How do fossil fuels impact on health?

Broadly speaking the impacts of fossil fuels on health fall into two categories: direct and indirect.

According to the World Health Organisation, air pollution is now responsible for one in every eight deaths worldwide, or 7 million premature deaths annually. Air pollution is not only a health hazard in industrialising countries: an estimated 40,000 deaths annually in the UK are attributable to air pollution. But premature mortality is only part of the problem. Even at low levels, long-term exposure to particulate air pollution elevates the risk of respiratory diseases (including asthma, COPD and lung cancer), cardiovascular disease, stroke and low birth weight.

Air pollution is closely linked to climate change, because ambient air pollution in most countries is produced primarily by fossil fuel combustion for energy and transport. In addition to particulate matter (the major pollutant which affects health), many short-lived climate pollutants (SLCPs), such as ozone, also have adverse health effects.

Moreover, jobs in the fossil fuel industry can be among the most hazardous occupations, with over 1,000 times the number of deaths per unit of energy generated in the coal industry compared with wind power generation.

Indirectly, the health impacts of climate change are likely to be more severe than the direct effects of fossil fuels and fall broadly into three categories: direct effects of extreme weather and sea level rise, effects mediated primarily through ecosystems, and those mediated primarily through social systems. These are severe and subject to uncertainty regarding both climate impacts and interactions between climate change and human responses to it. These issues and the available evidence are described in detail in the Lancet Countdown (see Resources).

How much do we need to keep in the ground?

Pretty much every government on the planet committed at the COP21 in Paris in 2016 to hold global temperature rise ‘well below 2°C’, aiming for 1.5°C. We already know that there is a massive gap between these goals and governments’ actual plans for action. But what would need to happen for us to meet these goals and avoid tipping us over into runaway climate change?

Scenarios for how we can meet the 1.5°C target leave us with as little as 200 gigatonnes of CO2 (IPCC), and maybe even less, left to release into the atmosphere as of 2016. We’re currently emitting around 40 Gt CO2 per year (due to both fossil fuel combustion and land use change). So on our current trajectory, we have five years before we overshoot the budget.

In fact, scientists no longer talk about keeping warming below 1.5°C. They talk about returning warming to below 1.5°C. All 1.5°C scenarios involve an ‘overshoot’ to up to 1.7°C before cooling back down again.

This ‘drawdown’ is supposed to be achieved, in part, by carbon capture and storage, also known as carbon capture and sequestration (CCS). Even if CCS technology was deployed under a best-case scenario (which would involve nearly 3,800 CCS projects running by 2050), it would only start taking out emissions after 2030 and would extend the carbon budget by about 125 Gt only. In other words, as of now we have virtually exhausted the carbon budget left for even a 50% chance of meeting the 1.5°C target. From now on, we would have to draw down every tonne of carbon we emit.

Even for a chance to meet the 2°C target, emissions need to peak now and decline precipitously. For a 66% chance of staying below 2 °C, we could emit no more than 470 GtCO2 from 2015 onwards. This is the lowest number in a range of several budget scenarios that goes up to 1020 Gt (this one takes into account emissions of greenhouse gases other than CO2, such as methane).  It is also important to remember that agriculture, forest fires and natural feedback mechanisms also release greenhouse gases, and that the entire budget cannot be spent on fossil fuel combustion.

Recent analysis by Oil Change International found that the extractable oil, gas and coal in already-developed fields and mines (not just reserves) exceeds what the Intergovernmental Panel on Climate Change (IPCC) says can be burned to stay below 2°C of warming. The implication is that any investment in new extraction could take the world beyond 2°C, or alternatively lead to assets being stranded. This means no new fossil fuel power plants, extraction projects, pipelines, drilling permits or fossil fuel financing. It also means massive fossil fuel production decreases.

When Bill McKibben wrote his now infamous article Terrifying New Math in 2012, the logic of which underpins 350.org’s film Do the Math, they found that 80% of known fossil fuel reserves needed to be kept underground. But at this point, even 80% is likely to be inadequate given the fast dwindling carbon budget and growing fossil fuel reserves.

What is divestment?

Simply put, divestment is the opposite of investment. The basic idea of divestment is simple. Health institutions have significant financial investments in the fossil fuel industry and we are asking them to move their money elsewhere.

