As of 2019, the United States (US) has led the world in oil and gas production.1 Historically, the energy policy decisions that led to this were primarily based on short-term economic, energy independence, and air quality considerations, largely ignoring the consequences of the full lifecycle for a given energy source.2,3 Epidemiologic studies that could be used to inform policy, generally focus on specific phases of the energy lifecycle, such as upstream (e.g., extraction and production) or downstream (e.g., electricity generation and consumption). Energy justice, the concept that all members of society have a right to energy without an overburden of pollution or health impacts,4 is often omitted from both health studies and energy policies. Energy poverty is a major problem, even in wealthy countries such as the US, and equitable access to energy resources can promote positive health outcomes.5–7 We need energy, but sources must be selected with health, equity, and climate in mind.
In this commentary, we present an examination of a wide spectrum of health-related concerns across the lifecycle of an energy source through an application to natural gas. This assessment analyzes energy use more holistically by integrating considerations of public health, environmental justice, and climate change. We surveyed epidemiologic literature relevant to steps across the entire process from upstream and downstream phases of natural gas development to energy transport and use. As opposed to the traditional economic-oriented approach, this viewpoint places energy equity considerations at the forefront of the conversation.
Natural gas was originally touted as a bridge fuel between coal and renewable energy because it has lower combustion emissions of CO2 per unit energy than coal.8 For most uses in the near term, natural gas is now widely recognized to produce greenhouse gas emissions that rival that of coal or oil due to methane releases across the lifecycle.9 However, as natural gas production has increased, evidence has mounted about the harm associated with precombustion aspects of the fuel lifecycle (primarily extraction), which was not generally included in past health assessments. By considering the entire lifecycle of natural gas, an energy equity perspective in epidemiologic work can help illuminate the upstream impacts associated with the natural gas development process.
The natural gas development process
Natural gas development is a multi-step process that has become increasingly complex. Most extraction takes place in deep geological formations that require an intensive industrial process, and production has dramatically increased over the last century per the US Energy Information Administration (Figure 1).10 Natural gas is used in a variety of sectors – in 2020, 4.7 million cubic feet (MCF) was consumed by residential buildings, 3.2 MCF by commercial buildings, 8.2 MCF by industry, and 11.3 MCF by electric power generation.11 Natural gas is often labeled as “clean” relative to other fuels because its combustion generally emits less harmful byproducts than those emitted during the combustion of coal (e.g., mercury and sulfur dioxide) or by other solid fuels (e.g., carbon monoxide, soot).12 However, this disregards that the toxic emissions are associated with the extraction, transport, and storage of natural gas before combustion in power plants or households.
Here, we focus on the typical process in the US (Figure 2).
Multiple phases of natural gas extraction can affect the health of nearby populations, ranging from the construction of the well pad to production itself.13 As documented in several reviews,13–16 studies have linked exposure to natural gas extraction with asthma exacerbations,17–19 adverse pregnancy outcomes,20–35 cardiovascular disease,36–38 adverse mental health outcomes,39,40 and mortality.41 Flaring–a form of waste disposal–from natural gas development sites also has measurable adverse health impacts.18,42 Natural gas extraction has been associated with increased concentrations of radioactive particles in the air.43 Disposal of wastewater has triggered earthquakes in regions where they did not historically occur, potentially resulting in elevated levels of anxiety among residents.44,45 Occupational health concerns exist during the extraction process, where fatalities are common,46 and injuries are typically underreported.47 These risks are estimated to be higher than similar jobs for renewable energy, particularly for mortality (for example,130 deaths per year could be averted by eliminating oil and gas extraction in the US).48,49 Renewable sources generally have fairly low fatality rates, except for wind energy where fatalities are largely attributed towards most renewables to have fairly low deaths, except for wind energy where the accidents largely involved only one or two people.49 At the end-use stage, using natural gas for cooking yields nitrogen dioxide, carbon monoxide, and formaldehyde concentrations that often exceed acute exposure guidelines.50,51 Natural gas leaks from stoves and ovens while not in use can result in indoor benzene concentrations that exceed regulatory standards and are comparable to environmental tobacco smoke.50,52 Other exposures, such as chemicals from the hydraulic fracturing process showing up in drinking water, incomplete combustion byproducts from natural gas power plants in the air, and gas leaks in distribution systems, have not been robustly assessed for public health impacts.
