Precious little research has been done in Australia despite coal communities like those in the Upper Hunter region of New South Wales asking for comprehensive health studies for nearly a decade. Earlier this year an article in the MJA highlighted the health impacts of coal and summarises the available literature,1 but governments appear reluctant to find information that would slow the mining juggernaut and the flow of royalties. Coal is a health hazard because every stage in the life cycle of its production from exploration, extraction, processing, transport and combustion produces a waste stream of air and water pollutants that harm human health. Communities living around mountaintop removal coal mines in the US have a higher incidence of cancer, cardiovascular disease, lung and kidney disease, low birth weight as well as higher rates of birth defects and learning difficulties, even when results are adjusted for age, level of education and smoking status. Children are particularly vulnerable. Burning coal releases mercury, lead, chromium, carbon monoxide, fine particulates, arsenic and sulphuric acid to name just a few. Living within 30 miles (48.2 km) of a coal-fired power station increases the risk of premature death by 3“4 times compared with living at a distance from coal power stations. Coal is also a health hazard because it is the largest contributor to Australia's greenhouse gas emissions. The 2009 Global Humanitarian Forum Climate Change Human Impact Report estimates climate change now claims 315,000 lives annually and severely affects 325 million people. This is only the beginning of a prolonged rise in such effects. Addiction is a disorder where short-term dependence overrides the capacity for reasoned decision-making despite damaging long-term consequences. In an individual with an addiction, their welfare and that of those close to them suffers. In the case of our addiction to coal, individual citizens and whole communities suffer while governments do not accept the responsibility of harms beyond their term of government. It is easier to take another dose of coal than the reforms necessary for withdrawal. Australia is the world's largest exporter of coal, and coal mining is expanding because 75% of it is exported. Of course all energy sources have their hidden environmental and health costs, even renewables. In an age of increasing energy hunger and increasing consequences on climate and environment, governments should be weighing up carefully the externalities for each and every energy source: coal, gas, unconventional gas, solar, solar-thermal, wind, geothermal, biomass, wave, etc. A health impact assessment should be part of any assessment for new mines and energy projects. We should understand the full economic, social and environmental consequences and health implications, both in the short and long term before deciding on any particular source of stationary or transport energy. Once the health and social costs of coal are accounted for, coal is no longer a cheap energy source. The damage arising from mining and burning coal doubles or triples the true cost of electricity generation.2 So who pays? We all do, with our current and future health. For more information, contact Doctors for the Environment Australia at: www.dea.org.au Dr Helen Redmond FAFRM (RACP) Doctors for the Environment Australia will send a poster Coal is a health hazard to 22,000 GPs across Australia tomorrow. References 1. MJA 2011; 195: 333-335\ 2. Ann NY Acad Sci 2011; 1219: 73-98