissions of Sulphur Dioxide, Different Sectors, Ontario, 2003-2012 (OMOECC, 2014)

Over the last 20 years, the public health sector, the Ontario Medical Association, environmental organizations, cottagers’ associations, and labour organizations have been outspoken advocates for the phase-out of coal plants in Ontario. All of these groups shared the common view that many health and environmental benefits could be gained simultaneously by closing Ontario’s coal plants.

While there were technologies that could be applied to reduce emissions of sulphur dioxide, nitrogen oxides, and mercury from these plants, there was no technology at that time that could eliminate emissions of greenhouse gases. Given the age of Ontario’s coal plants, the availability of combined cycle natural gas plants, the promise of energy efficiency, and renewable technologies, it made more sense economically to accelerate the closure of coal plants than to re-invest in them.

Figure 2: annual air levels of sulfur dioxide in Ontario, 2004-2013
Figure 2: Annual Air Levels of Sulphur Dioxide, Selected Sites, Ontario, 2004-2013 (OMOECC, 2014)

The Fraser report and press release suggest that coal plants are not a major contributor of fine particulate matter (PM2.5)—the air pollutant that has been mostly clearly linked to chronic health impacts such as heart disease and lung cancer, and one of two air pollutants responsible for most of the smog alerts that used to be common in Ontario. This is simply not true.

Coal plants emit significant quantities of SO2 and substantial quantities of NOx. Both are gaseous air pollutants that can harm human health directly. When they enter the atmosphere, they can be transformed into sulphates and nitrates—acid particles that contribute to air levels of PM2.5. In fact, this secondary PM2.5 is the major culprit behind high levels of PM2.5 measured in many airsheds and is often more hazardous for human health than other forms of PM2.5 (RIAS, 2011). This PM2.5 does not, however, show up in emission inventories for PM2.5.

The Fraser Institute suggests that Ontario’s coal phase-out had little impact on emissions and air quality. This is misleading. Between 2003 and 2012, SO2 emissions from coal plants were reduced by about 140,000 tonnes (see Figure 1). During that same period, annual air levels of SO2 across Ontario declined by nearly 50% (see Figure 2) and annual air levels of PM2.5 declined by about 25% (see Figure 3) (OMOECC, 2014). While the improvements in air levels of SO2 and PM2.5 cannot be attributed solely to the closure of coal plants, their closure was an important contributor to reductions in air levels.

Figure 3: annual air levels of fine particulate matter in Ontario, 2004-2013
Figure 3: Annual Air Levels of Fine Particulate Matter, Selected Sites, Ontario 2004-2013 (OMOECC, 2014)

Air quality is impacted by multiple sources of pollution. The actions to reduce air pollution are intentionally broad-based because the improvements are cumulative. Coal plants are an efficient target for emission reductions because they are stationary sources that emit large volumes of air pollutants. They are also a significant source of air toxics such as mercury and greenhouse gases.

Air pollution is also a transboundary issue. Emissions of SO2 and NOx from coal plants in the U.S. have a significant impact on Ontario’s air quality, while emissions from Ontario’s coal plants have a substantial impact on air quality in Quebec, Vermont and New York (Yap et al., 2005). In recognition of this reality, Canada and the United States committed in 1991 to take action on both sides of the border with the Canada-US Air Quality Agreement. This agreement has proven very successful. Emissions and air quality on both sides of the border have improved because of cooperation between the two countries (Canada-US, 2014).

In 2005, Ontario estimated the contribution of coal plants to air pollution across Ontario and the adverse health impacts associated with that contribution. Because coal plants release air pollutants so high in the air, the pollutants are dispersed over long distances. The impact, therefore, on any one airshed is relatively small, but the impact overall on human health can be significant because so many people can be affected. Using methodologies that were well-accepted in other jurisdictions, Ontario estimated that air pollution from its  coal plants were responsible for over 600 premature deaths, 900 hospital admissions, and 1000 emergency room visits, each year, in Ontario. These health impacts were valued at $3 billion per year (OMOE, 2005).

The Fraser report suggests that the $3 billion in health benefits estimated cannot be accurate because it represents too great a percentage of Ontario’s health care budget. This statement reflects a misunderstanding about the health benefits estimated in 2005. The $3 billion per year in health benefits reflect the value of the many lives that are shortened by air pollution, as well as health care costs. They do not reflect health care costs alone. The 2005 report is clear about this point.

