Balancing the potential benefits and harms of using coal as an energy source is an ongoing challenge for local communities and the global economy. Coal is a natural resource that has long been used to power a wide variety of activities. It is a non-renewable resource; the bulk of the coal mined today is about 300 million years old and will not be replaced during human existence. Though it is a naturally occurring substance, coal can be dangerous to human health, especially in its particulate form. Additionally, the extraction, transportation, and combustion of coal can have major impacts on natural, social, and economic conditions. This health analysis considers the potential impacts and human health consequences of three proposed coal export projects that could result in rail transport of coal through Multnomah County.