European coal power plants are causing tens of thousands of premature deaths each year.

A new study from the Health and Environment Alliance finds that coal pollution in Europe causes more than 18,200 premature deaths each year. That number rises to 23,300 when you include Serbia, Croatia and Turkey.

HEAL claims this is the first report to comprehensively study the effect coal has on society. This study framed the data in terms of coal’s economic and health effects. HEAL’s report found that in addition to these tens of thousands of premature deaths, burning coal is also costing Europe billions of dollars. This cost comes out to between 42.8 and 54.7 billion Euros ($71 billion) every year. This kind of economic hit translates to about 4 million working days lost annually. The study also claims that the air pollution is causing 8,500 new cases of chronic bronchitis every year.

Europe had been using less coal for about a decade, but high natural gas prices may be encouraging the region to go back to coal. Germany turned back to coal after the Fukushima disaster gave the country cold feet about nuclear energy. The Atlantic Cities reports that 50 more coal plants are planned for Europe, and some of these will be what’s known as “brown coal” plants, which burn lignite, a brown fuel that resembles coal and peat. Lignite is cheaper to mine, but is also not as efficient as higher-grade coal. It is also much more polluting.

A huge amount of this coal pollution is coming from locations in Eastern Europe. More than half of these adverse health effects were reported in Romania, Germany and Poland. Other countries contributing high numbers include the Czech Republic, Turkey, Bulgaria, France and the United Kingdom.

Increased coal-burning would only increase already dangerous levels of pollution in European cities. The World Health Organization estimates that between 80 and 90 percent of urban Europeans are breathing unclean air.

A PDF of the report can be found on HEAL's website.