 An independent assessment conducted by Toronto Public Health in 2014 suggests that improvements in Ontario’s air quality have translated into significant health benefits for Ontario residents. Toronto Public Health found that improvements in Toronto’s air quality from 2000 to 2011 have reduced air pollution-related premature deaths by 23% (from 1,700 to 1,300 per year) and hospital admissions by 41% (from 6,000 to 3,550 per year) in Toronto alone.  It attributes the improvements in air quality to a variety of policies implemented by different levels of government including the phase-out of coal plants by Ontario (TPH, 2014).

With the evidence of catastrophic climate change mounting daily, the need to modernize Canada’s electricity sector has never been more clear. With the costs of renewable technologies dropping, the opportunity to transform our economy has never been greater. CAPE stands by its position. We believe that the phase-out of coal plants in Alberta and across Canada is an economically prudent decision that will improve the health of Canadians while taking the steps needed to address climate change.

Prepared by Kim Perrotta, MHSc, Executive Director, CAPE


  • Canada-US, 2014. Canada-U.S. Air Quality Agreement Progress
  • Fraser Institute.  (2017). Did the Coal Phase-out Reduce Ontario Air Pollution? Prepared by Ross McKitrick and Elmira Aliakbari.
  • Ontario Ministry of Energy (OMOE).  2005. Cost Benefit Analysis: Replacing Ontario’s Coal-Fired Electricity Generation. Prepared by DSS Management Consultants Inc. RWDI Air Inc. April, 2005
  • Ontario Ministry of the Environment and Climate Change (OMOECC). 2014. Air Quality in Ontario 2013 Report.
  • Ontario Public Health Association (OPHA). 2002. Beyond Coal: Power, Public Health and the Environment
  • Regulatory Impact Assessment Study (RIAS). 2011.  Reduction of Carbon Dioxide Emissions from Coal-Fired Generation of Electricity Regulations.
  • Toronto Public Health (TPH). 2014. Path to Healthier Air: Toronto Air Pollution Burden of Illness Update. Technical Report.
  • World Health Organization (WHO). 2013. Review of evidence on health aspects of air pollution – REVIHAAP Project.
  • Yap, David, Neville Reid, Gary De Brou, and Robert Bloxam. 2005. Transboundary Air Pollution in Ontario 2005. Queen’s Printer.

Health and the Environment Belong in the Same Box: Why Health Impact Assessments Belong in Environmental Assessments

Perhaps because we mostly work inside boxes—hospitals, clinics, universities, and office buildings—it has taken the world’s health community far too long to realize that human health belongs in the same box as what we call “the environment.”

These ideas have been part of other thought systems, including Aboriginal concepts of wellness, for generations—but until recently they have been largely neglected within Western medical thought, other than in the realm of public health and environmental medicine.

As health professionals, it is not actually easy to admit that what happens outside our clinics and hospitals has a greater impact on overall health status than what happens inside them. We have put a lot of time and effort into learning what to do in our boxes. But as professionals who have committed a lifetime to the pursuit of optimal health for the people and populations we serve, we recognize that when the evidence demands it, we must peek over the edges of our boxes, open the windows, and let in new ideas and collaborations.

As with many diagnoses, however, the connection between health and the environment is becoming more obvious as ecological decline gets worse. Happily, the narrow perspective of health professionals is beginning to change. The past 5 years have seen the World Health Organization call climate change the “greatest threat to global health in the 21st century,” and the Canadian Public Health Association (CPHA) tell us that “the ultimate determinant of human health (and that of all other species) is the health of the Earth’s life-supporting systems.” Also last year the prestigious medical journal The Lancet published the report of its Commission on Planetary Health, defining planetary health as “the health of human civilization and the state of the natural systems on which it depends.”

In response, a Planetary Health Alliance has been launched out of Harvard, funded by the Rockefeller Foundation, the world’s first Chair in Planetary Health has been established at the University of Sydney, and health professionals are mobilizing worldwide to ensure that our growing understanding of the linkage between human health and the natural environment is integrated into policy.

Here in Canada, the Minister of Environment and Climate Change Canada has established an Expert Panel Review of Environmental Assessment (EA) Processes that is soliciting submissions and touring Canada to hear from community members about how the EA process can better function. This is a critical opportunity to connect the health box and the environmental box. We urge the Federal Government to do so by integrating health impact assessments into its environmental assessment processes.

To that end, the Canadian Association of Physicians for the Environment (CAPE), the CPHA, key academics, other health organizations, and individual health professionals and advocates have submitted a letter asking that comprehensive human health impact assessments be integrated into the Federal Environmental Assessment process.

