Repercussion Section: “The Science is as Clear as Our Skies Must Be”
Reporting from the World Health Organization’s Second Global Conference on
Air Pollution and Human Health
by Sandra Steingraber, SEHN senior scientist and writer in residence
Last month I was invited by the Fossil Fuel Non-Proliferation Treaty Initiative to give two presentations at the World Health Organization’s Second Global Conference on Air Pollution and Public Health.
With the specific goal of “accelerating action for clean air, clean energy access, and climate change mitigation,” this gathering took place in Cartagena, Colombia during the last week of March.
My column this month is a report back about that experience and includes the text of my first presentation, which was delivered during a pre-conference gathering of civil society groups.
If this is the first time you are hearing about this major international gathering, do not be ashamed. The withdrawal of the United States from the World Health Organization in January meant that there was no U.S. delegation and also no U.S. media to let us know whether the member nations assembled there did or did not agree to ratify the aspirational commitment proposed in advance of the meeting: an agreement to reduce by 50 percent the health harms of air pollution by 2040 (over 2015 levels).
[Spoiler alert: they did so agree although the commitments are widely understood as symbolic.]
Indeed, Madeleine MacGillivray, the Climate Communications and Policy Coordinator of Seeding Sovereignty in New York, and environmental justice leader John Beard, who leads the Port Arthur Community Action Network in Texas, were two of the only other Americans I saw during the week I was there, attending meeting after meeting, panel after panel, and luncheon after luncheon.
Which felt surreal. Every large international conference I’ve ever attended—from the Persistent Organic Pollutants treaty negotiations in Geneva in 1998 to the Paris Climate Accords in 2015—have always been full of American voices. Which, in the case of U.S. chemical industry lobbyists working the hallways and attempting to water down the commitments to reform, were not always a welcome sound.
And yet, the complete absence of our nation from international negotiations was honestly unsettling. The WHO conference gathered together participants from 100 nations. They included government representatives, World Bank representatives, civil society groups, scientists, and health societies. In the audience, at the podiums and behind the doors of the negotiating rooms were Ministers of Health, Ministers of Environment, and Ministers of Energy from around the around the world. There were CEOs of development agencies, health professionals, mayors, urban planners, citizen activists, and advocates for solar ovens.
And yet, with one big exception (more on this below), the United States was never mentioned in any of the formal talks I attended. Neither was the name of our President.
It was as if my nation did not exist at all.
***
The withdrawal of the United States from the world stage was a hot topic of discussion out in the hallways and during those many luncheons.
First of all, WHO is now facing a fiscal crisis. Not only did the United States contribute 17 percent of WHO’s budget, it also set the tone, said many of the delegates I spoke with. Without an American presence, other nations were jockeying for leadership positions. I heard lots of speculation about the possible deepening engagement of China and Saudi Arabia within WHO and about the ongoing attempt of the United Kingdom to lead a coalition of nations.
The conspicuous U.S. absence was also mentioned in international coverage of the convention. From Health Policy Watch in Switzerland:
Cutting emissions enough to halve deaths from air pollution within just 15 years is a highly ambitious goal. The challenges to attainment are particularly daunting given not only the current trajectory of fossil fuel emissions – but also rollbacks to environmental and climate commitments by trend setters like the United States.
I also heard conversations about the ways that WHO’s budgetary crisis has been exacerbated by the decision of the White House to defund the U.S. Agency for International Development. From continuing efforts to contain tuberculosis and HIV to the rescue and relief efforts following the Myanmar earthquake, WHO is now clearly trying to leap into the breach left by the U.S. exit from the world stage.
By the end of the week, the schedule of events had been amended to accommodate emergency meetings of various kinds.
Notably, Dr. Tedros Adhanom Ghebreyesus, WHO’s Director-General, canceled his own appearance at the last minute, a decision understood to reflect the agency’s worsening budget crisis.
***
Colombia’s Deputy Minister of the Environment, Tatiana Roa Avendaño, provides a keynote address at the World Health Organization’s Land, Air, and Climate event on March 24, 2025. The sign on her podium says “Air and water are worth more than any extractivism. No to fracked gas and coal seam gas.”
Air pollution harms us all—fully one in five people around the world are killed by fossil-fuel derived air pollution—but the data are clear that communities of color, impoverished communities, pregnant women, and children suffer proportionally higher exposures, greater injury, and more mortality. Any meaningful strategy to slash global deaths from air pollution in half by 2040 must therefore necessarily use words from the diversity, equity, and inclusion (DEI) lexicon.
And the keynote speakers did use those words. With their whole chests, as the kids say.
