Time for the US Surgeon General to call fossil fuels a public health emergency

About the author

Andreas Vilhelmsson is an associate researcher with a Ph.D. in public health from Lund University in Sweden, where he works with interdisciplinary research at the Division of Occupational and Environmental Medicine. He has a broad interest in different aspects of human health, with a specialized focus on issues concerning global and environmental health (special focus on endocrine disruptive chemicals and fertility), climate change (mostly health aspects, but also policy), mental health (including suicidology), pharmaceuticals (regulation, toxicology, and pharmacovigilance), pandemics, nudging, AI and digitalization. He is a 2022 Fellow with the Global Catastrophic Risk Institute where he collaborated on public health implications of nuclear winter. Andreas is also a community editor for the PLOS ECR blog.

Recently, the U.S. Surgeon General Dr. Vivek Murthy issued two landmark public health advisories, declaring gun violence a public health crisis and calling for a warning label on social media platforms to protect youth mental health. Surgeon General’s Advisories are public statements that call the American people’s attention to significant public health challenges that require the nation’s immediate awareness and action. They do not come frequently, but sometimes become turning points in American life, like in the case of tobacco and smoking in the 1960s.

Today, the global threat of smoking has been replaced by fossil fuel air pollution, driving not only global warming but also escalating multiple health issues, including asthma, cancer, heart disease and premature death. Between five and eight million people die every year globally because of fossil fuel use [1,2]. According to some estimates, this means that air pollution from burning fossil fuels like coal and diesel is responsible for 1 in 5 deaths worldwide every year [1]. In the United States alone, 350,000 premature deaths can be attributed to fossil fuel pollution on a yearly basis and fossil fuel combustion accounted for more than 40% of all premature deaths attributable to human-caused particles PM2.5 in 2020 [1]. Globally, over a third of premature births across the planet can be attributed to the mother’s exposure to particulate pollution from fossil fuels [3].

It is obvious we have a public health problem of a magnitude almost unheard of, but for some reason it is being treated like the big coal elephant in the room. Humanity’s Faustian climate bargain [4] has led to a fossil fuel dependence undermining not only global health directly, but also indirectly through climate change impacts and through a volatile energy system and geopolitical conflicts [5]. But while the Paris Agreement set a crucial global climate target, many governments have continued to approve new coal, oil and gas projects and continue subsidies [6].

The public health community on the other hand is quite clear on what needs to be done. The Lancet Countdown’s 2023 U.S. Brief underscores the escalating threat of fossil fuel pollution and climate change to health, highlighting an 88% increase in heat-related mortality among older U.S. adults and calling for urgent, equitable climate action to mitigate this public health crisis [7].

As health professionals increasingly see patients suffering from harm caused by climate change, global health bodies have begun to demand governments to urgently phase out fossil fuels. An interesting suggestion that has got some traction is the Fossil Fuel Non-Proliferation Treaty, which has been endorsed by the World Health Organization and more than 100 Nobel laureates, as well as by academics, health organizations and health professionals around the world. With a precedent in the Nuclear Non-Proliferation Treaty, this planetary health treaty has been proposed as a mechanism to ensure that remaining fossil fuels stay in the ground [8].

Phasing out fossil fuels would be an historic effective intervention to improve public health and ought to part of the United Nations’ goal of climate neutrality by 2050. Reductions in emissions related to fossil fuels and associated air pollution would decrease the number of attributable deaths substantially. Millions of unnecessary excess deaths per year globally could be avoided by phasing out fossil fuels. According to some estimates, controlling all anthropogenic emissions would correspond to 82% of the maximum number of avoidable deaths linked to air pollution [2]. Ambient air pollution would no longer be a leading, environmental health risk factor if the use of fossil fuels were superseded by equitable access to clean sources of renewable energy. As a co-benefit, this would also help with the problems of plastic production and the harmful emissions that plastic waste generates.

From nuclear disarmament to tobacco control to mercury phase-out, the health sector has a history of advocating for healthy public policy on behalf of its patients. As a global leader, the United States could position itself at the forefront by recognizing fossil fuels a public health hazard. Given the global attention that the U.S. Surgeon General’s advisories receive, the issuing of such a declaration would be a powerful step in the direction of effective action.

References

[1]. Vohra K, Vodonos A, Schwartz J, Marais E, et al. (2021). Global mortality from outdoor fine particle pollution generated by fossil fuel combustion: Results from GEOS-Chem. Environmental Research. 2021; 195: 110754.

[2]. Lelieveld J, Haines A, Burnett R, Tonne C, et al. Air pollution deaths attributable to fossil fuels: observational and modelling study. BMJ. 2023; 383: e077784.

[3]. Conway F, Portela A, Filippi V, Chou D, Kovats S. Climate change, air pollution and maternal and newborn health: An overview of reviews of health outcomes. J Glob Health. 2024; 14: 04128.

[4]. Hansen J. Storms of my grandchildren. Bloomsbury Publishing; 2011.

[5]. Romanello M, Di Napoli C, Drummond P, Green C, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. The Lancet 2022; 400 :1619-1654.

[6]. SEI, Climate Analytics, E3G, IISD, and UNEP. (2023). The Production Gap: Phasing down or phasing up? Top fossil fuel producers plan even more extraction despite climate promises. Stockholm Environment Institute, Climate Analytics, E3G, International Institute for Sustainable Development and United Nations Environment Programme.

[7]. Beyeler NS, Knappenberger P, Hess JJ, Salas RN. Lancet Countdown on Health and Climate Change 2023. Policy Brief for the United States of America. 2023. Lancet Countdown U.S. Policy Brief, London, United Kingdom; 2023.

[8]. Howard C et al. (2022). Why we need a fossil fuel non-proliferation treaty. The Lancet Planetary Health; 6(10): e777-e778.