This idea is now well-accepted in Canadian medical circles. In 2012 the Canadian Medical Association General Council passed a motion supporting a comprehensive federal environmental review process, including health impact studies, for all industrial projects and the CPHA proposed in 2015 applying “comprehensive impact assessments that address the ecological, social, health and economic impacts of all major public policies and private sector developments.”

Comprehensive human health impact assessments include an assessment of the impact of a project on the social determinants of health such as housing and income, as well as the ecological determinants of health including greenhouse gas emissions. This will allow health authorities to recognize and consider potential positive and negative health impacts of projects on their communities, to plan and fund healthcare provision services to address those impacts, and, to suggest modifications to plans in order to mitigate negative health impacts.

This integration has the potential to save not only lives but also money as it is well-recognized that preventative medicine is cheaper than acute care.

Prepared by Dr. Courtney Howard, Dr. Trevor Hancock, and Robert Rattle

The full letter to the MoECC calling for the integration of health impact assessments into federal environmental impact assessment processes and a list of signatories can be found here.

Some Good News for People and the Planet

It has been a good week for people and the planet. Last Monday, November 21st, 2016, the federal government announced that it will take steps to phase out pollution from coal-fired power plants across the country by 2030. And on Thursday, November 24th, the Government of Alberta announced that it has signed an agreement with three major power generators to ensure a phase-out of coal plants in Alberta by 2030.

There will be time in the coming days to examine and critique the details surrounding these two new announcements but today we want to acknowledge what they can mean for human health in Alberta, across Canada, and around the world.

A new report endorsed by 15 health and environmental organizations—including the Canadian Association of Physicians for the Environment, the Asthma Society of Canada, and the Lung Association—estimates that a Canada-wide phase-out of coal power by 2030 would prevent more than 1000 premature deaths, 900 hospital admissions or emergency room visits and nearly $5 billion in health care costs by improving local air quality. In fact, most of these national health benefits will be realized in the Prairies—about $3 billion in Alberta and up to $1.3 billion in Saskatchewan. While the lion’s share of the benefits will happen in the Prairies, there will still be important benefits realized in the Atlantic provinces and in central Canada, making a Canada-wide coal-phase out truly in the country’s national interest.

The 2030 phase-out will also significantly reduce mercury emissions. Mercury is the reason that pregnant women are warned not to eat certain types of fish during pregnancy. It is a persistent substance that accumulates in the aquatic food chain that can harm the brains of children exposed during pregnancy. Reducing this pollution will mean that these harmful effects can be minimized; that we can reclaim fish as a healthy protein source for all.

In addition, the 2030 phase-out will help Canada’s fight against climate change. Renowned medical journal The Lancet estimates that climate change is already responsible for approximately 150,000 deaths each year. People are dying from malnutrition, malaria, infectious disease and extreme heat; conditions made worse by a climate characterized by more frequent and more intense storms, heat waves, and droughts. People in countries that are already struggling to feed their people will experience many of these health impacts, but Canada will not be immune. Over the last 10 years, Canada has experienced an increase in droughts, wildfires, extreme rain and ice storms, floods and extreme heat. We have seen the spread of insect- and tick-borne diseases such as West Nile virus and Lyme disease. And we have seen permafrost and ice roads melting in the far north. Canadians are already being affected by climate change, both in economic and health terms.

By accelerating the closure of coal plants across the country, we will cut Canada’s greenhouse gas emissions by about 8%. This will help Canada to meet its commitments under the Paris Agreement on Climate Change and put us in a stronger position to ask the same of other countries. But more importantly, we will be acting decisively to improve the health of Albertans, Canadians and other people around the world from the ravages of uncontrolled climate change.

We congratulate the governments of Alberta and Canada in their decisions to phase out coal-fired power, and to reap the important health benefits for Albertans and all Canadians. Now the hard work begins: designing plans to ensure this transition happens quickly, in partnership and collaboration with communities most impacted. We look forward to working with all levels of governments throughout this process.

Prepared by Kim Perrotta, MHSc, Executive Director of Canadian Association of Physicians for the Environment (CAPE), on November 25, 2016

Health Benefits from a Canada-Wide Coal Phase-Out

In collaboration with CAPE and nine other health organizations, energy think tank the Pembina Institute has released a new report titled “Out with the coal, in with the new: National benefits of an accelerated phase-out of coal-fired power”. This report estimates the air pollution-related health benefits associated with a Canada-wide phase-out of coal-fired power plants by 2030.

