Muswellbrook and Singleton have been subjected to air quality that has consistently breached international guidelines for safe levels of pollution every year for the past seven years, since 2015.

Both townships also breached the much less stringent Australian air quality standards - six out of the past seven years in Muswellbrook, and four in Singleton, according to Healthy Futures' analysis of air quality monitoring data held by the NSW Office of Environment and Heritage.

Health professionals say that pollution can affect every system in the human body, as well as push the planet towards catastrophic climate change which brings a swathe of dire health impacts with it.

The consequences are already being felt, says palaeontologist, conservationist, activist and public scientist Professor Tim Flannery.

Megafires, droughts, floods, and extreme temperatures were just the start of devastating levels of climate disruption Australians are already experiencing on a crash course to climate catastrophe.

The 2020s, he says, are our "make-or-break decade" for climate action.

During the past 12 months alone, Muswellbrook has exceeded WHO guidelines 18 times and Singleton five times. Camberwal and Mount Thorley have also breached both WHO and Australian guidelines multiple times this year.

The results are backed up by Australian Conservation Foundation analysis of national pollutant data which identifies Muswellbrook as the third most polluted suburb nationally, due to the digging and burning of coal.

Six of the ten postcodes with the highest air pollution across the nation are home to a coal-fired power station or coal mine. The 2333 postcode, which takes in Muswellbrook, Bulga, Liddell, Wybong, and Bengalla, is home to both - two coal-fired power stations and six open cut coal mines. Singleton, which is home to eleven open cut coal mines, was ranked eleventh nationally.

The NSW Minerals Council disputes the relative value of the data, and the direct links being made to coal mining-related activity, saying that air quality is also affected by rain and smoke from woodsmoke heaters.

"The Upper Hunter has the benefit of long term, comprehensive air quality monitoring that is publicly available in real time, as well as several studies analysing the data and the sources of pollution," the council's chief executivie officer, Stephen Galilee said.

"The data shows that air quality, and exceedences of air quality standards, are closely tied to rainfall. That's why we saw air quality worsen during the drought, and then improve substantially under the wetter conditions, with last year having some of the best air quality on record. These same patterns are seen at air quality monitors right across the state.

"The data also shows that for PM2.5 - the smallest particles of greatest health concern - another primary driver of exceedences is smoke from domestic woodheaters. The CSIRO Upper Hunter Fine Particle Characterisation study found that woodsmoke was the biggest contributor to PM2.5 in Muswellbrook, averaging 62 per cent of PM2.5 in the winter months."

Overall, the Hunter's air pollution is getting progressively worse, not better, says Dr Ben Ewald, a Newcastle-based GP and Doctors for the Environment Australia (DEA) convener. "As the mines have expanded and as time's gone by the air quality has got worse and worse," Dr Ewald said.

"As the mines have expanded and as time's gone by the air quality has got worse and worse in places close to mines like in Muswellbrook, like in Camberwal.

"They've been exposed to more and more dust, both the PM10, the slightly coarser fraction, and of course the PM 2.5, the slightly finer fraction of particle pollution.

The effects have been quantified, Dr Ewald said. His research shows that in the Lake Macquarie and Central Coast local government areas there are about 650 children with asthma where the asthma can be blamed directly on the nitrogen oxide coming from power stations.

"The poor health outcomes mean people with asthma and people with Chronic Obstructive airways disease are more likely to have sick days on bad dust days," he said.

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And the impact of air pollution on human health go beyond the obvious effects on respiratory and cardiovascular function, Dr Ewald said. There is evidence that it can interfere with foetal growth and development during pregnancy, contribute to cognitive decline and dementia, as well as increasing the risk of heart disease and stroke.

Other studies have estimated the number of deaths directly attributable to the particles from power stations, with those estimates varying from about 270 per year, based on Dr Ewald's research, and other estimates of about 45.

"There are differences in the way that it's estimated but nobody says that it's zero."

Doctors for the Environment Australia (DEA) say human health is indivisible from environmental health. One of its chief concerns is that coal mining expansion will increase greenhouse gas emissions, driving increasing levels of climate change and global temperatures with "severe and predominantly negative health impacts" that will be felt on a local and global scale.

While power stations are on a pathway of closing, and NSW has a "very credible plan" to build lots of renewable energy, the issue of coal mining, and the contribution that further coal mining will make to climate change, is a different story, Dr Ewald said.

"I think there is a strong argument when you take a global perspective, for having no new mineral exploration for coal or gas and oil and not opening any new mine sites," he said.

The carbon budget approach, which gives a budget of how much carbon dioxide historically has been burnt and how much more could be burnt without driving it beyond the 1.5 or 2 degree warming limit, was very valid, he said.