Although the literature consistently points to greater health risks to nearby communities, the dominant hazard remains elusive, impeding the buildout of health-protective energy policy with respect to regulated exposure pathways (e.g., specific air pollutants or water contaminants). Even without comprehensive cradle-to-grave health accounting, studies have consistently reported associations between residential proximity to more and larger natural gas wells and adverse health outcomes.13,53 The most abundant and consistent evidence points to a relation between natural gas industry exposure and respiratory outcomes17–19 and adverse birth outcomes,20–35 as noted in oil and gas rulemaking.54 In light of this evidence, regulatory actions to extend the allowable distance between extraction sites and sensitive receptors (e.g., homes, hospitals, schools, and ecologically sensitive areas) have been taken in certain states and municipalities such as Colorado; California successfully implemented a 3,200 feet (975 m) setback distance.55–59 Other states, such as New York and Maryland, have banned hydraulic fracturing entirely,60,61 although this ban only applies to one aspect of the complex natural gas development process. The city of Los Angeles has gone further, with the City Council voting to ban all future oil and gas drilling.62
Environmental justice describes an inequitable distribution of environmental hazards and the placement of hazardous industries in low-income communities, communities of color, and other disadvantaged populations that have experienced structural discrimination.63,64 Unlike other polluting facilities such as toxic release inventory facilities,65–67 natural gas is somewhat unique in that fossil fuel reservoirs constrain siting locations.10 However, the advent of horizontal and directional drilling enables more flexibility in the location of well pads. A growing body of literature demonstrates that natural gas extraction sites and disposal wells are disproportionately cited within communities of color across multiple geographic contexts.68–71 For example, two recent studies found a strong relationship between racism in the housing marking as reflected in historical designations of investment risk (“redlining”) and siting of urban oil and gas wells and fossil fuel power plants.72,73 Extraction sites in marginalized communities are also more likely to flare excess natural gas, particularly in areas where co-occurring oil resources are more economically viable.74 Natural gas infrastructure, such as pipelines, compressor stations, and power plants, are often located in the middle of low-income neighborhoods.75–77 In areas where natural gas is used for cooking, historically marginalized populations are disproportionately exposed to gas leaks, and repair times are often longer in communities of lower socioeconomic status.78 Other aspects of the natural gas development process have not been robustly assessed with respect to environmental justice.
Cycles of boom-and-bust economies affect communities that depend on resource extraction, yielding precarious employment and social disruption.79–84 Although domestic gas extraction generates substantial revenue, the economic benefits accrue primarily to those who own mineral rights, work in the gas industry, and enjoy cheaper electricity prices, and these benefits usually accrue to people located in places physically removed from drill sites.85–87 When problems do arise, low-income households living nearby are less likely than wealthier peers to file complaints about perceived gas-related issues with their drinking water supply.88 This reflects a power imbalance, which can result in procedural environmental injustice. Those most exposed to the impacts of gas extraction accrue few economic benefits and have little input on siting decisions in their communities or on amelioration of potential gas-related exposures.89 Given its disproportionate burden on socially disadvantaged populations, phasing out natural gas would reduce “fossil fuel racism”90 and possibly environmental health disparities.
