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These days, the leading causes of death around the world include heart disease, cancer, COVID, and more surprisingly, pollution. New research in The Lancet confirms that since 2019, 9 million people have died every year from pollution-related causes. 

“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,” co-author Philip Landrigan, director of the Global Public Health Program and Global Pollution Observatory at Boston College, said in a press release this week. 

These new numbers mean that about one in every six deaths across the world correlates with pollution, making it the largest environmental risk factor for disease and premature death. This is especially evident in low- and middle-income countries where contamination of air and water can be the most detrimental to human health. 

[Related: Tiny air pollutants may come from different sources, but they all show a similar biased trend.]

“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,”  Rachael Kupka, co-author and executive director of the Global Alliance on Health and Pollution, said in the release. “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.”

The report breaks down the deaths by different types of pollution. The most drastic casualties come from what is called “modern” pollution. This number has gone up 7 percent since 2015 and 66 percent since 2000 due to urbanization and industrialization, despite some movement to minimize and prevent its spread. 

Modern pollutants include  particulate matter and ozone in outdoor air, carcinogens, occupational particulate matter, and lead pollution. All together, these add up to 5.84 million deaths a year. These pollutants can be linked back to heavy metals, agrochemicals, and fossil fuels, Kupka told Reuters. The report also notes that deaths linked to manufactured chemical pollutants could be underestimated due to a lack of safety testing. 

While some big cities have seen success in limiting these dangerous pollutants, smaller cities with large growth potential are still at risk

The remainder of pollution deaths are linked to “traditional” sources, which include air pollution in homes, water pollution from unsafe sanitation, and water pollution from other tainted supplies. “Traditional” pollution deaths have been declining since 2000, especially in Africa, the report notes. But they are still seen in the hundreds of thousands in developing nations like Chad, the Central African Republic, and Niger. 

The report leaves multiple suggestions for combating this issue—from prioritizing pollution as a health issue (the issues typically get left to environmental departments that are often underfunded, the authors write) to building up systems to monitor and control hazards. 

“The health impacts of pollution remain enormous, and low- and middle-income countries bear the brunt of this burden,” lead author Richard Fuller, board chair of the Global Alliance on Health and Pollution, said in the release. “Despite its enormous health, social, and economic impacts, pollution prevention is largely overlooked in the international development agenda.”