Powering Past Fossil Fuel Dependency to Advance Global Health

The global energy volatility triggered by the war in the Middle East is more than a geopolitical tremor. It is a clarion call for a fundamental shift in how the world’s most vulnerable nations power their futures. For low- and middle-income countries, the conflict has laid bare a brutal structural trap already made clear when the energy crisis caused by the war in Ukraine forced an estimated 141 million into extreme poverty. By remaining tethered to a centralized, fossil-fuel-dependent energy architecture, these nations are forced to import not just expensive fuel, but also the economic instability and environmental degradation inherent in the carbon economy. 

However, dependence on fossil fuel is also an insidious assault on human health, attacking especially low-income populations from multiple fronts. Chief among these is air pollution. A recent study published in the British Medical Journal estimated that 5.1 million excess deaths per year globally are attributable to ambient air pollution from fossil fuel use. This represents 82% of the maximum number of air pollution deaths that could be averted by controlling all human-caused emissions.

In lower-income settings, the threat of air pollution follows people home where billions in low- and middle-income countries experience energy poverty as a daily, life-threatening deprivation. This poverty forces households to rely on polluting biomass fuels—wood, dung, and charcoal—for basic needs like cooking and heating. The human cost of this reliance is staggering: up to 3 million deaths annually are attributed to household air pollution. When global energy markets spike as they are now, even cleaner alternatives like liquefied petroleum gas often become unaffordable, forcing families to revert to biomass and trapping them in toxic smoke that imposes a heavy disease from both acute and chronic conditions.

Fossil Fuel Dependence Makes Health Care Access Difficult During Conflict

Dependence on fossil fuels also impacts these populations when they seek medical help. Modern health care requires reliable electricity. Without it, inadequate power supplies mean vaccines spoil in non-functional refrigerators, oxygen concentrators fall silent, and neonatal incubators cannot protect the most fragile infants. Yet, remote health facilities operate under extremely constrained energy conditions, often powered by diesel generators if at all. When fuel supplies become unavailable or unaffordable, lifesaving procedures are shut down. 

Higher global fossil fuel prices also significantly impact nutrition in low-income settings by driving up the cost of farming resources, transporting food, and processing agricultural products. According to the United Nations (UN) Food and Agriculture Organization, low-income countries experienced food inflation peaking at 30% in 2023, largely driven by energy-induced supply shocks. This forced vulnerable populations to consume fewer micronutrient-rich foods and led to higher rates of acute malnutrition. Increases in fertilizer prices alone from the war in the Persian Gulf are already estimated to increase food prices by up to 18%; they will go higher as the conflict continues. Among low-income populations where these costs cannot be absorbed, food production will shrink and undernutrition surge. 

Low- and Middle-Income Countries Carry Highest Burden of Climate Impacts

Fossil fuel dependency also fuels a climate crisis that disproportionately ravages low- and middle-income countries. While these nations have contributed the least to historical emissions, they face the most severe climate impacts, from extreme weather to shifting disease patterns. According to the World Bank, climate change will cause between 14.5 million and 15.6 million deaths across these countries by 2050. Sub-Saharan Africa and South Asia will bear the brunt of the impacts, experiencing nearly one-half and one-quarter of all deaths caused by climate change. Limiting global warming to 2°C could avoid over 13.5 million premature deaths from air pollution by 2050, with the benefits concentrated in middle-income countries. It is a cruel irony that many developing nations are advised to build their growth on the same carbon-intensive fuels that are now threatening their food supplies, increasing vulnerability to heat-related illnesses and opening new opportunities for infectious disease transmission.  

The argument that economic development requires continued reliance on dirty fuels is increasingly considered a false dichotomy. While historical industrialization was driven by fossil fuels, contemporary evidence shows that clean energy now offers a more reliable, cheaper, and sustainable pathway to economic growth. According to the UN, in 2023, 91% of new renewable energy projects were cheaper than fossil fuel alternatives. Solar and wind power have seen massive cost declines—dropping 89% and 69% respectively over the past decade—making them the most affordable source of power in most of the world. More than 40% of the world’s electricity came from zero-carbon sources in 2023. Brazil, the country with the cleanest power mix of the G-20 economies, hit 88% renewable power generation in 2023. By leapfrogging the fossil fuel era, these countries can achieve a double win: reducing the toxic pollution that kills millions today while mitigating the long-term climate risks that will threaten millions more tomorrow.

Progress toward energy equity and security must also include decentralized renewable energy, especially in rural settings. Unlike massive fossil-fuel plants that depend on international supply chains and volatile fuel imports, decentralized renewable energy systems can be deployed at the community or facility level using local resources. For a rural health clinic, a decentralized solar array provides a guarantee that life-saving equipment stays running even when global markets collapse or national grids fail. It offers energy agency—an opportunity for communities to take charge of their own energy security. 

Fossil Fuel Dependency Harms National Security

The energy crisis catalyzed by conflict in the Middle East is a reminder that fossil fuel dependency is a form of national insecurity. For the Global South, the message is clear: the age of oil is an age of vulnerability. By embracing renewable power, low- and middle-income countries can reclaim their energy sovereignty, protect their citizens’ health, and lead the world toward a future where energy is safe, reliable and affordable, and not a commodity subject to the vagaries of war. 

Clasen led The Lancet series on "Energy and Health in Low-Income and Middle-Income Countries," published March 2026.