Divestment is a campaigning tactic that has been used in many high-profile progressive campaigns over the last 30 years. The health sector led calls for tobacco divestment and regulation and the World Health Organisation has long recognized the conflict of interest in allowing the tobacco industry influence over tobacco control negotiations.  Similar to the tobacco industry, a very small number of publicly-traded companies hold the vast majority of listed coal, oil and gas reserves. Those are the companies we’re asking the health community to divest from.

The global movement announced divestment commitments totaling over $5trillion in 2016.  This campaign already has broad-based supported from both health professionals, students, and those at the heart of the health community. Dr Fiona Godlee, Editor-in-Chief of the BMJ and Dr Sabaratnam Arulkumaran, the President of the British Medical Association, have both voiced their support for divesting from fossil fuels.  As of November 2016, three medical pension funds, in Berlin, Sweden and Denmark, have committed to divestment from fossil fuels.


How will divestment change anything?

Divestment has been employed as a tactic in challenging the social licence of many industries, from tobacco, to weapons, to companies that were complicit in South African apartheid. In the case of the latter the global divestment movement combined with grassroots action in South Africa, which ultimately led to the apartheid regime’s downfall. Fossil fuel divestment is principally a moral and social strategy, intended to remove the ‘social licence’ of fossil fuel companies to operate as they currently do – to bankrupt morally, rather than financially. Health institutions play a huge role in contributing to the shift in perspectives of the fossil fuel industry as they are fundamental in nurturing and reshaping societal narratives. Health professionals are among the most respected in the country, and play a key role in shaping public perceptions of the impacts of air pollution and climate change. Health professionals also have a professional duty of care to ‘do no harm’, and were among the leaders in tobacco divestment for this exact reason. By joining the global divestment movement they can significantly contribute to increasing the public and political will to transition to renewable energy.

When you divest, aren't you just selling to other investors?

Divesting will send an important message to the world that climate change is real and requires immediate preventative action through a drastic reduction of greenhouse gas emissions and rapid transition to a zero-carbon world. Such changes may be considered disruptive and difficult, but are necessary and can bring enormous benefits to human health and well-being both in the short term and in the years and decades to come.

On October 22nd, 2016, the World Medical Association passed a resolution calling on their members and health organisations worldwide to divest from fossil fuels, and reinvest in organisations upholding environmental principles.

Moreover, by divesting it is possible to impact the ability of the major fossil fuel companies to borrow in order to invest in high-cost extraction.  The cost of borrowing goes up when companies are perceived as a risky investment, therefore divesting contributes to the necessary ‘stranding’ of fossil fuel assets owned by the industry.

Wouldn’t it be better for shareholders to engage fossil fuel companies to get them to change their behaviour?

There is little evidence that this sort of engagement works. Some organisations and people, such as Jonathan Porritt, have dedicated a large proportion of their lives to this endeavour, only to come to the conclusion that no matter how much you engage with extractor fossil fuel companies, their business models will always rely on extraction in the pursuit of maximum profit. Historically, such attempts have been ‘futile’ and this is why we support divestment rather than engagement. Engagement is often tantamount to greenwashing and is often used as an excuse to delay decisions on divestment. Fossil fuel companies knew they were causing climate change decades ago, and took lessons from the tobacco industry, that the best way to stall action is to ‘seed doubt’ in the minds of the public and politicians. Exxon Mobil actively funded the discrediting of climate change science – and, as they’ve taken no meaningful action thus far, it’s unlikely to ever happen. Detailed arguments against the engagement argument can be found here, on 350.org’s website.

Engagement only works if it is tied to a condition that without a commitment from the fossil fuel company to change their business model, the investor will divest. Moreover, few investors are so large that they are significant shareholders in any one company – and an investor can vote at an AGM whether they own one share or a million shares. In either case they are not going to have a decisive vote, so divesting all but a small holding makes no difference to the capacity to engage if investors want to pursue stewarding of the business.

Shouldn't we instead support extractor fossil fuel companies like Shell and BP to diversify into renewables?

The business models of extractor fossil fuel companies rely on just that: the extraction of fossil fuels like oil and coal. There is no suggestion that that this will change in response to climate change. In the early 2000s, BP, for example, rebranded to Beyond Petroleum, but has since been selling off its alternative technology assets. Similarly, Shell’s ‘diversification’ strategy is not into renewable energy – the Shell New Energies arm of their business represents under 0.5% of the company’s overall capital expenditure. Their efforts are concentrated on carbon capture and storage and they’ve made it clear that they don’t believe the stranded assets/’carbon bubble’ argument holds much substance. This report outlines some of the industries own projections of fossil fuel consumption, which are far from compatible with action on climate change (see the OCI/Greenpeace report in our Resources section).