There are currently 14 coal plants operating in Canada: six in Alberta, three in Saskatchewan, four in Nova Scotia, and one in New Brunswick.  These plants are significant emitters of air pollutants, mercury that contaminates fish, and greenhouse gases that contribute to climate change.

In 2012, Environment Canada found that coal regulations, which limit carbon dioxide emissions from these plants or require their closure after 50 years of operation, would produce $4.9 billion in health benefits over a 20-year period by improving air quality in several provinces.

When the Pembina Institute extrapolated those health benefits to a 2030 phase-out date, it found that the health benefits would be doubled producing an additional $5 billion in health benefits over a 20-year period by further improving air quality.

In 2014 alone, the study found that these 14 coal-fired power plants were responsible for approximately 163 premature deaths and 141 hospital admissions or emergency room visits.  These health impacts, along with other related impacts, were valued at approximately $816,000,000.


While these health benefits would be realized in the four provinces that operate coal-fired power plants, the provinces downwind of them – Manitoba, Ontario, Quebec and Prince Edward Island – would also experience improved air quality and reduced health impacts.  The report notes that greatest health benefits would be realized in the prairies because of the heavy use of coal plants in Alberta and Saskatchewan.

The report notes that substantial health benefits would also result from the elimination of mercury emissions from these coal plants.  The 2030 phase-out would also cut Canada’s greenhouse gas emissions by up to 8.5% and make Canada a role model for other countries around the world.

Click here to read the full report or download a two-page summary factsheet.

Click here to view the press release.

Prepared by Kim Perrotta, MHSc, Executive Director, CAPE, November 21, 2016

Strong Support for Ban of Cosmetic Pesticides in Alberta

A new opinion poll reveals that nearly two thirds of Albertans (62%) would support a provincial law that phases out the use and sale of toxic pesticides for lawns and gardens. The poll, conducted by OraclePoll Research, is based on interviews with 1000 Albertans from the last week of August 2016. The results are considered accurate 19 times out of 20.

The poll found that 66% of Albertans believe that lawn and garden pesticides, often called cosmetic pesticides, pose a threat to the health of children. This demonstrates that Albertans have a high level of awareness about the health hazards posed by pesticides, particularly for children.

The poll also found that many Albertans (nearly 7 out of 10) believe that pesticides present a health risk to their pets. Again this perception aligns with the scientific literature that reports increased rates of cancer among pets exposed to lawn and garden pesticides.

Pesticides used on lawns and gardens have been linked to cancer, reproductive problems, and deficits in the mental and physical development of children. Early life exposure to pesticides can affect the health and abilities of a child for their entire life. Pesticides used on lawns and gardens can be tracked indoors where they can be a substantial source of exposure for young children and pets.

Alberta is one of only three Canadian provinces that has no provincial law banning the sale and use of cosmetic pesticides. This new poll indicates that there is considerable voter appetite for a provincial law that bans the use of toxic pesticides on lawns and gardens.

“Would you support or oppose a law that phases out the use and sale of all but the safest pesticides for lawns and gardens in Alberta? The law would not apply to mosquito control, agriculture or forestry.”

Bar graph: 62% Support, 33% Oppose, 5% Don't know

Press Release (October 11, 2016)
Pesticides Policy Report (August 2016)
Provincial Scorecard (August 2016)

All Children Should Have a Space Free of Toxic Pesticides to Explore

Photo: A young child sits on grass holding a bunch of dandelions.

On August 30, 2016, CAPE released a new report which examines provincial laws and municipal bylaws across Canada that have been used to ban the cosmetic use of toxic pesticides on lawns and gardens.

There is a robust body of evidence that links pesticide exposures to certain types of cancer in children and adults, deficits in the mental and motor development of children, and adverse reproductive effects such as low birth weights and cleft palate.  While the increased risk associated with pesticides is considered small by some, many researchers and public health professionals have recommended that exposure to toxic pesticides should be avoided or minimized, particularly for non-essential uses such as lawn and garden care.

CAPE found that while seven provinces have cosmetic pesticide bans, only two provinces provide strong protection from toxic pesticides: Ontario and Nova Scotia, which scored an A- and a B, respectively.  Both of these provinces ban the use of toxic pesticides for gardens, shrubs and trees, as well as lawns.  And both laws are structured around a white list that identifies the pesticide ingredients/products that can only be used for cosmetic purposes because they have been found to be safe, low in toxicity, and not persistent.

