The purpose of this study is to question the world’s dependence on coal power by exploring the avenues through which coal production (extraction, transportation, and combustion) impact the health, climate, and economic wellbeing of communities. It uses South Africa as a case study because South Africa has a high percentage of coal in its energy mix and extracts large amounts of coal. This research finds that coal production in South Africa worsens the health of South African communities and accelerates climate change, threatening the food and water supplies of millions of people within and outside of the country. This analysis does not find conclusive evidence that coal production contributes to widespread economic growth in South Africa. It also reveals that potential gains from economic growth on communities are offset by health and climate damages.