[NAIROBI] While deaths from some traditional pollution sources, like domestic cookstoves and unsafe water and sanitation are declining, increased exposures to “modern” sources of pollution, such as chemicals and outdoor air pollution, mean that pollution-related mortality remains steady at about 9 million a year. 

This is a key finding of a new report on “Pollution and health; a progress update”, published today by Lancet Planetary Health.

“Modern sources of pollution such as industrialisation and urbanisation are increasingly becoming major causes of deaths but there are very little responses in tackling the [menace] from players such as donor agencies and national governments,” says Rachael Kupka, a study co-author and Executive Director of the Geneva-Based Global Alliance on Health and Pollution (GAHP).

“There is also insufficient public awareness on the dangers of pollution,” she adds. 

Overall, about 16% of all premature deaths annually are due to pollution, finds the study, an update of a 2017 Lancet Commission paper on pollution and health.  This also means that pollution remains the world’s largest environmental risk factor for disease and premature death.

The estimates are based on the Institute of Health Metrics and Evaluation’s 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, which looks at a broader range of risks to health from environments, diets, lifestyles and other factors.

Outdoor air pollution sources now the most dangerous to health 

Among pollution sources, air pollution remains the biggest killer by far, the report found – with about 6.7 million deaths in 2019 from both household  and ambient air pollution sources. 

However, a shift is also occurring in the balance of air pollution sources. Deaths from household air pollution, generated by the reliance of billions of people on coal and biomass cookstoves are declining gradually as households shift to cleaner domestic fuels.  

But at the same time, deaths from outdoor air pollution sources have risen sharply over the past two decades – from an estimated 2.9 million deaths in 2000, when WHO first published data on mortality from air pollution risks, to an estimated 4.5 million deaths in 2019.

That increase is largely due to the continued increases in outdoor air pollution from traffic emissions, power plants and industries, in cities of the global South that are seeing explosive growth into rural areas, in  unsustainable patterns of development, researchers have said, adding: 

“The triad of pollution, climate change and biodiversity loss are the key global environmental issues of our time. These issues are intricately linked and solutions to each will benefit each other.” 

The study also notes the deep equity fault line that pollution creates – with 92% of pollution-related deaths, and the greatest burden of pollution’s economic losses, occurring in low-income and middle-income countries.

"We are going backwards" #Pollution still kills 9 million people /yr.
90% deaths in low- and middle-income countries.

Outdoor #airpollution: 4∙5m deaths in 2019, up from 2.9m deaths in 2000.

Essential update @TheLancetPlanet https://t.co/1nYCvpjL9Q pic.twitter.com/FoLQIhkEPg

— Nina @CleanAirFund (@ninawren) May 18, 2022

Lead pollution still a major factor in chemical risks 

The report adds that exposure to lead, a neurotoxin that also lowers IQ in children, caused 900 000 premature deaths in 2019 while other toxic chemical exposures in the workplace, accounted for 870 000 deaths.

But the figures on deaths from chemical pollutants are likely underestimates as only a small number of manufactured chemicals in commerce have been adequately tested for safety or toxicity.

Overall, deaths from the so-called “modern” pollution sources 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, according to the study’s authors.

“The total effects of pollution on health would undoubtedly be larger if more comprehensive health data could be generated, especially if all pathways for chemicals in the environment were identified and analysed,” the study’s authors say.

According to Kupka, one out of five children globally is exposed to lead contamination despite the global phase out of leaded gasoline. In some countries, up to 50% of children may be exposed to lead through water piping, leaded household ceramics, lead in spices, as well as exposures in paint, artisanal mining and oil extraction and waste scavenging, according to GAHP.  

Pollution has it’s biggest impacts on health in LMICS

Pollution remains the world’s largest environmental risk factor for disease and premature death, particularly in low- and middle-income countries where air pollution accounts for about 75% of the nine million deaths.

The authors are now calling for immediate action to address this existential threat to human and planetary health as, with a few notable exceptions, little efforts have been done to deal with this public health crisis.

“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,” said Professor Philip Landrigan, another co-author and director of the Global Public Health Program and Global Pollution Observatory at Boston College.

This trend is more evident in Southeast Asia, where rising levels of urban  pollution combine with ageing populations – who are more vulnerable to the health impacts of air pollution, and related diseases, such as heart attack, hypertension, cancers and chronic respiratory diseases. 

Reduction in deaths from “traditional” pollution sources most evident in Africa

The drop in deaths from traditional pollution since 2000 is most evident in Africa, the report found. Theres a decline in household air pollution as families shift away from biomass, coal and kerosene for cooking and lighting. 

Household air pollution is a leading risk for childhood pneumonia deaths – along with cleaner household fuels, better medical treatment is gradually bringing that burden down. Similarly, improvements in clean water supply, storage and sanitation have reduced deaths from diarrhoeal diseases –  traditionally another major killer of children under 5, the report found.  Even so, lack of access to safe drinking water and improved sanitation still remains responsible for 1.4 million premature deaths every year.  

Pollution prevention largely overlooked  

Despite the bright spots of progress, pollution prevention is a neglected priority both among donors as well as among top officials in many of the of the low- and middle-income countries that suffer the most – including health sector leaders. 

“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 have only minimally increased since 2015, despite well-documented increases in public concern about pollution and its health effects.”

This is despite estimates that pollution-related deaths led to economic losses totalling US$ 4∙6 trillion in 2019, equating to 6.2% of global economic output.  

Intergovernmental Panel Report on Pollution 

The authors called for an independent, Intergovernmental Panel on Climate Change (IPPC)-style science/policy panel on pollution, increased funding for pollution control from governments, independent, and philanthropic donors, and improved pollution monitoring and data collection.

 Approval and establishment of better connection between science and policy for pollution by international organisations.

“Prioritization of this issue by policymakers, understanding the consequences of pollution is extremely important. Ministers for environment need to ensure that pollution is factored in their national strategic plans and are budgeted,” according to Kupka.

Image Credits: Mohammad Hossein Taaghi, UN Water, Lancet Planetary Health, ISGlobal – Barcelona Institute of Global Health , Uncommonthought.com, DFID, Lancet Planetary Health .