"Atmospheric scientists have worked out how much Co2 (carbon dioxide) can be released into the atmosphere over the next hundred years," he said.

That means something like half or 80 per cent of the known fossil fuel reserves have to be left in the ground to avoid catastrophic climate change, he said.

"It's a strong reason for leaving those resources in the ground. The politicians that go around telling people there's a great future in coal and we've just got to keep digging it up out of the ground are doing everyone a disservice because as much as they might wish that to be true, the markets will collapse and the technology is moving on.

Dr Kathleen Wild, who has been involved (DEA) since she was a medical student and has contributed to efforts to prevent further coal mining in the Hunter Valley, agrees.

"It's just always struck me how a lot of the impacts get swept under the carpet," Dr Wild said.

She too has seen ample evidence if the effects of air pollution.

"It impacts almost every system. Dementia and kidney disease, for example, can be affected by air pollution. There is a lot of emerging research that mental health is also affected."

Psychiatrists gathered at the Royal Australian and New Zealand College of Psychiatrists annual Congress in Sydney have warned that political leaders' inaction on climate change was harming people's mental health, particularly young people.

Sydney child and adolescent psychiatrist Dr Cybele Dey, who presented at the conference, said more than three in four young people are worried about climate change, and feel betrayed by governments' lack of effective action on climate change.

"Leaders avoiding or distracting from the issue actually worsens climate distress," Dr Dey said.

Climate anxiety, which is related to the existential threat of climate change - the fear and dread of climate change impacts, is "very real", says Associate Professor Fiona Charlson, a researcher and psychiatric epidemiologist - particularly in young people.

"A new study of 10,000 young people in ten different countries found 60 per cent were very worried or extremely worried about climate change," she said.

There is also solastalgia, a loss of connection to land; and 'eco-grief', a sense of loss from experiencing or learning about environmental destruction or climate change.

And there are serious questions being asked about the potential neurodevelopmental impacts.

Along with despair among young people, he is seeing anger, Flannery said. "That scares me almost more than anything," he said. "I can see young people may feel very let down by our generation."

"That scares me almost more than anything," he said.

"We've seen it before where an older generation has let down a younger generation, and perhaps nowhere as clearly as in Germany after the 2nd world war where Nazism and the impact it had was swept under the carpet and people .. not even acknowledging what they'd done.

"I can see young people may feel very let down by our generation."

Government policy is needed more than anything, and an "aggressive target", he said.

"Study after study after study have showed that we can de-carbonise our grid here in Australia within five years if we wanted to."

Many are now likening the health impacts of coal on climate change to smoking, Dr Wild among them.

"Every cigarette you don't smoke is good for you," Dr Wild said. "And every tonne of CO2 we don't emit is better for the environment and health impacts. The message is, we've gotta get off it - it's the same - we have got to quit and every tonne we don't get out of the ground will have a health benefit."

Laureate Professor Nick Talley, editor of the Medical Journal of Australia, also likens coal mining to smoking.

"It's like smoking, smoking is an invisible killer too, it's the same ... you don't realise you are killing yourself until you do," he said.

"We have a duty of care not only us as health professionals, but CEOs and leaders and even politicians to protect the community from the impact of climate change."

With friends who work in the coal mining industry, Professor Talley said he understood that people's livelihoods "really matter".

"The last we want to do is take that away from people... but we also know that coal burning is going to stop. The question is not if, it's when. WHO has called for this to occur by 2030 which is a very aggressive timetable, as have others.

"It will occur, so clearly, whatever happens there's going to have to be a transition and if we don't get ready for it really soon we could find ourselves, in places like the Hunter Valley, that coal becomes a stranded asset.

More than 200 medical journals have called for urgent action to address climate change as a public health emergency, he said.

"To avoid the worst impacts on public health, it's time for Australia's biggest greenhouse emitters to heed the WHO call to replace coal with renewable energy by 2030.

Dr Kate Charlesworth, a public health doctor and a member of the Climate Council and DEA, describes the impacts of coal on human health as "a double-whammy".

"From an air pollution perspective, as we understand more about air pollution, these fine particles are more harmful than we actually thought," she said.

"PM2.5 are tiny air pollution particles which can get into the bloodstream and can have an impact not just on heart disease and asthma but brain development.

"Coal in Australia contributes to 800 premature deaths and 14,000 asthma symptoms. In terms of climate health impacts, Harvard University has found that fossil fuel pollution is responsible for more than 8 million deaths globally each year - that is the same as from cigarette smoking - coal mining is the new tobacco.

