Air pollution continues to pose one of South Africa’s most serious public health threats, with new research estimating that more than 42,000 people die prematurely each year because of exposure to fine particulate matter (PM2.5).
According to a report released by the Finland-based Centre for Energy and Clean Air (CREA), Gauteng remains the country’s hardest-hit province, accounting for approximately 16,000 pollution-related deaths annually. KwaZulu-Natal records around 7,000 deaths each year, while Mpumalanga also experiences a significant health burden due to its concentration of heavy industry and coal-fired power generation.
Researchers estimate that the health impacts of air pollution cost South Africa about R960 billion every year—equivalent to roughly 14% of the country’s gross domestic product. These costs include medical treatment, lost productivity, missed working days and the long-term economic impact of reduced educational and employment outcomes.
The report also found that approximately 1,300 children under the age of five die annually from illnesses linked to poor air quality.
Experts said South Africa’s current National Ambient Air Quality Standards are already less stringent than those adopted by countries such as China and India. Even so, pollution levels in many parts of the country continue to exceed legal limits.
If South Africa simply met its existing national standards, researchers estimate that about 9,300 premature deaths and R225 billion in economic losses could be avoided every year.
Air pollution is particularly severe in the Highveld Priority Area, which stretches across parts of Gauteng and Mpumalanga and is home to numerous Eskom coal-fired power stations and Sasol industrial facilities. Scientists describe the region as one of the most polluted areas in the world, with high concentrations of nitrogen dioxide and sulphur dioxide visible even through satellite observations.
Air quality monitoring company IQAir also highlighted the severity of the problem after naming Johannesburg the world’s most polluted city during May 2026.
Coal policy raises fresh health concerns
While the report highlights the scale of South Africa’s current air quality crisis, CREA warned that future policy decisions could make the situation significantly worse.
The organisation expressed concern over the Department of Mineral Resources and Energy’s latest Integrated Resource Plan, which proposes extending the operating life of ten Eskom coal-fired power stations, with some remaining in service for at least another decade.
According to CREA’s modelling, delaying South Africa’s coal phase-out could result in approximately 32,000 additional premature deaths between 2026 and 2050.
Gauteng is expected to experience the greatest impact, with an estimated 15,200 additional deaths linked to prolonged coal use. Mpumalanga could record another 4,800 deaths, while KwaZulu-Natal may see an additional 5,600 fatalities over the same period.
Children expected to face the greatest burden
Researchers warned that children are likely to suffer disproportionately if coal-fired generation continues for longer than planned.
The report projects an additional 41,000 premature births, around 17,000 new childhood asthma cases and approximately 370 additional deaths among children younger than five.
CREA estimates that the combined economic cost of these additional health impacts would reach roughly R721 billion, placing further strain on South Africa’s healthcare system and the broader economy.
The organisation argued that accelerating cleaner energy investment could substantially reduce preventable deaths while easing the long-term financial burden created by air pollution.
Source: BusinessTech / Centre for Energy and Clean Air (CREA)