Coal’s unpaid health bill

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€8.5 billion in health costs from Balkan coal plants prompt call for EU policy rethink

  • New study quantifies the public health costs of polluted air from existing coal-fired power plants in the Western Balkans at up to 8.5 EUR billion per year
  • The region is home to seven of the 10 most polluting coal-fired power stations in Europe. Fumes from these plants contribute to air pollution, which is a serious health risk in these countries. Polluted air is associated with unnecessarily high rates of premature death, chronic lung disease, heart conditions and asthma
  • Europe’s leaders should support countries in the region by encouraging a move away from coal to improve health and tackle climate change

Today, HEAL released the first-ever estimates of the huge health costs associated with air pollution from coal power plants in the Western Balkans. The report provides an estimate of the total health damage from air pollution released from existing coal power plants in five Western Balkans for the European region, and for Serbia, Bosnia and Herzegovina, Macedonia, Montenegro and Kosovo. The estimated health costs of future coal plants in the Western Balkans are also given.

Currently home to 15 existing coal plants with an installed capacity of 8.1 gigawatt (GW), the Western Balkans could see the installation of 24 new projects with 7.8 GW capacity.

The findings are being presented at a press conference in Sarajevo, Bosnia. With health costs of up to 3.1 EUR billion per year, existing coal plants in Bosnia and Herzegovina contribute about one third to the total health costs.

The costings of the significant health damage should prompt a rethink on the EU’s policy approach to the region, with European decision-makers increasing financial support for a healthy energy future and pulling their weight for air quality and pollution control in the region. The Western Balkan policy-makers should now make decarbonisation their priority and support the rapid phase out of coal power generation.


Press Releases

- Press release EU launch of the Unpaid Health Bill – English

- Press release Bosnia and Herzegovina launch of the Unpaid Health Bill EnglishBosnian

- Press release Serbian launch of the Unpaid Health Bill English - Serbian

- Response by the Health and Environment Alliance (HEAL) to statements made by Minister Antic, Serbian Minister of Energy on HEAL’s report - English - Serbian

The Unpaid Health Bill Reports and Factsheets

- Technical report: The Health Impacts of coal-fired power stations in the Western Balkans
English - Serbian

- The Unpaid Health Bill EU factsheet
English - Serbian

- Serbian factsheet of the Unpaid Health Bill
English - Serbian

- Bosnian factsheet of the Unpaid Health Bill
English- Bosnian

- Macedonian factsheet of the Unpaid Health Bill
English - Macedonian

- Montenegro factsheet of the Unpaid Health Bill
English - Montenegrin

- Kosovo factsheet of the Unpaid Health Bill
English - Albanian

Other resources
- Video by Dr. Mike Holland on the methodology to calculate the health costs of coal power generation (with subtitles in Serbian)

From left to right: Garret Tankosic-Kelly of SEE Change Net, Professor Dr. Zehra Dizdarević, a pulmonologist and clinical allergologist, and Vlatka Matkovic Puljic, Health and Energy Officer, Balkans Region, Health and Environment Alliance (HEAL).

HEAL’s European coal and health campaign

In March 2013, HEAL launched the first ‘Unpaid Health Bill – How coal power plants make us sick’, highlighting that the health costs of coal-fired power stations add a financial burden to the European population of up to €42.8 billion a year.

The report includes testimonies from leading health advocates, medical experts and policy makers on why they are concerned about coal, as well as developing recommendations for policy-makers and the health community on how to address the unpaid health bill and ensure that it is taken into account in future energy decisions.

- Download the full report here - EN- DE - POL - RO - TU - Western Balkans - Technical report and EU factsheet - Bosnia
- Download the Executive Summary here - EN - DE - POL - RO - TU
- Download the coal and health postcard here - EN - POL
- Press release EN - FR - ES - IT - RO - DU - DE - POL - TU
- Media coverage updated 2 April 2013 here
- Check out our Facebook page on coal and help us grow the network by liking our page!

The Unpaid Health Bill marked the beginning of a coal and health campaign in which HEAL continues to work closely with medical, health and climate advocacy groups, especially in countries where coal is a particular threat to health. Since the start of the campaign, the report has been launched in Romania (December 2013), Poland (June 2013), Germany (April 2013), Turkey (May 2015) and most recently in the Western Balkans (March 2016).

About HEAL

The Health and Environment Alliance (HEAL) is a leading European not-for-profit organisation addressing how the environment affects health in the European Union (EU). We demonstrate how policy changes can help protect health and enhance people’s quality of life. Read more »


HEAL has over 70 member organisations, representing health professionals, not-for-profit health insurers, doctors, nurses, cancer and asthma groups, citizens, women’s groups, youth groups, environmental NGOs, scientists and public health institutes. Members include international and Europe-wide organisations, as well as national and local groups. Read more »

Contact us

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B1000 Brussels, Belgium
Phone: +32 2 234 3640
Fax: +32 2 234 3649
Press: Diana Smith

Direct telephone numbers: HEAL team page.

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