History can help guide future public health decision-making on climate change. As early as 1954, the American Petroleum Institute understood that increased atmospheric carbon dioxide was driven by fossil fuel combustion.91 Through the 2000s, major gas companies continued to publicly deny climate change, including advertorials in the New York Times stating: “Natural variability and human activity may lead to climate change that could be significant and perhaps both positive and negative.”92,93 Recent tactics to prolong fossil fuel use include framing global warming as a long-term (i.e., not present-day) risk, positioning natural gas as the key to modern energy demands, and touting fossil fuels as social justice tools to eliminate poverty.94 Fossil fuel companies have focused on individual demand, for example, BP popularized the carbon footprint.93,95 This focus places the cause of–and solution to–climate change with the individual consumer, allowing gas companies to appear neutral, simply serving individual demands, and limiting their perceived corporate culpability.95
Although total fugitive methane emissions are hotly debated,96,97 methane emissions occur throughout natural gas development, with the highest emissions in the production, gathering, and storage stages.98 Some emissions, such as flaring and venting, are intentional, whereas others are due to equipment malfunction.98,99 Even more concerning, natural gas stoves in homes often leak methane when the stove is not in use.50 Although total emissions may vary, natural gas clearly contributes towards climate-driving methane emissions. The most recent International Panel on Climate Change report confirms that to avoid catastrophic global warming, we must accelerate our energy transition away from fossil fuel combustion towards alternative sources.100
Natural gas has the benefit of providing firm generation (i.e., around-the-clock electricity for local communities.) However, its complex infrastructure and supply chain, consisting of pipelines, storage facilities, and compressor stations, spreads across large geographic areas but is often reliant on a few major pipelines. An interruption of service from a single weather event or natural disaster can create sweeping energy shortages across regions, especially if unusual weather events occur that the infrastructure is not designed to withstand. In 2021 alone, Hurricane Ida in the Gulf Region and Winter Storm Uri in Texas knocked out power for millions of customers for multiple days.101,102 Without substantial upgrades to current electrical grids, these outages will likely occur more often as the rate of climate-related disasters increases, thereby removing one of the key benefits touted for natural gas energy.
Future of natural gas development
The future of natural gas is uncertain. Policymakers, communities, and other stakeholders should consider the multiple dimensions of impacts across the lifecycle or natural gas production and usage–goals of reducing air pollution and exposure disparities and the Paris Agreement–when making decisions regarding reliance on natural gas and potential substitution energy sources. Many municipalities–including over 45 cities in California–have already banned natural gas in new building construction.103 Replacing gas stoves in public housing could help reduce health disparities,104 particularly with respect to asthma, which has a steep social gradient.105 These efforts demonstrate the feasibility of moving large swaths of the population away from natural gas towards a more climate-friendly future. If society does continue to rely heavily on natural gas as a key component of our energy mix, we will require new research that quantifies the public health, environmental justice, and climate implications across the entire natural gas lifecycle to inform mitigation strategies and prevent further health harms that will most likely disproportionately harm communities hosting natural gas infrastructure.
Economics alone cannot determine energy equity, but the costs should be considered in concert with impacts on other domains. In the US, direct subsidies to fossil fuel industries total at least 20 billion dollars per year, and the European Union provides an estimated 55 billion euros annually.106,107 Shifting these subsidies to decarbonize, including sustained funding for just transition programs for workers and municipalities currently reliant on the fossil fuel industry for their livelihoods and tax revenue, would ensure decarbonization ameliorates rather than exacerbates social and health inequalities.108
Armed conflict will likely increase as climate change worsens.109 Without forethought, fossil fuels may ignite, power, constrain choice, or become further entrenched during the war. Europe, reliant on Russian oil and gas imports has tread lightly during the recent Russia-Ukraine war. The US, with access to domestic resources, rapidly shifted away from Russian oil and gas imports and plans to increase the export of natural gas to Europe.110 This energy security came at a price–possibly locking the US. into domestic natural gas production for decades to come. For example, two export permits, valid through 2050, were granted to four liquified natural gas companies,111 and another approved program will financially support building natural gas and other energy facilities, largely due to energy security concerns.112 Currently, European countries such as Germany and the Netherlands, are considering reverting to coal instead of natural gas to ensure that their countries have a continuous source of energy.113 Reliance on fossil fuels constrained European and U.S. choices. Surely, we can find a better way forward.
