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The Pollution and Health progress update shows that pollution remains the world’s largest environmental risk factor for disease and premature death.

In 2017, The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015 – one in six deaths worldwide. That is more than war and terrorism, AIDS, tuberculosis, malaria, and drug/alcohol use combined for 2019.

Based on data from the 2019 Global Burden of Disease (GBD) study, the Update found that overall figures are about the same – and that pollution remains a major global threat to health and prosperity, particularly in LMICs.

While deaths due to pollution associated with extreme poverty – such as household air pollution, water pollution and inadequate sanitation – have declined, those reductions are offset by increased deaths attributable to modern pollution, e.g., ambient air, lead poisoning and toxic chemical pollution, which have risen by more than 66 percent over the past two decades (from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019). Of the 9 million total deaths due to pollution: the single largest contributor is air pollution (household and ambient air pollution), followed by water pollution, lead toxicity and occupational pollution.

Deaths from modern pollution have risen by more than 66 percent over the past two decades, from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019.

Data also suggested that men are more likely than women to die from exposure to ambient air pollution, lead and occupational pollutants, whilewomen and children are more likely to die from exposure to water pollution.

Emerging Global Threats

© Sean Gallagher

Lead and chemical pollution remain a major yet underestimated health risk factor. The estimated 900,000 global deaths due to lead is likely an undercount.

A recent long-term study of American adults suggests that the cardiovascular and renal toxicity of lead may extend to very low blood lead levels (BLLs), and there may be no threshold for these effects. The burden of mortality due to lead may therefore be several times greater than current estimates.

Lead poisoning in children may be more prevalent than previously recognized. More than 800 million children (or 1 in 3) are estimated to have BLLs exceeding 5 µg/dl, until recently the trigger level for intervention established by the US Centers for Disease Control and Prevention (now reduced to 3.5 µg/dl). The implications for children’s intellectual impairment are staggering. Children with blood lead levels greater than 5 µg/dL may score 3-5 points lower on intelligence tests than less heavily exposed peers. Lead-related IQ losses translate to increased rates of school failure, disorderly behavior, and diminished productivity, all of which result in global economic losses of almost $1 trillion annually.

Chemicals can compromise cognitive function, especially in children. More than 200 chemicals (e.g., lead, methylmercury, and polychlorinated biphenyls) are neurotoxic to humans and many are widespread in the environment. Children are especially vulnerable. Even low-dose exposures to neurotoxic chemicals during key fetal and postnatal development have far more serious health effects than high-dose exposures to the same chemicals in adults. Chemicals can be toxic to human reproduction. Exposure to certain manufactured chemicals, even at low doses, can have adverse impacts on fertility and pregnancy. Pesticides, industrial chemicals (e.g., halogenated flame-retardants), pharmaceutical chemicals and toxic metals have been linked to a range of reproductive problems, including: diminished quality and quantity of human sperm and eggs, embryonic and fetal malformations, disruption of reproductive processes, such as uterine implantation.

Some chemicals are toxic to immune function and can worsen communicable diseases. For example: exposure to perfluoroalkyl acids has been associated with reduced antibody responses to vaccines, an increased risk among children for hospitalization for infectious disease, and recently, increased severity of COVID-19 infections. Exposure to traffic-related air pollution and cadmium has been associated with increased mortality from COVID-19 and influenza, respectively.

Transboundary pollution

© Sean Gallagher

While most pollution remains near its country of origin, growing evidence shows that pollutants can travel long distances via wind, water, food chains, and consumer products.

For example, industrial activity in China has increased airborne pollutants in places as near as Japan, South Korea, and Taiwan and as far away as California. Pollution footprints – areas affected by pollution associated with production of goods consumed elsewhere – are growing faster than carbon footprints and are more likely to affect LMICs.Pollution of soil and water in LMICs by lead, arsenic, cadmium, and mercury can contaminate exported foods and threatens global food safety. Lead and/or cadmium detected in infant foods and formulas in Poland, France, Canada, and the United States is especially concerning.

This translates into an enormous negative economic impact. Based on 2019 GBD data, a World Bank study of air pollution concluded that in 2019 the global economic losses due to PM2.5 air pollution alone amounted to US$8.1 trillion, or 6.1 percent of global economic output. This is especially severe in East Asia and Pacific, and South Asia regions, where losses are equivalent to 9.3 and 10.3 percent of GDP, respectively.

Lead and/or cadmium detected in infant foods and formulas in Poland, France, Canada, and the United States is especially concerning.

Public Awareness

© Larry C. Price

Public awareness of pollution is growing but remains spotty. Tracking public attention to issues of pollution and health is important since public demand for more effective action against pollution can be powerfully catalytic.

Two metrics that can be tracked in this regard are media attention to pollution and health, and inclusion of pollution prevention in development strategy frameworks. Coverage of modern pollution in English-language media since 2010 rose steadily, with the largest annual increases in 2017-2019 following the report of The Lancet Commission in 2017.

An analysis of country strategy documents of multilateral aid agencies for 2015-2020 found that: ‘Household air pollution’ and ‘water pollution’ were mentioned more often than ‘ambient air pollution’ or ‘chemical pollution’, suggesting greater focus on traditional pollution than modern pollution. Little attention is directed to specific pollution problems known to contribute to a high burden of disease problems, such as air pollution or lead.