Just three short months has passed since the White House issued an executive order forbidding DEI initiatives from federal agencies that fund science. And yet, for me to hear the language of environmental justice and the values of diversity, equity, and inclusion articulately so freely and without fear or nuance during keynote addresses and PowerPoint presentations already felt shocking.
Dr. Maria Neira, who heads WHO’s work on climate, environment and health, did not intone about emissions rates, stakeholders, public-private partnerships, or balancing public health and economic development. Instead, she spoke unequivocally: “Clean air is not a privilege; it is a human right.”
Over and over, speakers emphasized that the lion’s share of air pollution—fully 80 percent—is derived from fossil fuels and that no meaningful solution to the problem of air pollution can happen without decarbonization.
The health harms from air pollution and ongoing destabilization of our planetary climate system have the same root cause, said the keynoters, and there is power and actionability in emphasizing that fossil fuel-derived air pollution is a global health crisis. Leveraging health arguments is a way to drive country cooperation and financial commitments to renewable energy.
Thus, one main goal of the WHO conference was mobilizing health professionals to “prescribe” clean air for their patients, advocate for just transition to renewable energy, and “iterate strategies to mitigate the health sector’s environmental footprint.” Pledges from health associations included support for integrating air pollution and the climate crisis in medical education.
Again and again, Dr. Neira emphasized the need to act. She said, “The time to generate evidence has passed. We have a lot of it. No one can say anymore that they didn’t know….The science is as clear as our skies must be.”
It's been a while since I heard talk like that from those in charge.
***
On Thursday afternoon, the convention center filled up with uniformed security officers, and the President of Colombia himself, Gustavo Petro, took the stage and spoke for nearly an hour. According to the simultaneously translation in my headset, President Petro exclaimed that in the choice between capital and life, Colombia will always choose life.
Petro also emphasized Colombia's commitment to fight against air pollution: “Air pollution claims more victims than violence itself. Poisoning our air costs lives in silence—this conference reinforces our determination to implement policies for both the environment and the health of our people.”
But most notable—and this is the exception to the silence about the United States mentioned above—was Petro’s full-throated condemnation of current occupant of the White House. He warned that effective action on both the climate crisis and the global air pollution crisis can only take place within a framework of multilateralism, and, if the multilateral system is replace by ultranationalism, “all of this will be in vain.”
Petro accused the current U.S. administration of “repeating the mistakes of history” that led to the rise of fascism and promoting an ideology that denies scientific facts. “As George Orwell said in 1984, when each individual will imagine their own reality, then one of the victims of that new reality is health.”
Encouraged by U.S. policies, the dominance of fossil fuel interests in the marketplace, he added, will impede a clean energy transition, which, as the President of Colombia made clear, is the solution to both the climate crisis and the public health crisis from air pollution.
Anti-fracking activists and researchers from across the Americas—Argentina, Colombia, Mexico, and the United States—gathered together at the World Health Organization meetings in Cartagena, Colombia last month.
Prepared remarks by Sandra Steingraber, delivered on March 24, 2025 at the World Health Organization’s Second Global Conference on Air Pollution and Human Health
Good morning! ¡Buenos días!
What brings us together today is our shared knowledge of two facts:
First, air pollution murders at least 8 million people each year around the world. That’s 22,000 funerals every day of the year.
Second, most of that air pollution—80 percent of it—comes from fossil fuels. That means 17,500 people are the daily human sacrifice for our inability to move away from running our economies by extracting the fossilized corpses of prehistoric plants and animals out of the Earth—in the form of coal, oil, and natural gas—and lighting them on fire.
The combustion of Devonian-era corpses is turning 17,500 living people into corpses every day of the year via the simple act of breathing.
Coal, oil, and natural gas are the unholy trinity.
In other words, fossil-fuel related air pollution is the deadliest serial killer the world has ever known, and it is right that the World Health Organization has brought us together to have a conversation about how to apprehend this mass murderer.
The Treaty for the Non-Proliferation of Fossil Fuels is a great start.
My name is Sandra Steingraber. I am a PhD biologist who works on public health as a senior scientist for the Science and Environmental Health Network. Our mission is to provide good science to frontline communities facing toxic threats.
My language is passionate because many of the people I serve as a scientist have died. And because I myself grew up in a toxic town with two coal-burning power plants and contaminated drinking water wells. When I was in high school, the air pollution was so bad that planes could not land at nearby airports.
There is a cancer cluster in my hometown, and I am one data point in that cluster. I was diagnosed with a rare cancer at age 20. The data on air pollution are more than statistics for me. It’s deeply personal.
So, before I begin the science part of my talk, I would like to make the issue personal for you as well.
Please take a deep breath. You have just drawn into your body one pint—a half liter—of the world’s atmosphere. Breathing is an ecological act. Whatever is contained in the air is now part of you.
