Report
Rural America produces nearly half of the nation’s energy, yet rural communities disproportionately shoulder the health and environmental burdens of fossil fuel extraction, production, and combustion. As federal energy policy increasingly tilts toward expanding fossil fuels over clean alternatives, it is vital that rural communities have the tools to assess the full health consequences of future energy decisions. While energy debates are often polarized, health provides a powerful, nonpartisan lens through which to evaluate the risks and benefits of different energy pathways.
This report series builds from three analyses to deepen our understanding of the opportunities and challenges of transitioning to renewable energy in rural America. By focusing on health as a central concern, we aim to equip communities, policymakers, and advocates with evidence to guide energy decisions that prioritize human well-being and long-term resilience.
What’s in the Report Series
1. Landscape Scan: Voices from the Field
Through interviews with organizations and advocates working on rural energy transitions across the country, this report identifies shared challenges and promising strategies. It highlights a growing interest in renewables—particularly when supportive policies and incentives are in place. For example, the Empowering Rural America (New ERA) program has seen demand outstrip supply by a factor of 13 to 1, signaling broad and urgent interest in clean energy investment.
2. Scoping Review: Health Impacts of Rural Energy Transitions
This literature review synthesizes what is known about the health outcomes associated with rural energy transitions. While data is limited, available research indicates that shifting away from fossil fuels toward renewables can reduce rates of preterm birth, respiratory illness, and hospitalizations. However, transitions must be approached carefully: without support for local jobs and tax bases, communities may face economic disruption in the form of reduced tax revenue and increased rates of unemployment.
3. Case Studies: Health Impact Assessments in Wisconsin and Missouri
This analysis applies a health lens to two specific projects: a proposed gas plant in Wisconsin and the retirement of a coal plant in Missouri. In both cases, our assessments reveal significant potential harms to health and the local economy—particularly for frontline and downwind communities. These findings underscore the need for proactive planning to maximize the health benefits of energy transitions and minimize unintended consequences.
This webinar breaks down the report series and features an expert panel discussion on the implications for health-focused clean energy decisions in rural communities.
Info Brief
Our analysis shows that exposure to pollution from the production and burning of fossil fuels is harmful at every stage of life and has long-term implications for population health.
Transitioning away from fossil fuels to cleaner energy sources reduces exposure to harmful pollution and leads to improved health outcomes.
For every 1microgram/cubic meter increase in coal PM2.5, mortality increases by 1.12%. In addition to premature mortality, pollution carries profound costs in terms of healthcare expenses and lost productivity. Our analysis found that the Missouri’s New Madrid coal-fired power plant results in $1.68 billion in health costs. In Wisconsin, a proposed gas plant’s carbon emissions would result in a social cost of carbon estimated between $1.8 billion and $14.6 billion.
On the flip side, reducing pollution has measurable benefits. After eight coal plant retirements in California between 2001 and 2011 there was a 5-7% reduction in preterm births among those living within 0 to 5 kilometers of a retired plant. After 3 coal plants closed in Chicago between 2009 and 2017, asthma-related ED visits among children 0-4 years old decreased by 12% in zip codes near the power plants.
Recent policy action was designed to help communities transition from fossil fuels.
The Inflation Reduction Act’s (IRA) Empowering Rural America program received nearly $100 billion in proposed projects, while the Powering Affordable Clean Energy program had $13 in funding requests for every $1 of funding available.
However, the 2025 budget reconciliation bill dismantles important pieces of the IRA. In addition, allocated ERA funding was frozen by USDA Secretary Rollins to ensure funding for these projects aligned with President Trump’s executive orders. Forty-two rural cooperatives wrote letters to the administration requesting release of the funds, but these repeals of IRA provisions and shifting federal priorities has cast uncertainty for the future of renewable energy in rural areas.
It’s time to invest in Rural America.
- Policymakers should reinvest in clean energy benefits, especially for rural utilities and co-ops.
- Health data on the impacts of gas and coal can help communities make informed decisions about the true costs of new fossil fuel infrastructure.
- Funders can support community-based organizations leading the transition from the ground up.
Key takeaway: With access to health data and resources, rural communities can make informed energy decisions that reflect the true health costs of fossil fuels and drive a just clean energy transition.
Health Impact Assessments
Clean Wisconsin Health Impact Assessment
Renew Missouri Health Impact Assessment
Media Coverage
Students power rural America’s clean energy future | Caroline Reinhart | Stanford Woods Institute for the Environment | April 29, 2025
Health at the Heart of Rural Energy Transitions: A Tale of Two Power Plants | Celina Scott-Buecheler | HPH Voices Blog | February 24, 2025