Limiting air pollution controls would cost thousands of lives and billions of dollars

Air pollution control devices (APCDs) prevented up to 9,000 deaths and saved up to $100 billion in health care costs by 2023, according to new estimates published in a American Journal of Public Health editorial.

But these public health benefits will be drastically reduced in the coming years if a future presidential administration implements the environmental policies outlined in Project 2025 and the America First Agenda, write researchers from the Boston University School of Public Health (BUSPH), the Sierra Club, institutes for the Environment at the University of North Carolina at Chapel Hill and at Columbia University Mailman School of Public Health.

Both far-right policy platforms seek to dismantle environmental regulations, including by weakening the Clean Air Act, the basic 1970 federal law that gives the Environmental Protection Agency (EPA) authority to regulate emissions of major air pollutants at power plants. Due to EPA policies requiring or encouraging power plants to use APCDs, SO₂ emissions fell by 93 percent and NO_x emissions fell by 87% between 1995 and 2022, translating into a massive drop in excess coal deaths from 40,000 in 2000 to 1,600 in 2020, the commentary said.

If Project 2025 and/or the America First Agenda federal policy platforms are adopted by the next administration, APCD use could decrease and seriously endanger public health, the authors argue.

“Air pollution control devices and other provisions of the Clean Air Act are a fundamental part of the public health infrastructure in the United States,” says Dr. Jonathan Buonocore, assistant professor of environmental health at BUSPH and lead author of the commentary. “This work serves to remind us how important the Clean Air Act is and that there are great public health benefits to protecting or strengthening it.”

To capture the environmental and health ramifications of a potential reduction in APCD use if Project 2025 or the America First Agenda is adopted, the team calculated changes in SO.₂ and NO_x emission levels based on a hypothetical “worst case” scenario where power plants stopped using existing APCDs.

The researchers estimated that SO₂ discounts would be 2.9 times higher and NO_x reductions would be 1.8 times greater if power plants — many of which are coal-fired — stopped operating APCDs. The team used a reduced-complexity model to estimate the health benefits from reduced emissions if APCD use continued at these plants. They found that in 2023, APCDs at power plants captured about 1.2 million tons of SO.₂ and 1 million tons of NO_x emissions, which would prevent between 3,100 and 9,000 premature deaths in 2023 and save between $35 billion and nearly $100 billion in health care costs.

“Power plants are no longer the largest contributor to the public health risk of air pollution in the US, thanks to federal policies that have drastically reduced SO emissions.₂ and NOx from this sector over this time period,” says Saravanan Arunachalam, deputy director, Institute for the Environment at the University of North Carolina at Chapel Hill. “Any future efforts to weaken the Clean Air Act may push this sector back to peak again and further increase the overall burden of disease for Americans”.

Even with these substantial health benefits, these models underestimate the additional health benefits of a reduction in emissions from the use of APCD, including lower risks of stroke, heart attack and asthma in adults, as well as low birth weight, births prematurity, onset of asthma, and other respiratory or developmental problems in children, the authors point out.

Although these health benefits are nationwide, the largest benefits have come from reduced emissions at power plants in Appalachia, the Midwest, and the Mountain West. More than 85% of these reductions were attributed to a sharp decrease in SO₂mostly from coal plants. While the researchers note that future policy changes are unlikely to eliminate all use of APCD, these new estimates quantify the health consequences that are at stake — as well as the future health benefits that may remain — depending on changes in authority EPA under a potentially weakened Clean Air Act.

“The health benefits of APCDs may be concentrated in certain locations, but these results show that strong environmental regulation benefits everyone,” says Dr. Mary Willis, assistant professor of epidemiology at BUSPH.

Importantly, any future policies that strip the EPA of its current regulatory authority would also exacerbate racial inequities in health and likely curtail other climate policies at all levels of government, the authors write. Policies that reduce the use of APCD would greatly burden environmental justice communities, most of whom are people of color or low-income populations, who already suffer the harms of other environmental hazards at disproportionate rates. Increases in air pollution emissions from power plants would also offset gains in cities with climate action plans to reduce greenhouse gas emissions by electrifying buildings and transport.

The authors point out that federal policies that disable regulatory authority for harmful practices can lead to short-term health consequences.

“These misguided plans to unravel pollution protections and undermine the Clean Air Act would endanger the health and safety of millions of people,” says Jeremy Fisher, senior climate and energy adviser for the Sierra Club. “Lives are on the line, and the American people deserve more accountability and oversight of polluting power plants, not less.”

Air pollution policy and climate policy are ultimately health policies, says Dr. Jonathan Levy, chair and professor of the Department of Environmental Health at BUSPH and lead author of the commentary. “These policy platforms targeting the EPA threaten to take us backwards and make Americans less healthy.”

The commentary was also co-authored by Dr. Frederica Perera, Emeritus Professor of Environmental Health Sciences and Distinguished Research Scientist in the Department of Environmental Health Sciences at the Columbia Mailman School of Public Health; Dr. Daniel Prull, Deputy Director of Research, Strategy and Analysis for the Sierra Club; Dr. Patrick Kinney, Beverly Brown Professor of Urban Health at BUSPH; and Brian Sousa, research data analyst in the Department of Environmental Health at BUSPH.