Pollution, Health, and the Planet: Time for Decisive Action
October 22, 2017 Pamela Das and Richard Horton / The Lancet & Pure Earth
For decades, pollution and its harmful effects on people's health, the environment, and the planet have been neglected both by governments and the international development community. Pollution is the largest environmental cause of disease and death in the world today, responsible for an estimated 9 million premature deaths in 2015. 92% of all pollution-related mortality is seen in low-income and middle-income countries.
Pollution, Health, and the Planet: Time for Decisive Action Pamela Das and Richard Horton / The Lancet
(October 19, 2017) -- For decades, pollution and its harmful effects on people's health, the environment, and the planet have been neglected both by governments and the international development community. Pollution is the largest environmental cause of disease and death in the world today, responsible for an estimated 9 million premature deaths in 2015. (1) 92% of all pollution-related mortality is seen in low-income and middle-income countries. (1)
A new Lancet Commission on pollution and health aims to confront and overturn this urgent predicament. (1) The substantial health and economic costs of pollution globally can no longer be ignored.
The Lancet Commission on pollution and health is the product of a collaboration between The Lancet, the Global Alliance on Health and Pollution (GAHP), including independent researchers and policy makers, and the Icahn School of Medicine at Mount Sinai, New York, USA.
The report was led by Philip Landrigan, an environmental scientist and physician, and Richard Fuller, Founder and President of the non-governmental organization Pure Earth and the secretariat of GAHP.
The Commission's report focuses much-needed attention on the problem of pollution, especially industrial, vehicular, and chemical pollution, and provides actionable and cost-effective solutions to policy makers, while dispelling the myth that pollution is an inevitable consequence of economic development. The Commission identifies knowledge gaps and sets out a research agenda for future work.
As the report shows, no country is unaffected by pollution. Human activities, including industrialisation, urbanisation, and globalisation, are all drivers of pollution. Through analyses of existing and emerging data, the report examines the health effects and economic costs of multiple forms of pollution for the first time, including air (ambient and household), water, soil, and workplace.
Additionally, the report presents troubling new data on the extent of chemical and pesticide pollution, including pollution by toxic chemicals at contaminated sites. The nature of pollution is changing, and is worsening in places. Many effects of chemical pollutants are yet to be determined but much is still known.
The Commission estimates welfare losses due to pollution to be more than US$4·6 trillion per year, which is equivalent to 6.2% of global economic output. (1)
The linkages between pollution, climate, and planetary health (the health of human civilisations and the natural systems on which they depend) are made throughout the Commission report. Pollution is a major theme within planetary health because the drivers of climate change, such as the combustion of fossil fuels or land use change, are also important contributors to pollution.
Pollution itself has effects, which are still incompletely understood, on a range of natural systems -- for example, toxic chemicals can cause reduced ecosystem function that can indirectly affect human health. (2)
In 2006, the Stern review commissioned by the UK Government was influential in reframing climate change as an economic issue, and not merely an environmental challenge. (3) The Stern review improved our understanding of the economic costs of climate change, and inspired a huge amount of subsequent work.
We hope that the findings and recommendations from this Lancet Commission will also marshal action in the health and development sectors, and persuade leaders at the national, state, provincial, and city levels to make pollution a priority. Although there is some activity on pollution internationally, much more is needed.
The Lancet Commission is launched in New York, USA, at a worrisome time, when the US Government's Environmental Protection Agency, headed by Scott Pruitt, is undermining established environmental regulations.
This year's annual UN Environment Assembly will convene in Nairobi, Kenya, on Dec 4–6, 2017. Ministers of Environment from member states, alongside civil society and the private sector, will be in attendance.
For the first time, the overarching conference theme is "Towards a Pollution-Free Planet". Recommendations from this Lancet Commission are under consideration, and it is hoped that the outcomes will prioritise pollution from a health perspective.
This Lancet Commission should inform policy makers and serve as a timely call to action. Pollution is a winnable battle. In the latest results of the Global Burden of Disease, for example, the age-standardised death rates for all causes of air pollution were reported to have fallen by 23% between 2006 and 2016. (4)
Now is the moment to accelerate our collective response. Current and future generations deserve a pollution-free world.
