Pollution and health: a progress update

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.

Risk Analysis Approaches to Evaluating Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries

Risk analysis offers a useful framework for evaluating and managing environmental health risks across different settings. In this Perspective, we question whether the principles and practice of risk analysis could be beneficial in the context of land-based pollution in low- and middle-income countries (LMICs) to better support risk-based decision making. Specifically, potential health and economic impacts from land-based pollution in LMICs has become an increasing issue of concern due to widespread environmental contamination from active and legacy operations, particularly informal activities that are becoming increasingly dispersed throughout communities, such as used lead acid battery recycling, artisanal and small-scale gold mining, and small-scale tanneries. However, the overall magnitude and scale of the public health problem arising from these sources remains highly uncertain and poorly characterized and cannot be compared to land-based pollution in high-income countries due to unique factors. This lack of knowledge has negatively affected the political priority and level of funding for risk mitigation actions targeting land-based pollution in these countries. Our primary objective is to raise further awareness of this emerging issue among risk analysts and decisionmakers and to advocate for more robust and focused research. Here, we highlight the types of industries and activities contributing to land-based pollution in LMICs and describe key findings and knowledge and data gaps that have hindered a fuller understanding of this issue. We also discuss how several risk assessment and risk management approaches might be useful in this resource-constrained context. We conclude that a combination of risk analysis approaches may be worthwhile, but more work is needed to determine which methods or tools will be most informative, technically feasible, and cost-effective for identifying, prioritizing, and mitigating land-based pollution in LMICs. Affected researchers, funding agencies, and local or national governments will need to work together to develop improved study designs and risk mitigation strategies.