Flaring in North Dakota causes thousands of hospital visits, costs millions in medical expenses, study finds

Researchers found that 11,877 respiratory-related hospital visits by people living within 60 miles of an oil well in North Dakota could have been prevented if the state had met its gas capture goal.

Natural gas flare
Natural gas is flared at an oil well in Williams County, N.D.
Amy Dalrymple / Forum News Service file photo

FARGO — Lisa Finley-DeVille lives near an oil well that flares natural gas on the Fort Berthold Indian Reservation. A few years ago, during a time when she was photographing flaring on the reservation, she and her husband came down with a respiratory illness.

They went to the emergency room in Watford City, where the doctor said she was treating about 15 similar cases of what she called “Bakken cough” — a cough and other respiratory symptoms attributed to oil and gas activity in the area.

“We were really sick,” Finley-DeVille said, adding that her husband was given a steroid shot when they both fell ill in 2018. Also during that time, she said, several children at Fort Berthold developed bloody noses that people suspected were caused by air polluted by petroleum extraction.

“The sad thing is, we don’t know what we’re breathing” because of a lack of monitoring, Finley-DeVille said.

Those cases point to a bigger pattern of respiratory illnesses associated with oil and gas development in western North Dakota documented in a recently published study — the first, its authors believe, to provide evidence of a connection between flaring and respiratory illness.


The researchers have determined that thousands of respiratory-related hospital visits — and many millions of dollars in medical expenses and lost wages — were caused by natural gas flared at oil wells in North Dakota’s Oil Patch.

The study, published by the Journal of Public Economics in April, analyzed a "unique dataset," incorporating oil well locations, flaring, gas processing plants, weather, satellite data and hospital records from 2007 to 2015.

Authors Wesley Blundell and Anatolli Kokoza, both economists, had input from other researchers with expertise in health and environmental science. The team found 11,877 respiratory-related hospital visits by people living within 60 miles of an active oil well in North Dakota could have been prevented if the state had met its gas capture goal during the nine-year period.

That translates to roughly $443 million in medical expenses over nine years, or $1.43 for every thousand cubic feet of flared gas, a conservative estimate the study said was on the “lower bound” of costs associated with flaring.

By the end of the study period, North Dakota’s goal was to capture 88% of natural gas produced in the state but fell short of meeting the objective, the study found. The capture rate averaged 72.6% during the years studied.

North Dakota’s gas capture rate since then has increased and recently reached 92%, slightly above the current 91% goal. Even so, as of 2021, North Dakota’s flaring rate was seven times greater than the next-highest state, according to a study for the Environmental Defense Fund.

Blundell and Kokoza, then doing their doctoral work at the University of University, decided to focus on North Dakota after seeing news reports in 2014 that the value of flared gas in the state exceeded $1 billion per year — an indication that there must also be significant air pollution, Blundell said.

Satellite data and air monitoring confirmed their suspicions and showed the plume of pollution extended downwind about 60 miles from an oil well.


“We were the first to define health effects that went 60 miles downwind,” said Blundell, now with Washington State University. “Many of the previous studies, or a few of the previous studies, had much smaller geographic ranges that were in consideration.”

The study found that as flaring increased, downwind respiratory illness also increased. A 1% increase in flaring was associated with a 0.73% increase in respiratory-related hospital visits in North Dakota, according to the study.

Natural gas flared in western ND
Natural gas is flared in McKenzie County, N.D., on Friday, Sept. 6, 2013.
Amy Dalrymple / Forum News Service file photo

The researchers said their analytical methods enabled them to distinguish the effects of flared natural gas from other oil extraction activities that can affect local health.

The study found that those who bore the adverse health effects from flaring often were unlikely to enjoy the economic benefits of oil development, and that poor and nonwhite people were disproportionately exposed to flared natural gas.

“What we were surprised about was that the people who were being exposed to the pollutants from flared natural gas are not necessarily those who are getting the direct economic benefit,” Blundell said.

The greatest concentration of nonwhite residents in North Dakota’s Oil Patch are American Indians living on the Fort Berthold Reservation, but the census data examined only distinguished between white and nonwhite residents, Blundell said.

People living in ZIP codes exposed to half of the damage from flaring extracted less than 20% of the resource wealth, the study found.

The study’s findings also suggest that flaring contributes to the deaths of elderly residents living within 60 miles of an active well. A 1% increase in flaring is associated with a 0.13% increase in elderly mortality, which could also stem from other pollutants in addition to flaring emissions.


“Overall, these results indicated that flaring may have substantial mortality related costs and that further investigation is warranted,” the study said.

“Earlier studies have found an association between air pollution and health outcomes beyond respiratory health, including infant mortality, cardiovascular health and cancer,” the study added.

As part of the study’s economic cost analysis, the researchers combined the average cost for a hospital stay, $28,919, with the estimated $8,379 associated earnings loss from hospitalization.

Total estimated potential health costs from flaring from 2007 to 2015 ranged from $400 million to almost $2.2 billion, or $40 million to $236 million per year, according to the study. The estimates merely provide the “rough bounds for the magnitude of health costs from flared natural gas in North Dakota,” the study said.

The study calculated the associated hospital costs of flaring to be $1.43 per thousand cubic feet for an area with a population density of 6.2 people per square mile. By comparison, researchers have estimated the climate cost associated with natural gas to be $2.19 per thousand cubic feet.

In other words, the hospital costs associated with flaring are almost two-thirds, or 65%, of the climate cost, according to the study.

“These results indicate that global initiatives to reduce flaring, which historically focused on the climate change costs, may significantly underestimate the external cost of flaring if they do not consider the associated health damages,” the study said.

For economists, external costs are those that aren’t reflected in market prices.


“When you buy a gallon of gasoline, that's you paying a company for a gallon of gasoline, but there are people paying a cost from your use,” Blundell said. “The climate cost, the local pollution cost from the exhaust from your vehicle.”

The health costs associated with flaring could be higher in areas with a greater population density than western North Dakota, much of which is sparsely populated, Blundell said.

The average price of natural gas during the study period was $5.34 per thousand cubic feet.

The study’s authors wrote that their analyses indicate “future research into flaring’s impact on mortality and other types of hospitalization is needed.”

North Dakota Rep. Lisa Finley-DeVille, D-Mandaree, poses for a portrait in Memorial Hall at the state Capitol in Bismarck on Tuesday, Dec. 6, 2022.
North Dakota Rep. Lisa Finley-DeVille, D-Mandaree, poses for a portrait in Memorial Hall at the state Capitol in Bismarck on Tuesday, Dec. 6, 2022.
Jeremy Turley / Forum News Service

Finley-DeVille, who was elected in November to represent a district at Fort Berthold in the North Dakota House of Representatives, said she ran in part to address environmental and health concerns involving oil and gas.

“It’s very important that we’re at the table at all levels of government,” she said. While she said she isn’t against oil and gas, Finley-DeVille noted she’d like to see more environmental monitoring and studies of the health effects of flaring and venting methane.

“What do we do?” she said. “Do we wait until something happens?”

See also:


North Dakota now captures 95% of natural gas, the vast amount of which comes from oil wells, but still stands out as a major source of flaring, which releases climate-warming methane.

Patrick Springer first joined The Forum in 1985. He covers a wide range of subjects including health care, energy and population trends. Email address:
Phone: 701-367-5294
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