Pollution and Health Metrics: Global, Regional and Country Analysis

“The report reminds us all that pollution is a global crisis. It does not matter where you live. Pollution will find you

Rachael Kukpa, GAHP Executive Director

The 2019 Pollution and Health Metrics: Global, Regional and Country Analysis report from the Global Alliance on Health and Pollution (GAHP) updates findings from The Lancet Commission on Pollution and Health, and provides a ranking of pollution deaths on a global, regional and country level.

Pollution remains the world’s largest environmental threat to human health, responsible in 2017 for 15% of all deaths globally, and 275 million Disability-Adjusted Life Years. The 2019 report, which uses the most recent Global Burden of Disease data from the Institute of Health Metrics Evaluation, underscores the extent and severity of harm caused by air, water, and occupational pollution. 

We’re facing serious risks from pollution and those risks are exacerbated by climate change. The U.S. has historically been the gold standard in tackling pollution, and today we are sadly not doing enough and the fact that we’re going backward is unconscionable. This report reminds us that climate change isn’t just about faraway countries or forest fires and floods – it’s about our health and the health of our kids – here and now,” says Gina McCarthy, former U.S. Environmental Protection Agency Administrator.

The top ten countries with the most pollution deaths include both the world’s largest and wealthiest nations, and some of its poorer ones. India and China lead in the number of pollution deaths, with about 2.3 million and 1.8 million deaths respectively. The United States, the world’s third most populous country with 325 million people, makes the top ten list with 197,000 pollution-related deaths, while ranking 132nd in the number of deaths per 100,000 people.

The GAHP report updates findings published in 2017 by The Lancet Commission on pollution and health. The Commission’s seminal report, which was based on 2015 data, deemed pollution the greatest environmental cause of death and disease in the world, responsible for 1 in 6 deaths.

Ambient air pollution kills more people around the globe than any other form of pollution. In the United States — which has invested in air, water and soil cleanup through the EPA’s Superfund program — ambient air pollution was responsible for more than half of the pollution-related deaths in 2017.

In order to tackle pollution, we must prioritize it as an issue that affects us all, integrating it into health planning, and increasing funding to allow more research into pollution, such as monitoring pollution and its effects, and developing ways to control pollution. Pollution prevention can be highly cost-effective – helping to improve health and reduce climate impacts, while boosting economies,” says Richard Fuller, Chair of the GAHP Board of Directors.

In addition to total pollution-related deaths, the report provides regional and topical data including:

  • Top ten countries with the most pollution-related deaths in proportion to their population. This list features many smaller countries where the impact of pollution in relation population size is more intense. Chad tops this list with 287 deaths for every 100,000 people, whereas India, the only country that appears on all three lists, had a toll of 174 deaths for every 100,000 people.
  • Top ten countries with the most deaths related to air pollution.  The impact of air pollution can be seen here, as this list corresponds closely to the list of top ten countries with the most pollution-related deaths.  Air pollution–both ambient and indoor–is one of the largest and most obvious types of pollution affecting global health.

Other significant revelations include:

  • The 2017 Global Burden of Disease (GBD) estimate of 8.3 million premature deaths from pollution is likely a serious undercount.  The GBD data does not account for exposure to many forms of toxic pollution, including mercury, cadmium, chromium, radionuclides, and obsolete pesticides.
  • What appears to be a decline in pollution deaths from a 2015 GBD estimate of 9 million deaths (reported in the 2017 Lancet Commission report) to the 2017 GBD estimate of 8.3 million deaths is due to changes in calculation methodologies, primarily related to air pollution.  New analyses, conducted by IHME’s air pollution experts, Health Effects Institute, reviewed the overlap between indoor air and outdoor air with new data and methodologies. Changes were also made in modeling for various occupational pollutants and for lead. Each of these updated the IHME calculations.
  • Overall, the results show an improvement in the number of premature deaths from traditional types of pollution— sanitation and household air—from 2015 to 2017. But modern pollution, which is caused by industrialization and urbanization, is on the rise. Modern pollution, now responsible for 5.3 million deaths a year, is poorly addressed in development agendas. While attention is growing, the modern pollution crisis still lacks substantive focus within international development agencies.

Although pollution is one of the world’s leading killers, it does not get the resources commensurate with the impact,” says Dr. Jack Caravanos, NYU Professor in the College of Global Public Health and GAHP Advisor.  “It is difficult to trace deaths to pollution because there are so many types of pollution and end results. A person dying from a disease, for example, may not be counted as a polluted-related death even if pollution was a major factor.” 

  • The disability impacts from pollution also continue to be undercounted. The current figure of 275 million DALYs (Disability-Adjusted-Life-Years, the internationally recognized measure of overall disease burden) will increase as data collection becomes more sophisticated.
  • More than two-thirds of the adverse health impacts of pollution are experienced as non-communicable diseases (NCDs). Pollution of all types was responsible for 21% of all deaths from cardiovascular disease, 26% of deaths due to ischemic heart disease, 23% of deaths due to stroke, 51% of deaths due to chronic obstructive pulmonary disease, and 43% of deaths due to lung cancer.

Below are the three Top Ten lists.

Ranking total deaths by country from all types of pollution give the following result:

 Total Annual Premature Pollution-Related Deaths 
1 India2,326,771
2 China1,865,566
3 Nigeria279,318
4 Indonesia232,974
5 Pakistan223,836
6 Bangladesh207,922
7 United States of America 196,930
8 Russian Federation118,687
9 Ethiopia110,787
10 Brazil109,438


Top Ten Countries – Premature Deaths Attributed to Pollution per 100,000 Population

 Pollution Deaths per 100,000 People 
2Central African Republic251
3North Korea202
6Papua New Guinea183
7South Sudan180


 Total Annual Premature Pollution-Related Deaths 
7United States of America107,507
8Russian Federation99,392

            All Air Pollution = Ambient particulates, households, and ozone.

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