That includes ultrafine particles that have been emitted by the tailpipes of the cars and trucks driving past this convention center. Right now, those particles that you inhaled have crossed the border of your lung’s alveoli and have entered your bloodstream. They are already altering your heart rhythm, and they are raising your risk for heart attack.
Those fossil fuel-derived particles are already silting up your arteries and creating inflammation, raising your risk for stroke and high blood pressure.
Some have entered your brain directly through the olfactory nerve in your nose and are raising your risk for dementia in old age.
If you are pregnant, air pollution is now crossing the border of the placenta and raising the risk for preterm birth and inhibiting prenatal growth. Air pollution makes babies smaller and brings them into the world too soon. Preterm birth is the number one cause of disability.
Put simple, breath is life, and fossil fuel-derived air pollution turns the living act of breathing into an act of self-harm.
What I want to talk with you about now is hydraulic fracturing or fracking, which is a method for getting oil and gas out of the ground by using water as a sledgehammer to smash apart shale bedrock and liberate tiny bubbles of oil and gas that are trapped inside the rock layers and that would otherwise be unable to flow to the surface.
Twenty years ago, fracking was an unconventional technique. But now, in my nation, the United States, fracking has become the dominant method of oil and gas extraction.
Hydraulically fractured wells produce 79 percent of U.S. natural gas and 65 percent of U.S. oil, with fracking used in 95 percent of new wells.
Shamefully—shamefully—fracking has enabled the United States to become the number 1 producer and exporter of oil and gas to the world and is driving a boom in liquefied natural gas, LNG.
The reason that I believe that fracking belongs at the heart of this meeting is that fracking radically expands the ability of fossil fuels to make air pollution.
Traditionally, we think of air pollution as fossil fuel combustion byproducts. And it is, of course, with fracking contributing to the problem.
However, the air pollution from fracking starts long before the gas or oil is burned.
Air pollution starts as soon as the drill bit hits the shale, turns sideways and begins tunneling horizontally for miles through the rock. Drilling for fracked wells is a week-long process. Explosives are sent down the borehole to begin the fracturing process. A stream of pressurized water and chemicals then follows.
During this time, there are no pipelines connected to the well. The rock being shattered is full of volatile organic compounds lighter than air that are now free, for the first time in 400 million years, and they begin rising up out of the hole. Benzene and formaldehyde are two—both are carcinogens—and, of course, methane, which is the chemical name for natural gas. Also, in some cases, chlorine and hydrogen sulfide gas.
Each well is a giant cigarette in the earth, and there is no controlling what comes out of it. Data shows that workers on well pads can have benzene in their urine high enough to cause leukemia.
We also know that children in Pennsylvania who live near fracking sites have higher rates of childhood leukemia. And just this morning, I read a new study in a journal called Cancer Epidemiology, Biomarkers, and Prevention which shows that “Colorado’s children living within 13 kilometers [8 miles] of oil and gas sites are at increased risk for leukemia, with children within 5 kilometers [3 miles] bearing the greatest risk.”
To keep fracking operations from blowing up, flare stacks are used to control pressures. The United States leads the world in the number of flare stacks. Air pollutants from flaring operations include VOCs, polycyclic aromatic hydrocarbons, carbon monoxide, heavy metals, formaldehyde, and soot.
In the state of North Dakota, rates of hospitalization for respiratory distress are linked to the intensity of flaring activity in fracking operations, with effects seeing in people up to 60 miles away. In Texas, living near gas-flaring operations raises the risk of preterm birth among pregnant women. And a 2020 study shows that Hispanic residents are exposed to much more fracking-associated flaring than white residents.
Even more air pollution is generated in the act of compressing and moving that fracked gas through a pipeline. Pipelines are serviced every 40-100 miles by compressor stations at that push the gas forward. Pipelines and compressor stations are inherently leaky. Indeed, they leak by design in order to prevent explosions. The leaks are baked into the engineering of fracking. These are not plumbing problems, and they are not fixable. A 2017 study identified 70 different air pollutants in compressor station emissions.
A 2019 study found that 39 of these chemicals are linked to cancer.
A 2020 study found that proximity to higher amounts of volatile chemicals from compressor stations were linked to higher death rates. A 2021 study found alarming levels of VOCs, including benzene, in the indoor air of homes located near a compressor station in Ohio.
Reminder: we haven’t even combusted the gas yet.
Researchers have documented 200 different air pollutants near fracking sites. Sixty-one are classified as hazardous. Twenty-six are endocrine disruptors.
In Colorado’s Front Range, nitrogen oxide emissions from fracking wells now exceed levels produced by all the regions cars and trucks.