"From a health perspective I find it extraordinary that it's not recognised as the enormous issue that it is. We need to transition as quickly as we can. The health case is a really strong case.

"The politics needs to be 'what is the plan for us, how are we going to do this reasonably and equitably'. Australia is one of the countries on the front line of climate health impacts and yet one of those with the weakest net zero plans so it's ironic - we're the biggest exporter of fossil fuel and one of the highest polluters in the world - and yet we are one of the country's most vulnerable to it."

A health adaptation plan was needed, she said, to plan for the impacts on the health system of extreme weather, particularly extreme heat, but also storms, floods, droughts, and bushfires, as well as a rise in infectious disease, mental health issues, and allergens.

"We have no health adaptation plan - that is negligent. WHO has said it is the biggest health threat of our generation - we don't have a just transition plan nor do we have an adaptation plan to look at what impacts are already locked in.

"This is happening now. From a national health climate perspective we need a rapid plan to de-carbonise the Australian economy, and a proper adaptation plan and strategies - along with funding and resourcing. Whatever we do now, even if we stop tomorrow, some impacts are baked in, we know that, and we need to be prepared and resilient for that."

At the coalface

Judith Leslie, a long-time resident of Bulga who lives opposite Yancoal's Mt Thorley coal mine, says she is "disgusted" with the lack of political will she has witnessed during her years-long battle against the expansion of coal mines in the Hunter.

"The plan is to keep going, keep going, keep," she said. "I have been to meetings about a just transition. It comes to nothing and will come to nothing because it is so fiercely opposed by the companies themselves and our political leaders ... They just change the rules."

"I find it just disgusting way that Australians are told coal is so important. One of my husband's pet hates is where else in the world do governments give base material to mining companies so they can make a profit. They ship it out and the profit can be shipped out too.

When the Leslie family moved into their home 25 years ago, a ridge separated them from Mt Thorley, but not for much longer.

"You couldn't see any sign of mining from our house, or hear it because it was quite a way on the other side of the river," Mrs Leslie said. Now you can see a "great scar on the landscape".

"It's very obvious now. You can see the trucks chugging along the top of the heap, and you can see the diesel fumes coming out of them and everything else. It used to be a relatively small operation. Drive along Putty Road now and you can see the absolute decimation of the landscape. It's shocking, absolutely shocking.

Judith, who is "pushing 80", is also disgusted with the air quality standards in Australia.

"We have permission to emit far more pollutants than anywhere else in the world. We turn a blind eye to things that elsewhere in the world would be illegal. It's unbearable because there's nothing you can do. I think that has an effect - not just on our physical health, breathing in cold dust all the time, but also mentally. You get drained of the whole atmosphere.

"Coal is dying but we won't admit it, we refuse to admit it. It's very draining and it's very upsetting and it's particularly upsetting when they're so gung-ho all the time because there's still coal in the ground."

The idea that it is our coal, but if isn't burnt here it's "not our responsibility" made her despair, Judith said.

"Back in the day when we used to make submissions to various planning things there was a short time where they did consider scope three emissions, these emissions that are produced by burning Australian coal but not on Australian territory. Better not to burn it at all, end of story."

Meanwhile, coal dust piles up around her home every day, and she, along with other residents of the Hunter Valley, continue to live with it and breathe in "what is essentially 25 per cent coal dust in the air".

"The whole prospect that we are still approving new mines, we are still subjecting people to more of the same, and we know what it does, and our political leaders know what it does, but they don't live in the Hunter, certainly not in this part of the hunter where they are forced to breath it and live with it.

"It's very, very apparent. You have only got to wipe a surface and there's coal dust on it."

About eight years ago they put in a letter box at the bottom of the drive, made out of a microwave clothed in sandstone. The top slab on top was golden sandstone when it was put there, she said, but not anymore.

"It is absolutely black, totally black, not even a hint of white. You wouldn't know that it was sandstone now. And, this is just the way it is because you have coal dust on coal dust on coal dust."

There is a way forward, say medical professionals and climate change scientists, but time is of the essence. And it comes down to strong leadership and action, says Dr Dey said.

"Many kids today feel betrayed by our leaders, but there is clear medical research that shows that when they see leaders take meaningful action on climate change, their mental health improves," Dr Dey said.

"Good mental health is linked to having a realistic hope that governments will do what scientists recommend and reduce fossil fuel emissions this decade to prevent global warming of more than 1.5°C."

Professor Flannery agrees, saying he is still hopeful and remains optimistic.

"I am pretty confident that we will turn around emissions growth within the next 3-5 years ... that will be a moment of great relief when at least we will be on course to start reducing emissions hard and fast."

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