Treating the climate with coal phase-out

*Reprinted with the permission of National Observer

Op-Ed By Dr. Courtney Howard, President, CAPE December 3, 2017

Canada, the UK and partners announced a global alliance to phase-out coal power at COP23 in Bonn, Germany. It was an honour to speak on behalf of the health community at the launch, as coal-power phase-out is a key recommendation of the 2017 Lancet Countdown Report and the Countdown’s associated UK brief, as well as the Canadian Brief which I co-authored on behalf of the Canadian Public Health Association.

The Lancet tells us that climate change is the biggest global health threat of the 21st century…and that tackling climate change could be the greatest global health opportunity of the 21st century.

Phasing out coal is about reducing the 44 per cent of global carbon dioxide emissions due to coal—and the trauma, displacement and heat-related deaths associated with severe weather events due to climate change. It’s about a future with less burns and cough-inducing smoke clouds from wildfires, less conflict and migration, and less undernourished children.

Phasing out coal is also about seeing less kids with asthma puffers from air pollution—less costly ER visits for asthma, less time off school and work. It’s about less morbidity and deaths from the long-term health impacts of coal-related air pollution—cancer, cardiovascular disease, stroke, lower respiratory infection. It’s about less neurodevelopmental problems from mercury, and less polluted water and habitat loss from coal extraction.

Health professionals worldwide are beginning to treat climate change with coal phase-out.In Canada, organizations such as the Canadian Association of Physicians for the Environment and the Canadian Public Health Association have been key contributors to coal phase-out commitments in Ontario, Alberta and Canada-wide.

Earlier at COP23, the World Health Organization Director General, Dr Tedros Adhanom, repeated his commitments to make action for a healthy climate one of the four priorities of his presidency, and met with myself and other members of the Global Climate and Health Alliance to discuss collaboration on both adaptation and mitigation work in service of health.


At the Global Climate and Health Alliance Summit, held in association with the World Health Organization, we spoke with health professionals from across the world, including medical students, to teach them what advocacy techniques work and who they need to partner with in order to support coal phase-out in their home countries. With income being a major social determinant of health, health professionals believe that active support of workers is key to a just and healthy transition.

The health professions are late to the climate fight, but we learn fast, we don’t need a lot of sleep and we’re used to dealing with crisis.

As we move forwards towards actioning the coal phase-out in Canada and beyond, health professionals will be looking to see as much coal as possible replaced with renewables as opposed to natural gas. An increasing proportion of natural gas in Canada is being produced via hydraulic fracturing—for which increasing studies are demonstrating negative impacts. One assessment of the peer-reviewed literature on the impacts of hydraulic fracturing found that 84 per cent of studies on public health, 69 per cent of studies on water and 85 per cent of studies on air pollution found concerning findings. A direct transition to healthy, low-carbon energy should be our goal.

As an Emergency doctor I know what it’s like to act too slowly and to have patients die. The first time a child died under my care was on a pediatric malnutrition project in the Horn of Africa. It was one of the worst moments of my life. I also know what it’s like to act quickly, to do the right thing, and to pull someone from the spiral back to where we can thrive.

The health professionals of the world are applying the skills they’ve learned from treating people—to work to resuscitating the planet.

COP23 has seen new initiatives, new alliances, and new skills created. In partnership with the global health community and our decision-makers, I’m looking forward to treating the climate with coal phase-out and moving forward to a healthier planet.

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Coal Plants have a Significant Impact on Air Quality and Health: Incomplete Facts Don’t Change the Truth

Prepared by Kim Perrotta, Executive Director, CAPE, March 7, 2017

It is a sad statement of our times that in the middle of an important public health debate, the National Post has printed a commentary that muddies the water with incomplete facts and misleading information about coal plants, air pollution and human health (Warren Kindzierski, They keep saying shutting down coal will make us healthier, so how come there’s no evidence of it? February 24, 2017).

Coal Plants and Air Pollution

Kindzierski maintains that coal plants are not a major contributor of fine particulate matter (PM2.5), the air pollutant that has been most clearly and consistently linked to chronic heart and lung diseases as well as acute health impacts. Kindzierski refers readers to several of his own studies, one of which contains a graph (posted above) that identifies coal combustion (the mustard yellow bar) as a small contributor of ultra fine particles in Alberta’s air (Md. Anul Bari et al., 2015). He fails to explain however, that coal plants are one the most significant sources of sulphur dioxide (SO2), the gaseous air pollutant that is transformed in the air into secondary sulphate (the large brown bar).

Secondary sulphate, as illustrated by the author’s own graph, is the most significant source of ultra fine particles, the most worrisome portion of PM2.5. In 2014, coal-fired power plants were responsible for 40% of the SO2 emitted in all of Alberta and 60% of the SO2 emitted in the Edmonton Region (Pembina 2016a). In other words, coal plants were the largest source of SO2 that is transformed into the secondary sulphates that contribute most significantly to air levels of ultra fine particles and PM2.5 in Alberta.

Air Pollution and Human Health

Kindzierski then goes on to challenge the view that air pollutants other than PM2.5 and ground level ozone are harmful to human health, and even calls into question the health evidence associated with PM2.5. Thousands of studies have been directed at the acute and chronic health impacts associated with air pollution over several decades. In 2013, the World Health Organization (WHO) reassessed the health literature on air pollution and found, among many other things, stronger evidence that short- and long-term exposure to PM2.5 increases the risk of mortality and morbidity particularly for cardiovascular effects; stronger evidence that short-term exposures to ozone can have negative effects on a range of pulmonary and vascular health-relevant end-points; new evidence that short- and long-term exposure to nitrogen dioxide (NO2) can increase the risk of morbidity and mortality, mainly for respiratory outcomes; and additional evidence that exposure to SO2 may contribute to cardiovascular and respiratory mortality and morbidity and asthma symptoms in children (WHO, 2013). These findings are well known and well accepted by public health, environmental, and medical professionals around the world.

