Written By: Faith Jemosop
Every morning, the sky over Mpumalanga carries a heavy fog, not the kind that signals rain, but the kind that coats your lungs.
For 9-year-old Thato Mokoena, this is just life. She coughs her way through school days, takes a puff from her inhaler before running outside, and sleeps near a window that’s always shut. Thato has never known a day without asthma. And though her mother suspects the coal-fired plumes from the nearby power plant might be the reason, she can’t afford to move, not when her husband works for that very plant.
Now imagine multiplying that suffering by millions and adding a R960 billion price tag to it. Yes, South Africa is silently paying nearly a trillion rand each year in health costs, economic losses, and human tragedy tied directly to air pollution.
The Real Cost of Breathing in South Africa
Recent findings from the Centre for Research on Energy and Clean Air (CREA) have painted a devastating portrait of South Africa’s air quality. According to their report, air pollution, notably from Eskom’s coal-fired power stations in Mpumalanga, is inflicting a R960 billion annual economic burden on the country.
That’s more than 5% of the national GDP. And this isn’t just about some vague environmental damage. These are tangible, devastating costs: hospitalizations, premature deaths, lost work productivity, and even preterm births.
“It’s a silent pandemic,” says Lauri Myllyvirta, lead analyst at CREA. “The damage is woven into every facet of society, from healthcare costs to school performance, from GDP growth to infant survival rates.”
Mpumalanga The Epicenter of a Crisis
Mpumalanga hosts 12 of Eskom’s largest coal plants, some of which rank among the most polluting in the world. Here, the air is thick with sulfur dioxide, nitrogen oxides, and particulate matter microscopic toxins that slip unnoticed into lungs and bloodstreams.
This region, dubbed “the world’s worst hotspot for NO₂ emissions” by Greenpeace in 2018, has not improved. Instead, emissions have intensified due to aging infrastructure and lenient regulation.
The economic cost of air pollution in South Africa is particularly pronounced in Mpumalanga. In this region alone, pollution-related illnesses are blamed for:
- Over 25,000 premature deaths annually
- Tens of thousands of asthma attacks
- Chronic bronchitis cases rising steadily
- A spike in preterm births, costing both lives and millions in neonatal care
When Profits Come Before People
While families like the Mokoenas pay with their health, Eskom, South Africa’s state-owned energy utility, continues to profit from coal. In 2024 alone, Eskom reported a R7.2 billion operational surplus, despite ongoing environmental non-compliance and a string of court cases demanding emission control upgrades.
And Eskom isn’t alone. Sasol, another major player in the region, contributes significantly to local air pollution with its synthetic fuels operations.
Yet the government’s response has been tepid. A 2019 Highveld Priority Area Air Quality Management Plan, originally designed to mitigate pollution, remains largely unenforced. Critics argue that regulatory capture and political reluctance have rendered the plan toothless.
“We know what’s killing us,” says Makoma Lekalakala, an environmental activist and director at Earthlife Africa. “But the people in charge refuse to stop it because stopping it would cost money. And money, apparently, is worth more than lives.”
The Cost of Preterm Birth from Air Pollution
Among the most heart-wrenching effects of air pollution is its link to preterm births. A baby born weeks too early may require extensive medical care, face developmental delays, or die shortly after birth. costing the health sector upwards of R2.2 billion each year.
The cost of preterm birth from air pollution is more than financial, it’s emotional, generational, and systemic. Children born prematurely are more likely to have lifelong health complications, trapping families in cycles of poverty and stress.
Work, Productivity, and the Price of Pollution
A less visible, but no less damaging, cost is lost work productivity. Polluted air makes workers sicker and more prone to absenteeism. The air pollution and lost work productivity in South Africa adds up to millions of workdays lost each year primarily among the most economically vulnerable.
Small business owners suffer when employees are constantly ill. Schools are interrupted when teachers or students can’t show up. And the economy bleeds efficiency and momentum.
“We are literally suffocating our workforce,” says Dr. Thuli Ndlovu, a pulmonologist based in Johannesburg. “Every breath of polluted air translates to lower national output.”
A Future Worth Breathing For
Back in Mpumalanga, Thato’s mother dreams of a different life. One where her daughter can breathe without coughing, run without wheezing. She doesn’t want a miracle, just clean air.
And yet, for change to happen, South Africa needs a reckoning. Not just with the R960 billion air pollution South Africa report, but with the policies and profits that have enabled such devastation.
The solutions exist: cleaner energy sources, emission regulations, transparent governance, and investment in public health infrastructure. What’s missing is the collective political will.
“Air pollution isn’t just an environmental issue, it’s a justice issue, a human rights issue,” says Lekalakala. “We owe it to every South African child to do better.”
South Africa can no longer afford to pay the invisible bill just to breathe. The economic cost of air pollution in South Africa is more than a statistic it is a mirror reflecting the country’s priorities. The time for silence is over. The science is clear. The human toll is mounting.
So the question remains: how many more children like Thato must struggle for breath before clean air becomes a right, not a luxury?
