Pollution— ie, unwanted waste of human origin released to air, land, water, and the ocean without regard for cost or consequence—is an existential threat to human health and planetary health, and jeopardises the sustainability of modern societies. Pollution includes contamination of air by fine particulate matter (PM2·5); ozone; oxides of sulphur and nitrogen; freshwater pollution; contamination of the ocean by mercury, nitrogen, phosphorus, plastic, and petroleum waste; and poisoning of the land by lead, mercury, pesticides, industrial chemicals, electronic waste, and radioactive waste.
The 2017 Lancet Commission on pollution and health, which used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2015, found that pollution was responsible for an estimated 9 million deaths (16% of all deaths globally) and for economic losses totalling US$ 4·6 trillion (6·2% of global economic output) in 2015.1 The Commission noted pollution's deep inequity: 92% of pollution-related deaths, and the greatest burden of pollution's economic losses, occur in low-income and middle-income countries (LMICs).
This report presents an updated estimate of the effects of pollution on health, made on the basis of the GBD 2019 data, and also makes an assessment of trends since 2000. These data show that the situation has not improved, and that pollution remains a major global threat to health and prosperity, particularly in LMICs. Since 2000, the steady decline in the number of deaths from the ancient scourges of household air pollution, unsafe drinking water, and inadequate sanitation are offset by increasing deaths attributable to the more modern forms of pollution. These modern forms of pollution—eg, ambient air pollution, lead pollution, and chemical pollution—require major increases in mitigation and prevention.
Death and disease due to pollution in 2019
The analysis of disease and premature death due to pollution that we present uses GBD methodology that was developed in the 1990s by WHO, which was expanded by the Institute for Health Metrics and Evaluation (IHME).2 Similar to earlier iterations of the GBD study, the 2019 study included new input data and several methodological updates.3 Given the large number of chemical pollutants and their ubiquity in the modern environment, the disease burden attributable to chemical pollution is likely to be substantially greater than current estimates.
Pollution-related death
In 2019, pollution was responsible for approximately 9·0 million premature deaths. Air pollution (both household and ambient air pollution) remains responsible for the greatest number of deaths, causing 6·7 million deaths in 2019. Water pollution was responsible for 1·4 million premature deaths. Lead was responsible 900 000 premature deaths. Toxic occupational hazards, excluding workplace fatalities due to safety hazards, were responsible for 870 000 deaths (table). 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 GBD 2019 data show that the effect of pollution on disease and disability varies . Men are more likely to die from exposure to ambient air pollution, lead pollution, and occupational pollutants than women. Women and children are more likely to die from exposure to water pollution than men.
A comparison of the effects of pollution on morbidity and mortality with those of other risk factors on morbidity and mortality shows that pollution continues to be one of the largest risk factors for disease and premature death globally. The impact of pollution on health remains much greater than that of war, terrorism, malaria, HIV, tuberculosis, drugs, and alcohol, and the number of deaths caused by pollution are on par with those caused by smoking
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