Peer-reviewed/Modelling and review
- An update to The Lancet Commission on Pollution and Health reveals that there were nine million deaths attributable to pollution in 2019 (equivalent to one in six deaths worldwide), the same number as in 2015.
- Increases in deaths from modern types of pollution (for example, ambient air and toxic chemical pollution) overshadow progress made in reducing pollution deaths associated with extreme poverty (for example, household air and water pollution).
- Pollution remains the world’s largest environmental risk factor for disease and premature death, especially affecting low- and middle-income countries.
- Air pollution accounts for nearly 75% of the nine million deaths. More than 1.8 million deaths are caused by toxic chemical pollution (including lead), an increase of 66% since 2000.
- With a few notable exceptions, little has been done to deal with this public health crisis. The authors call for immediate steps to be taken to address this existential threat to human and planetary health.
Pollution was responsible for nine million deaths in 2019 – equivalent to one in six deaths worldwide – a number virtually unchanged since the last analysis in 2015.
The new report is an update to The Lancet Commission on Pollution and Health , published in The Lancet Planetary Health, and states that although the number of deaths from pollution sources associated with extreme poverty (such as indoor air pollution and water pollution) have decreased, these reductions are offset by increased deaths attributable to industrial pollution (such as ambient air pollution and chemical pollution).
“The health impacts of pollution remain enormous, and low- and middle-income countries bear the brunt of this burden. Despite its enormous health, social and economic impacts, pollution prevention is largely overlooked in the international development agenda,” says Richard Fuller, lead author. “Attention and funding has only minimally increased since 2015, despite well-documented increases in public concern about pollution and its health effects.” 
“Pollution is still the largest existential threat to human and planetary health and jeopardizes the sustainability of modern societies. Preventing pollution can also slow climate change – achieving a double benefit for planetary health – and our report calls for a massive, rapid transition away from all fossil fuels to clean, renewable energy,” adds co-author Professor Philip Landrigan, Director, Global Public Health Program and Global Pollution Observatory at Boston College. 
The 2017 Lancet Commission on Pollution and Health, using data from the 2015 Global Burden of Disease (GBD) study, found that pollution was responsible for an estimated nine million deaths – 16% of all deaths globally. The new report provides updated estimates for the health effects of pollution based on the most recently available 2019 GBD data and methodological updates, as well as an assessment of trends since 2000.
Of the nine million pollution-attributable deaths in 2019, air pollution (both household and ambient) remains responsible for the greatest number of deaths at 6.67 million worldwide. Water pollution was responsible for 1.36 million premature deaths. Lead contributed 900,000 premature deaths, followed by toxic occupational hazards at 870,000 deaths.
The decline in deaths from traditional pollution since 2000 (household air pollution from solid fuels and unsafe water) is most evident in Africa. This can be explained by improvements in water supply and sanitation, antibiotics and treatments, and cleaner fuels.
However, this mortality decrease has been offset by a substantial increase in deaths from exposure to industrial pollution – such as ambient air pollution, lead pollution, and other forms chemical pollution – across all regions over the past 20 years. This is particularly evident in Southeast Asia, where rising levels of industrial pollution are combined with ageing populations and increasing numbers of people exposed.
Ambient air pollution was responsible for 4.5 million deaths in 2019, up from 4.2 million deaths in 2015 and 2.9 million in 2000. Deaths from hazardous chemical pollutants increased from 0.9 million in 2000, to 1.7 million in 2015, to 1.8 million in 2019, with 900,000 deaths attributable to lead pollution in 2019. Overall, deaths from modern pollution have increased by 66 percent in the past two decades, from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019. Figures on deaths from chemical pollutants are likely to be underestimates as only a small number of manufactured chemicals in commerce have been adequately tested for safety or toxicity.
Excess deaths due to pollution have led to economic losses totalling US$ 4∙6 trillion in 2019, equating to 6∙2% of global economic output. The study also notes pollution’s deep inequity, with 92% of pollution-related deaths, and the greatest burden of pollution’s economic losses, occuring in low-income and middle-income countries.
The authors of the new study conclude with eight recommendations that build on those given in the Lancet Commission on pollution and health. These include calls for an independent, Intergovernmental Panel on Climate Change (IPCC)-style science/policy panel on pollution, alongside increased funding for pollution control from governments, independent, and philanthropic donors, and improved pollution monitoring and data collection. International organisations also need to approve and establish a better connection between science and policy for pollution, like those for climate and biodiversity, initially for chemicals, waste, and air pollution.
“Pollution, climate change and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or occasionally with regional policy in higher income regions. However, it is clear that pollution is a planetary threat, and that its drivers, dispersion, and health impacts transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed,” says Rachael Kupka, co-author and Executive Director of the Global Alliance on Health and Pollution. 
NOTES TO EDITORS
This study was funded by the Swiss Agency for Development and Cooperation (SDC) and the Ministry of Environment of Sweden with support from the Global Alliance on Health and Pollution (GAHP) and Pure Earth.
It was conducted by researchers from the Global Alliance on Health and Pollution, Pure Earth, Schiller Institute for Integrated Science and Society at Boston College, Department of Environmental Health Engineering at Sri Ramachandra University, Clean Air Asia, Social and Environmental Medicine at University Hospital Munich, School of Population and Public Health at The University of British Columbia, School of Global Public Health at New York University, Health Effects Institute, Department of Economics at University of Maryland, Keck School of Medicine at University of Southern California, Nuffield Department of Population Health at University of Oxford, Togo Run, Simon Fraser University, University of Pittsburgh, Consortium of Universities for Global Health, Nigerian Institute of Medical Research, The World Bank, Indiana University, World Resources Institute, NIEHS Division of Extramural Research and Training, Instituto Nacional de Salud Pública - Mexico, Shanghai Jiao Tong University.
 The Lancet Commission on Pollution and Health: https://www.thelancet.com/commissions/pollution-and-health
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The Lancet Planetary Health
Method of Research
Subject of Research
Pollution and health: a progress update
Article Publication Date
MB reports institutional support from the Bill & Melinda Gates Foundation; JH also reports consulting fees from the German Ministry of Environment to develop ideas for advancing the Strategic Approach to Chemicals Management process; and JH reports fees from the UK Department for Environment, Food & Rural Affairs for teaching workshops. HH reports grants from the US National Institutes of Health for neuro-epidemiological research on the developmental neurotoxicity of pollutants; HH also reports consultant fees to law firms on cases related to the developmental neurotoxicity of pollutants; and HH serves as Chair of the Scientific Advisory Board of the Marilyn Brachman Hoffman Foundation and is a member of the Advisory Board for Physicians for Human Rights. PJL reports grants and contracts from the Centre Scientifique de Monaco, UN Environment, and the Barr Foundation, and consulting fees from the Centre Scientifique de Monaco; and PJL serves as President of the Collegium Ramazzini, Chair of the Scientific Advisory Board of the Collegium Ramazzini, and Treasurer for the Consortium of Universities for Global Health. BL reports grants from the US National Institutes of Health, Canadian Institutes of Health, and US Department of Housing and Urban Development for research projects and personal consulting to study the effects of toxic chemicals on human health; BL also served as an expert witness in cases related to lead and fluoride poisoning in the USA and Canada but received no personal compensation for these services; and his expert witness fees are deposited in a research and training fund at Simon Fraser University (Burnaby, BC, Canada). All other authors declare no competing interests.