Pollution was responsible for more than nine million premature deaths, or 16 percent of all deaths, worldwide in 2015, making it accountable for more than three times the number of people killed by AIDS, malaria, and tuberculosis combined, according to a report published in The Lancet Thursday.
For the report, more than 40 international experts spent two years tracking the effect of indoor and outdoor pollution in air, water, and soil, as well as chemical pollutants. The report drew data from the Global Burden of Disease Study.
Key findings on health
According to the report, most pollution-related deaths were from non-communicable diseases such as asthma, cancer, and heart disease.
Poor air quality, which includes outdoor pollution and indoor pollution, was the leading cause of a pollution-related deaths, the researchers said. Specifically, the researchers found that in 2015 there were:
- 6.5 million air pollution-related deaths;
- 1.8 million water pollution-related deaths; and
- 800,000 workplace pollution-related deaths.
The researchers found that deaths related to household air pollution, water pollution, and poor sanitation are falling. However, deaths related to air pollution overall have increased by 700,000, since 1990. Moreover, given that many emerging chemical pollutants are not yet identified, the findings likely underestimate the total burden of pollution-related illness and mortality, the researchers said.
The researchers noted that while "no country is unaffected" by pollution, low- and middle-income countries accounted for 92 percent of pollution-related deaths. Overall, according to the researchers, India had the highest number of pollution-related deaths, at 2.5 million, followed by China, at 1.8 million. Other countries that were highly affected included Pakistan, Bangladesh, and Kenya.
Key findings on financial ramifications
When the researchers assessed pollution's financial toll, they found that pollution-related diseases make up 7 percent of health spending in rapidly industrializing, low- and middle-income countries, compared with 1.7 percent of annual health spending in wealthy nations.
Conversely, the researchers found that addressing pollution incurred substantial savings. For instance, according to the researchers, every dollar the United States has invested in air pollution control since the Clean Air Act passed in 1970 has yielded about $30 in benefits. The benefits are largely related to increased productivity from healthier citizens, according to the report.
Philip Landrigan—a lead author on the report, pediatrician, and professor of environmental medicine and global health at the Icahn School of Medicine at Mount Sinai—noted that "pollution in rapidly developing countries is just getting worse and worse and worse." He added, "And it isn't getting the attention it deserves. It needed to be rigorously studied."
Landrigan cited asbestos as a "blatant example" of a form of pollution that disproportionately affects developing countries. "About two million tons of new asbestos is produced every year. ... Virtually all of that goes to the world's poorest countries that have poor or no regulations against it."
According to Landrigan, the researchers recommended establishing a Global Pollution Observatory to track progress toward addressing pollution and reporting on that progress in regular updates to The Lancet.
He added that experts in developed countries can provide technical assistance to lower-income countries to monitor and address pollution. Furthermore, the researchers have set up an interactive website to spur action on the issue (Thielking, STAT News, 10/19; Boyles, MedPage Today, 10/19; Brink, "Goats and Soda," NPR, 10/19; Dennis, Washington Post, 10/19).
From healthy food access to stable housing: The case for collaboration with community partners
Population health leaders know that health care delivery is incomplete without addressing the social determinants of health. But effective patient management cannot only include tasking care teams with addressing patients' social needs on top of their complex clinical needs.
Instead, providers should also partner with community-based organizations already providing quality non-clinical support for a range of needs, from healthy food access to stable housing, to scale patient management beyond traditional care settings.