We declare no competing interests. We would like to thank Philip Landrigan and Richard Fuller for their leadership of the Lancet Commission on pollution and health, and the Commissioners, independent researchers, and policy makers for their contributions to this report.
We would like to thank USAID, US National Institute of Environmental Health Sciences, the European Commission, and the Governments of Germany, Norway, and Sweden for their funding and input into the report.
1. Landrigan, PJ, Fuller, R, Acosta, NJR et al. The Lancet Commission on pollution and health. (published online Oct 19.) Lancet. 2017;
2. Whitmee, S, Haines, A, Beyrer, C et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015; 386: 1973–2028
3. Stern, N. Stern review report on the economics of climate change. (accessed Sept 29, 2017).)
4. GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390: 1345–1422
2016 World's Worst Pollution Problems:
The Toxins Beneath Our Feet Pure Earth
(October 2017) -- The 2016 World's Worst Pollution Problems report is the 11th in an annual series published by Green Cross Switzerland and Pure Earth. Over the past decade, this series has identified and drawn attention to the worst, and most dangerously polluted places on the planet, while documenting and quantifying the startling health and environmental impacts of this neglected problem.
The "World's Worst" series of reports aim to raise global awareness about the extent and impacts of toxic pollution in low- and middle-income countries.
This year's report, The World's Worst Pollution Problems 2016: The Toxics Beneath Our Feet presents an update of the top ten polluting industries based on each source's global burden of disease.
The top ten industries are identified as used lead acid battery (ULAB) recycling, mining and ore processing, tanneries, dumpsites, industrial estates, smelting, artisanal small-scale gold mining (ASGM), product manufacturing, chemical manufacturing, and the dye industry.
These industries collectively put over 32 million people at risk and account for 7 million to 17 million Disability-Adjusted Life Years (DALYs) in low- and middle-income countries.
The number of toxic sites identified and recorded by Pure Earth, Green Cross and local collaborators has continued to increase and an extrapolation from this suggests that there are perhaps 150,000 sites in the approximately 50 countries where investigations are underway. The current estimate of the population at risk in low- and middle-income countries is about 200 million.
Large as these numbers are, they are almost certainly underestimates. As researchers and communities continue to identify and expose toxic hotspots and their surrounding populations, the numbers will likely increase.
Similarly, though it is now accepted that pollution can lead to a broad range of acute effects as well as longer-term consequences, scientists are still trying to understand the true depth and mechanisms of these connections.
In its most current figures, the World Health Organization reports that an estimated 23 percent of all deaths in 2012 (representing 12.6 million people) and 26 percent of deaths in children under age five were attributable to environmental risk factors, including pollution.
Approximately one-fifth of the global cancer incidence is associated with environmental exposures. This number is disproportionately higher in developing countries.
As this knowledge grows, it is expected that deaths and disabilities that were previously linked to other risk factors will be more accurately attributed to pollution. However, much of the needed research is still in its nascent stages.
There is only limited data on many of the complex biological and biochemical mechanisms behind the health impacts of toxic pollutants and this gap prevents researchers from truly grasping the scope of the health effects of pollution.
To expand on these efforts, The Global Commission on Pollution and Health has been convened by The Lancet medical journal, the Global Alliance on Health and Pollution and Mount Sinai Medical Center (New York). Its aim is to present critical data to key decision makers about pollution's severe and under recognized contribution to the global burden of disease and its staggering economic costs.
Significantly, until recently the lack of detailed information across a sufficient range of sites and conditions has precluded robust economic analysis of the costs of pollution.
Developing and presenting key health and economic facts can help to motivate governments that have been slow to prioritize pollution control measures. The Commission is scheduled to present its report in early 2017.
Pure Earth, formerly known as the Blacksmith Institute, is a leader in global toxic pollution cleanup. Since its inception in 1999, Pure Earth has completed 80 environmental remediation projects in 20 countries, improving the lives of millions of people, especially children, who are most at risk from the threat of toxic pollution.
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