And, again, we haven’t even combusted the gas yet. According to a 2023 assessment, air pollution from U.S. oil and gas extraction operations alone is responsible for 477 billion in yearly health harms, which includes 410,000 asthma attacks, 2,200 new childhood asthma cases, and 7,500 excess deaths.
7,500 dead Americans every year from oil and gas air pollution before we even light the match.
Okay, I’d like to close by telling you about where all this data I’ve been describing comes from.
It’s all in this fracking science Compendium, ninth edition, which is a peer-reviewed, fully referenced compilation of evidence outlining the risks and harms of fracking.
And because I believe in the power of material objects, I am going to pass it around the room.
Otherwise, the fracking science Compendium is a public, fully searchable, open-source document that is housed on our website, which I will share with you in a minute.
The only difference between this Compendium and a scientific monograph is that we have written it in plain, non-technical English because our intended audience is not just other scientists but also people living near fracking sites, journalists, and elected officials. This Wednesday we are launching an update Spanish-language edition.
At the Science and Environmental Health Network, we believe that knowledge is power.
Here is the origin story: The first edition of the fracking science Compendium was compiled a dozen years ago when fracking was proposed for New York State, where I live, and our governor had to decide to permit or prohibit it.
He ordered his Department of Health to review the evidence for harm. However, the process was very secretive. So, a group of scientists, public health researchers, and physicians joined together to form Concerned Health Professionals of New York, and we began compiling the research ourselves.
Both groups asked two questions. One: is fracking harmful to public health and the climate? And two: If it is harmful, can we devise rules and regulations that would make it safe, or are the dangers unavoidable?
In December 2014, both groups—the government scientists plus the independent scientists in my group—had reached the same conclusion. Fracking injures the health of people who lives nearby both because of water and air pollution, and current technologies could not make fracking safe enough to allow it.
Thus, fracking was banned in New York State.
At that time, 400 studies in the peer-reviewed scientific literature showed the evidence for harm. No, 11 years later, there are more than 2,500 such studies. In other words, today we have six times as much evidence for harm as when we banned fracking in New York in 2014. The current compendium has 637 pages and 2,557 footnotes. All together, the new studies plus the old studies show that our governor made the right decision.
And our fracking science Compendium is about much more than air pollution. We include chapters on climate risks, water contamination, earthquakes, flood risks, radioactive releases, environmental justice, and threats to agriculture, to name some of its 17 topic areas.
Further, the Compendium is much more than a giant encyclopedia. We have created an entire too kit for communities, including doctors and nurses, to use in their own public education campaigns. This tool kit includes PowerPoint slides, scripts for public talks, and fact sheets.
What we learned during the early days of fighting fracking in New York State was the importance of not only bringing the data to our legislators and governor but to take it to the people who were targeted for fracking. This is a science-for-the-people project.
I and other members of Concerned Health Professionals NY spent the better of two years traveling throughout our state to rural communities, bringing the findings of our compendium to church basements and schools and public libraries, and town halls.
What we learned is that the more we shared the science in communities, the more people felt empowered. Once they understood what risks they were being compelled to endure, they were more likely to testify, to organize, to stand up and speak out and public meetings, to call the governor, to show up at rallies, and to write letters to their local newspapers.
We used the science to inform and inspire and social movement that became so big that the governor could not ignore it. I learned that, sometimes, activism opens a space in the culture for science to speak.
After we banned fracking in New York State, we continued to release updated editions of our Compendium. I am proud to say that it has been used around the world. It played a role in bringing about fracking bans in the U.S. states of Maryland, Washington, and Oregon. It has twice been translated into Spanish—with thanks to the Heinrich Böll Foundation—and I traveled with it to Mexico and Argentina in 2016.
The Compendium has helped successful ban efforts in Ireland and has been used in the European Union, South Africa, and the United Kingdom. And in 2023, I testified before the Congress here in Colombia and shared our data.
Even in this current political moment—especially in this political moment—we would like to keep the Compendium going. Science matters.
So here is a sample of our PowerPoint slides. We have more than 30 of these with description of the peer-reviewed science behind each one. Any group can used these.
Here is one on air pollution.
Here is one that summarizes our findings on the indoor air pollution from gas stovies, which is a new chapter in our ninth edition.
And here is a slide announcing our new Spanish language translation.
I will let the Compendium have the last word here. From our abstract:
In sum, the vast body of scientific studies confirms that public health and climate risks from fracking are real and the range of environmental harms wide. Our examination uncovered no evidence that fracking can be practiced in a manner that does not threaten human health directly or without imperiling climate stability upon which human health depends.
Today, I did not bring the gas to the burner tip and only focused on the upstream air pollution from fracking. I promise that I will ignite the gas during my presentation on Friday and tell you more about our new work on the dangers of gas stoves.
Thank you!