Elsevier

The Lancet

Volume 370, Issue 9591, 15–21 September 2007, Pages 979-990
The Lancet

Series
Electricity generation and health

https://doi.org/10.1016/S0140-6736(07)61253-7Get rights and content

Summary

The provision of electricity has been a great benefit to society, particularly in health terms, but it also carries health costs. Comparison of different forms of commercial power generation by use of the fuel cycle methods developed in European studies shows the health burdens to be greatest for power stations that most pollute outdoor air (those based on lignite, coal, and oil). The health burdens are appreciably smaller for generation from natural gas, and lower still for nuclear power. This same ranking also applies in terms of greenhouse-gas emissions and thus, potentially, to long-term health, social, and economic effects arising from climate change. Nuclear power remains controversial, however, because of public concern about storage of nuclear waste, the potential for catastrophic accident or terrorist attack, and the diversion of fissionable material for weapons production. Health risks are smaller for nuclear fusion, but commercial exploitation will not be achieved in time to help the crucial near-term reduction in greenhouse-gas emissions. The negative effects on health of electricity generation from renewable sources have not been assessed as fully as those from conventional sources, but for solar, wind, and wave power, such effects seem to be small; those of biofuels depend on the type of fuel and the mode of combustion. Carbon dioxide (CO2) capture and storage is increasingly being considered for reduction of CO2 emissions from fossil fuel plants, but the health effects associated with this technology are largely unquantified and probably mixed: efficiency losses mean greater consumption of the primary fuel and accompanying increases in some waste products. This paper reviews the state of knowledge regarding the health effects of different methods of generating electricity.

Introduction

Economic growth through industrialisation and rapid technological change has produced a huge improvement in the living standards and health status of the population of the now industrialised countries. From 1820 to 2002, western European countries saw their real incomes per head rise from US$1204 to $19 256, or 16 times.1 This economic growth was also accompanied by major improvements in health: life expectancy, for example, has risen from around 40 years at the beginning of the 19th century in Europe to nearly 80 years today. The increase in life expectancy is not uniform with income per head of population. It increases rapidly with income up to a level of $7500 and then rises more slowly with further increases in income.2, 3 The availability of modern forms of energy, especially electricity after 1900, has contributed substantially to these positive developments. The replacement of traditional fuels, such as wood and candles, and animal power by steam power, and then by electricity and gas, has reduced the risk of fires, made the air in homes cleaner and warmer in winter, and reduced the risk of health hazards associated with animal waste. Thus it has improved the quality of life of individuals in many ways, and continues to do so in developing countries. A 2001 World Bank study4 looked at demographic and health data from more than 60 low-income countries and investigated the determinants of health outcomes by use of cross-country data between 1985 and 1999. It found that in urban areas, linking households to electricity is the only key factor that reduced both infant mortality rate and under-5 mortality rate, and that this effect is large, significant, and independent of incomes. In rural areas, improvement of secondary education for women is crucial for reducing the infant mortality rate, whereas expansion of vaccination coverage reduces the under-5 mortality rate. Even with allowance for the limitations of such cross-sectional studies, the results are noteworthy and not unique.

Key messages

  • Access to electricity is pre-requisite for the achievement of health, and lack of access to it remains one of the principal barriers to the fulfilment of human potential and wellbeing

  • However, electricity generation from fossil fuel—resources of which could sustain their continued dominant role in electricity production well beyond this century—is also a cause of substantial adverse health burdens

  • Fossil-fuel use can be used with greater efficiency than it is currently, and with lower emissions of pollutants harmful to human health. This is especially the case in developing countries, and realising these efficiency gains will be increasingly important as demand for electricity increases sharply

  • An accelerated switch to renewable sources has the potential to deliver appreciable health benefits, though a major switch will pose (superable) challenges particularly in relation to the intermittency of renewable production, land use requirements, and cost

  • The demand for valuable agricultural land will limit the role of fuel crops in future electricity production in Europe, but the potential contribution of such crops is greater in regions where crops with higher energy yields per hectare can be grown

  • Nuclear power has one of the lowest levels of greenhouse-gas emissions per unit power production and one of the smallest levels of direct health effects, yet there are understandable fears about nuclear accidents, weapons uses of fissionable material, and storage of waste; nonetheless, it would add a substantial further barrier to the achievement of urgent reductions in greenhouse gases if the current 17 percent of world electricity generation from nuclear power were allowed to decline

  • CO2 capture and storage could in future have an economic role in reducing CO2 emissions from large point sources, but its effects on health are likely to be mixed because efficiency losses mean greater consumption of the primary fuel and other resources, and greater production of waste

  • Fusion power offers some hope as a comparatively clean technology for future electricity generation, with environment and health risks that are substantially smaller than for nuclear fission. However, commercial viability is still too far away for it to make a significant contribution to mitigation of climate change over most of this century

Electricity has also contributed to economic development more generally by increasing the efficiency with which energy is used, so that an increased level of production is possible with the same amount of energy. Energy use in France, Germany, and the UK increased by 4·7 times between 1840 and 1990, wheres real GDP increased by 21·5 times.5 Thus each unit of energy now produces more than 4·5 times as much output as it did in 1850.