Alongside these examples, the fossil fuel majors seem to recognise the impacts of climate change but refuse to reflect on their role in contributing to it. For example, Mobil Oil’s response to rising sea levels has been to build their oil rigs a bit higher above the ocean to ensure their business isn’t affected. There is little to indicate that these companies have anything like a genuine commitment to diversification or transitioning to renewables.

Given the financial pressures on healthcare, do we risk losing money if we divest?

If anything, the opposite is true. ‘Fiduciary duty’ exists to ensure that those who manage other people’s money act in the interests of beneficiaries over the long-term. While it’s true that fossil fuel companies pay high dividends (annual payments to shareholders), they’re also very risky investments. Coal, oil and gas companies’ business models rest on emitting five times more carbon into the atmosphere than is possible if we are to stay below 2-degrees warming, which makes their share price five times higher than it should be in reality. In addition, disasters like Exxon Valdez, the BP oil spill, along with massive fluctuations in supply and demand of coal, oil and gas, make energy markets particularly volatile, and therefore risky investments.

In the last few years as oil and gas prices have remained low, fossil fuel companies have had to borrow large amounts of money to maintain their dividend payments to shareholders.  If these payments are reduced, even slightly, there is likely to be a huge sell-off of shares in the oil and gas majors, which will adversely affect share prices.

There are several stock market indices now available to fund managers that if looked at historically show that divesting from fossil fuels five years ago would have generated investors the same or better returns than remaining invested.

But isn’t divestment hypocritical as we use fossil fuels every day in healthcare?

Indeed we do rely on them in healthcare, from the packaging and materials for single use items, through to fuelling our transport and deliveries, and powering hospitals and health facilities. Fossil fuels are currently intrinsic to healthcare, but this is neither an essential truth, nor a healthy or sustainable means of delivering healthcare. The most recent estimate is that the health and care sector carbon footprint was 26.6 million tonnes of carbon dioxide equivalent (MtCO2e) in 2015, contributing roughly 39% of public sector emissions. Alternatives exist to many of fossil fuel based health-care practises, including sourcing renewable gas and electricity, investing in energy efficiency measures and procuring products made from sustainable materials. The NHS has a target to reduce emissions by 80% by 2050 in line with the legally binding Climate Change Act 2008, and therefore the direction is set to massively reduce our reliance on fossil fuels in healthcare.

In the UK the Sustainable Development Unit provides regular updates on NHS progress towards reduced CO2 emissions.  It is important to remember that increased energy efficiency translates into greater financial efficiency also, and the Centre for Sustainable Healthcare present a range of case studies of departments that have made major cost-savings by adopting sustainable practises.

What are stranded assets?

Stranded assets are economic resources held by a company that cannot earn an economic return. In the case of fossil fuels, it means that changes in the market and regulatory environment associated with the transition to a low-carbon economy lead to fossil fuel reserves becoming economically unviable and seeing no return on investment.

What is the carbon bubble?

The carbon bubble refers to an inflated investment bubble in fossil fuels. It is the result of an over-valuation of coal, oil and gas reserves that does not take into account that the majority of proven fossil fuel reserves carry the risk of being unexploitable and turning into stranded assets.

There are various factors for this risk, a key one being climate legislation. If governments take regulatory action to stay below 2 degree global warming, 80% of proven fossil fuel reserves are unburnable. Other factors that make fossil fuel reserves unlikely to see a return of investment include falling renewable energy costs, environmental challenges, changing resource landscapes, evolving social norms and consumer behaviour, litigation and changing statutory interpretations.

If uncontained, there is a risk that this ‘carbon bubble’ will burst, which would have a ripple effect that would hit all markets, including the European economy. A study commissioned by the the Greens/ European Free Alliance warns that over €1 trillion in European financial institutions is at risk from the carbon bubble.


We can't just let the lights go out - are renewables ready to support our energy demands?

It is impossible to over-state the extent to which renewables have exceeded all expectations of the amount of energy they can supply.  In both April and May 2016 solar energy in the UK provided more electricity than coal for 24 hour periods, and on occasions the UK energy mix completely omitted coal for the first time since the industrial revolution.  In 2016 Germany was also powered by almost 100% renewable energy for a day, and Portugal for four whole days. Globally last year more new electricity capacity was added from renewable energy sources than coal. Research by the University of Stanford has also shown that 100% of energy could be sourced from wind, sun and water by 2050, with no impact on economic growth.