Pollution and health: a progress update

Abstract

The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical 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, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health.

Figure 1

Global estimated deaths by major risk factor or cause Data from Institute for Health Metrics and Evaluation and Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Error bars are 95% CI.

Figure 2

Downward trend in mortality rate from traditional pollution in Africa, 2000–19 Mortality rate is deaths per 100 000 population. Data from Institute for Health Metrics and Evaluation and Global Burden of Diseases, Injuries, and Risk Factors Study 2019.

Figure 3

Upward trend in mortality from modern pollution in south Asia and southeast Asia, 2000–19 Mortality rate is deaths per 100 000 population. Data from Institute for Health Metrics and Evaluation and Global Burden of Diseases, Injuries, and Risk Factors Study 2019.

Figure 4

Global distribution of childhood lead exposures in 2019 Childhood lead exposures represented by average blood lead concentration (μg/dL). This figure is reproduced from a previous report by permission of UNICEF and Pure Earth.

Figure 5

Lost economic output as a proportion of country GDP due to deaths from modern and traditional pollution in 2000 and 2019 (A) Traditional pollution includes deaths from household air pollution from solid fuels and unsafe water, sanitation, and hand washing., , (B) Modern pollution includes deaths from ambient ozone pollution, ambient particulate matter pollution, lead exposure, occupational carcinogens, occupational particulate matter, gases, and fumes., , GDP=gross domestic product.

Figure 6

Probability of subject matter coverage of pollution, biodiversity, and climate change (composite terms and key phrases) in country framework documents (A) Composite data are from the World Bank, the AfDB, and the ADB (1995–2019); data for individual search terms are from the World Bank (2015–19)., , , (B) Composite data are from UN (2000–19); data for individual search terms are from UN (2015–19). AfDB=African Development Bank. ADB=Asian Development Bank.

Figure 7

Coverage of modern pollution topics in major media outlets in 2020 Data obtained through a search of the Factiva database from Jan 1, 2010, to Dec 31, 2020.