Overall, there is little doubt that electricity has had a large positive effect on wellbeing. At the same time, new problems have emerged. The burning of large amounts of fossil fuels to produce the electricity we demand generates emissions that are harmful to health and are a source of climate change. Our paper focuses on these issues. We separate the discussion into the situation in developing countries and that in developed countries, and we offer some views on emerging trends in the relation between electricity use and health.

Section snippets

Developed countries

The health effects of electricity generation can most easily be assessed by a bottom-up approach, in which emissions and hazards from each stage of the power generation cycle are measured and tracked to the endpoints at which they cause harm to individuals. The effects are calculated for specific technology and location—ie, for a given power station using specified fuel sources.

The effects are referred to as external costs because the party generating the emissions does not take full account of

Conclusion

The generation of electricity has both health benefits and costs. The health benefits of a shift away from non-commercial fuels to commercial ones, particularly when they are used for electricity generation, are evident from the evidence in developed countries in the past century and which is still taking place in developing countries. Moreover, the substitution of dirty energy for clean is not the only change that increases wellbeing. Efficient lighting, refrigeration, clothes washers, radios

References (62)

  • CA Pope et al.

    Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution

    JAMA

    (2002)
  • DW Dockery et al.

    An association between air pollution and mortality in six US cities

    N Engl J Med

    (1993)
  • KA Miller et al.

    Long-term exposure to air pollution and incidence of cardiovascular events in women

    N Engl J Med

    (2007)
  • L Filleul et al.

    Twenty five year mortality and air pollution: results from the French PAARC survey

    Occup Environ Med

    (2005)
  • D Krewski et al.

    Reanalysis of the Harvard Six Cities Study, part I: validation and replication

    Inhal Toxicol

    (2005)
  • U Gehring et al.

    Long-term exposure to ambient air pollution and cardiopulmonary mortality in women

    Epidemiology

    (2006)
  • O Naess et al.

    Relation between concentration of air pollution and cause-specific mortality: four-year exposures to nitrogen dioxide and particulate matter pollutants in 470 neighborhoods in Oslo, Norway

    Am J Epidemiol

    (2007)
  • TJ Woodruff et al.

    The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States

    Environ Health Perspect

    (1997)
  • RJ Sram et al.

    Ambient air pollution and pregnancy outcomes: a review of the literature

    Environ Health Perspect

    (2005)
  • SV Glinianaia et al.

    Does particulate air pollution contribute to infant death? A systematic review

    Environ Health Perspect

    (2004)
  • APHEIS-3, Air Pollution and Health: a European Information System health impact assessment of air pollution and communication strategy. Third year report, 2005

  • F Hurley et al.

    Methodology for the cost benefit analysis for CAFE. Vol 2: health impact assessment

    (2005)
  • H Anderson et al.

    Meta-analysis of time series studies and panel studies of particulate matter (PM) and ozone (O3). Report of a WHO Task Group

    (2004)
  • Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS)

    Eur Respir J

    (1996)
  • DJ Ward et al.

    Particulate air pollution and panel studies in children: a systematic review

    Occup Environ Med

    (2004)
  • ML Bell et al.

    The exposure-response curve for ozone and risk of mortality and the adequacy of current ozone regulations

    Environ Health Perspect

    (2006)
  • K Ito et al.

    Associations between ozone and daily mortality: analysis and meta-analysis

    Epidemiology

    (2005)
  • JI Levy et al.

    Ozone exposure and mortality: an empiric bayes metaregression analysis

    Epidemiology

    (2005)
  • J Just et al.

    Short-term health effects of particulate and photochemical air pollution in asthmatic children

    Eur Respir J

    (2002)
  • TJ Hiltermann et al.

    Asthma severity and susceptibility to air pollution

    Eur Respir J

    (1998)
  • E Extern

    ExternE National Implementation; Germany

  • Cited by (228)

    View all citing articles on Scopus
    View full text