Coal-fired power plants in India take the highest toll in the world when it comes to health, according to a study of global emission hotspots which found that China and the US are the largest producers of coal power.

Coal power generation is a primary cause of greenhouse gas (GHG) and toxic airborne emissions globally, said researchers from ETH Zurich in Switzerland.

Coal burning not only produces carbon dioxide, which contributes to global warming, but also releases particulate matter, sulphur dioxide, nitrogen oxide and mercury — thus damaging the health of many people around the world.

To estimate where action is urgently required, the researchers modeled and calculated the undesired side effects of coal power for each of the 7,861 power plant units in the world.

The results, published in the journal Nature Sustainability, show that China and the US are the two largest producers of coal power, but power plants in India take the highest toll on health.

Central Europe, North America and China all have modern power plants, but Eastern Europe, Russia and India still have many older plants equipped with insufficient flue gas treatment, said Stefanie Hellweg from ETH Zurich’s Institute of Environmental Engineering, who led the study.

As a result, these power plants only remove a fraction of the pollutants — while also often burning coal of inferior quality.

“More than half of the health effects can be traced back to just one-tenth of the power plants. These power plants should be upgraded or shut down as quickly as possible,” said Christopher Oberschelp, the lead author of the study.

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