What will replace natural gas? Likely it will be renewables. In 2020, demand declined for most fuel types except renewable energy use, which increased by 3%, driven by wind energy.114 Falling costs continue to make renewable technologies more attractive, regardless of climate implications.115 In some countries, such as India and China, onshore wind and solar are already cheaper than natural gas, this is also true in the US certain market conditions that account for subsidies.116 Due to differing baseline infrastructure and electricity demand, energy transitions away from gas will vary by country. Countries that rely primarily on household solid fuels could switch to renewable energy electrification, thereby leapfrogging gas and its health and equity externalities. In 2020, the number of homes in the US with electric heating surpassed those using natural gas.117 Blanket fossil fuel bans, without other supplemental policies, would likely continue the cycle of poverty for some regions, so programs must ensure that low-income countries are not burdened with the costs of moving away from natural gas.118 Stranded assets, convenience, and preference (e.g., gas stoves for cooking) may slow the energy transition in industrialized countries.119 An honest accounting of the hazardous exposures across the full lifecycle of natural gas development will provide data with which we can weigh the costs of our energy choices to society in terms of environmental justice, public health, and climate change.
As climate change increases the intensity and frequency of extreme weather events,120 a smart electricity grid, weatherized generation facilities and distributed energy systems, such as solar plus storage, could provide greater resilience to disasters compared to natural gas.121,122 The switch to renewables should receive the same lifecycle treatment to holistically assess and promote health and equity–we cannot let renewables, with their eco-friendly reputation, off the hook. For example, many renewable technologies require rare earth metals, requiring ongoing mining, with considerable health concerns.123 Distributed solar adoption in California already tracks socioeconomic status (with more solar in higher-income communities).124 By placing considerations related to equity up front, our proposed perspective forces a quantitative, critical look at the pros and cons of latching onto a new type of energy.
Even if we succeed in eliminating natural gas from electricity generation, we must be on alert to its use shifting to other sectors. Plastic manufacturing, for instance, relies on methane, along with a host of other petrochemicals, including the natural gas liquids such as ethane, propane, and butane as a feedstock. Production of natural gas liquids increased by roughly 50% between 2014 and 2019, from 1.12 million barrels per year to 1.79 million barrels per year.12 The US Energy Information Administration does not explicitly track plastic feedstocks or the use of petrochemicals for plastic manufacture. However, companies such as Exxon Mobil have expanded current processing plants to accommodate a larger plastics output in the future, evidence that the natural gas industry has anticipated the shift away from using natural gas for electricity generation.125
Although epidemiologic work on criteria air pollutants (i.e., CO, O3, Pb, NO2, PM, SO2) has influenced health-protective policy that has saved lives,126–133 the near-exclusive focus on this specific set of pollutants has limited our ability to examine the full scope of what exposures may be important for population health, particularly for comparing energy sources (e.g., coal vs. natural gas.) Consideration of lifecycle impacts that incorporate environmental justice and climate considerations would help highlight some of the drawbacks of attempting to use gas as a “bridge fuel,” and could bolster the public health rationale for more rapid decarbonization of the energy sector. Such an approach may be challenging to fit into a traditional epidemiologic framework, as mandatory industry reporting is highly limited, but this multi-dimensional lifecycle approach is used in other sectors. For instance, this premise conceptually integrates aspects of the Department of Energy’s Lifecycle Assessment and the Environmental Protection Agency’s Health Impact Assessment frameworks. Lifecycle assessment is widely used to estimate the environmental impact of a material, technology, or other product considering the raw materials, energy, water, and other resources used and wastes generated in its production and operation.134 Though similar in some ways, health impact assessment is used to assess the health consequences of a single proposed project, program, or policy and its alternatives to inform decision-making to maximize benefits and minimize harm for population health. For those of us in epidemiologic research, incorporating clear lenses of environmental justice and climate change may require a research triangulation angle as one data source cannot often answer all of these questions and all relevant data sources may not be easily available.135,136 Reframing the discussions around the energy sector transitions into a holistic health-oriented framework could have an immensely positive impact on society.
To protect public health, the full lifecycle of energy production must be considered in an epidemiologic context. For natural gas, almost every step in the process creates immediate environmental hazards and long-term climate change threats for local communities and the broader global context, largely burdening populations unable to fight back. Policy decisions should be informed by calculating the energy source’s full lifecycle influence on population health, akin to a combined health impact assessment and a lifecycle assessment. Only then can we make fully informed decisions about how to provide reliable energy while protecting local communities, reducing health disparities, and slowing global climate change.
We thank Heather McBrien (Columbia University) for her assistance with Figure 1 and Brian S. Schwartz (Johns Hopkins University) for his feedback on an earlier version of this commentary.
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