Coal Plants, Air Pollution and Human Health

In 2012, using the Air Quality Benefits Assessment Tool (AQBAT) developed by Health Canada, Environment Canada estimated that improved air quality resulting from the current coal regulations would prevent approximately 994 premature deaths and 860 hospital admissions or emergency room visits between 2015 and 2035 (Environment Canada, 2013). These avoided health outcomes were valued at $4.9 billion. In 2016, the Pembina Institute extrapolated these results to determine the additional health benefits associated with a 2030 coal plant phase-out in Canada. It found that a 2030 phase-out date would nearly double the health benefits associated with the existing coal regulations, preventing an additional 1,008 premature deaths and 871 hospital admissions or emergency room visits between 2015 and 2035. These additional health benefits were valued at nearly $5 billion (Pembina 2016b).

It is clear to us: a 2030 Canada-wide phase-out of coal-fired power plants is a public policy that will produce many direct public health benefits for Canadian while simultaneously helping us to meet our commitments under the Paris Climate Change Agreement.


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.

Act Now to Prevent Global Flooding

Photo: Cpt Marie Preece, Cornwall, UK. The Wildlife Trust
Photo: Cpt Marie Preece, Cornwall.  The Wildlife Trust

Prepared by Kim Perrotta, Executive Director, CAPE , March 29, 2016

Climate change is no longer a distant problem.  It is happening.  And we only have a few decades to make the dramatic changes needed to avoid impacts that could be devastating (Carrington, 2016).  This is the declaration of some of the world’s leading climate scientists. 

A Flooded World

In March, nineteen climate scientists released a new study that indicates that climate change is happening much more quickly than previously predicted.  This study, which combined modern observations, modelling, and the examination of geological formations created thousands of years ago, is predicting that global sea levels could rise by several meters within 50 to 150 years if greenhouse gas emissions continue to grow (Hansen et al., 2016).   The lead author, former NASA researcher James Hansen, maintains that this multi-meter increase in sea levels could occur even if we manage to limit global temperature increases to the 2 degree C target set by the United Nations Framework on Climate Change (UNFCC) (Milman, 2016). He and his colleagues are pushing for a more aggressive target.     

Another study, released in February, predicted that 20% of the world’s population will have to migrate away from coasts swamped by rising oceans unless we can halt climate change in the very near future (Clark et al., 2016).   Under this scenario, cities such New York, London, Rio de Janeiro, Cairo, Calcutta, Jakarta and Shanghai would all be submerged (Carrington, 2016).  These changes, which would be devastating at a social and economic level, are expected to last for thousands of years (Hansen et al., 2016; Clark et al., 2016).

Photo-PdPhoto-Boston University-storm-surge-hurricane2
 Photo: PdPhoto, Boston University 

These researchers are making a clarion call; they are calling for immediate action to save the world for future generations. They say that this future may still be avoided if fossil fuel emissions are rapidly phased out and agricultural and forestry practices are improved (Hansen et al., 2016).   But time is running out.

Action Needed in Canada

To keep the global temperature increase below 1.5 degrees C (relative to pre-industrial times), the International Panel on Climate Change has indicated that greenhouse gas emissions must be cut by 70 to 95% by 2050 relative to 2010 (IPCC, 2015).  

In 2010, Canada emitted 707 megatonnes (1 million tonnes or MT) of greenhouse gases; 23% from the oil and gas industry, 24% from the transportation sector, 14% from the electricity sector, 12% from buildings, 11% from energy intensive industries, 10% from the agricultural sector, and 7% from waste and other sectors (Canada, 2016).  In order to meet our obligations to slow climate change, we will need to transform our society.  We will need to cut our reliance on fossil fuels.  We will have to revolutionize our transportation sector and redesign our communities to support walking, cycling, and public transit. We will need to invest in renewable energies, increase the energy efficiency of our buildings and industries, and change the practices in our agricultural sector. 

While the electricity sector is responsible for only 14% of all Canada’s emissions, it is seen as the sector from which reductions can be made most quickly.  Since 2005, Ontario has reduced its emissions by close to 20%.  Almost all of these reductions can be attributed to the closing of its six coal-fired power plants (Canada, 2016).  In 2015, Alberta announced its decision to accelerate the closure of its coal-fired power plants.  By doing so, it can cut its emissions by 17% by 2030 and reduce Canada’s total emissions by 6%, while producing air quality-related health benefits worth $300 million per year for its residents (Pembina et al., 2013).  


  • Canada. 2016.  Canada’s Second Biennial Report on Climate Change. 
  • Carrington D. 2016.  Sea-level rise ‘could last twice as long as human history’. The Guardian, Feb 8, 2016
  • Clark P et al. 2016. Consequences of twenty-first-century policy for multi-millennial climate and sea-level change.  Nature Climate Change.  February 8, 2016
  • Hansen J et al. 2016. Ice melt, sea level rise and superstorms: evidence from paleoclimate data, climate modeling, and modern observations that 2 degrees C global warming could be dangerous.  Atmospheric Chemistry and Physics. March 22, 2016.  
  • International Panel on Climate Change (IPCC).  2015.  Climate Change Synthesis for Policy Makers.
  • Milman O.  Climate Guru James Hansen warns of much worse than expected sea level rise.  The Guardian.  March 22, 2016.
  • Pembina Institute, CAPE, Asthma Society of Canada, Lung Association of Alberta and Northwest Territories.  2013.  Costly Diagnosis: Subsidizing coal power with Albertans’ health.