The white list approach has also been adopted by Manitoba (which scored a B-), but it applies only to herbicides used on lawns.  Unfortunately, the current government in Manitoba is considering withdrawing this law when it should be extending it to gardens, shrubs and trees.

Quebec’s current regulations (which scored a C) are not as protective as those in Nova Scotia and Ontario because they only apply to about 20 active ingredients when used on lawns.  Quebec is the only province in the country to provide some coverage to indoor environments.  It applies a white list approach to indoor environments frequented by children, such as child care centres.  Given the sensitivity of children to toxic substances and their increased potential for exposure (because they spend more time on floors and put their hands in their mouths more than adults), this is an important public health policy that should be adopted by other jurisdictions.  In November 2015, Quebec proposed a new pesticides strategy that would overhaul its approach to agricultural pesticides as well as those used for cosmetic purposes.

While Newfoundland and Labrador has a law banning pesticides, the law only applies to five active ingredients when applied to lawns.  PEI and New Brunswick have laws banning the use of 2,4-D on lawns.   Alberta, British Columbia and Saskatchewan have no laws prohibiting the use of toxic pesticides on lawns or gardens.

The CAPE report, Cosmetic Pesticides – Provincial Policies & Municipal Bylaws: Lessons Learned & Best Practices (cape.ca/pesticide-policy-report), identifies and discusses best practices for both provincial laws and municipal bylaws. For a high-level summary, please review the accompanying backgrounder.

Pesticides scorecard

Prepared by Kim Perrotta MHSc, Executive Director of CAPE, and Ian Arnold MHSc, LLB, lead author.

WHO Conference on Climate Change and Health


In July, I had the privilege of participating in the second World Health Organization (WHO) Conference on Climate Change and Health.  The conference brought together government officials, ministers of health and environment, technical experts, NGO representatives, civil society, and even the Queen of Spain to discuss priorities and actions on behalf of the health community to respond to climate change.

The many health impacts of climate change were identified including intense heat waves, extreme weather events, vector-borne diseases, contaminated water, forced displacement, the increased risk of violent conflict from resource scarcity, and exacerbation of poverty.  It was acknowledged that the most vulnerable are paying the human cost of our energy consumption.

Forest Fire in British Columbia, 2015

Several people reported on the climate health impacts being experienced in their countries.  For example, Dr. Mario Baquilod of the Philippines reported that they experienced record breaking temperatures of 52 degrees C in the Philippines this year.  He indicated that they had over 20,000 cases of diarrhea and 19 deaths this year due to contaminated water supplies and that rates of vector-borne diseases such as dengue fever have increased.  He also noted that more than 2,000 health facilities were destroyed in Typhoon Haiyan which hit the Philippines in 2013.

A few speakers identified the many health co-benefits that can be realized by taking action on climate change.  For example, WHO Climate Health Lead, Dr. Diarmid Campbell-Lendrum, reported that the burning of fossil fuels for transport and energy production contributes to nearly 7 million air pollution-related deaths each year.  He noted, for example, that by promoting the transition from cars to healthy public transport and cycling to reduce greenhouse gases, we can also produce health benefits by improving air quality, reducing road traffic injuries, and fostering physical activity.

Commuters on bicycle in the city.

Some described the innovative steps that are being taken in some jurisdiction to mitigate or adapt to climate change. For instance, in West Africa, they are creating cereal banks to address the cyclical food crises from droughts.  In Rwanda, a project called DelAgua has distributed over 60,000 advanced water filters and clean cook stoves.

Others spoke about the need to build climate resilience into health care systems, particularly in low income nations.  They identified the need for more health education and technology transfer to low income nations to help predict climate health risks, triage financial resources, and invest in key resilience strategies such as early warning systems.

There were discussions about the need to educate the public and decision-makers about the impact that climate change is having on human health, to reframe it as a social justice issue, and to identify it as an inter-generational issue.  Dr.Nick Watts, head of the Lancet Commission on Climate Health, reported that he is creating indicators that can be used to monitor the impacts of climate change on human health. The goal is to create a social license that can be used to clearly advocate for health and climate issues.

There was a sense of urgency at the closing of the conference. There was a feeling that we have limited time to change the trajectory of our economic systems. But there was also a feeling of optimism and positivity.  Many agreed that we have an opportunity to reframe and mobilize political and social will on what could be the greatest health opportunity of our time.

Guest Blog:  Kelly Lau, Medical Student at McGill University, and CAPE Member