A sense of urgency for action against pollution is building. Air pollution and climate agendas both acknowledge the immediate threat to human health and longer-term changes to the planet’s habitability. Uncontrolled industrial pollution in some lower middle-income countries is visible worldwide, and citizens in numerous cities, each experiencing versions of “airpocalypses”, fear for their children’s health and are demanding change. Corporate leaders are responding to demands from board members and consumers for clean supply chains and the development of toxic chemical “footprint” metrics. Pollution is a threat to biodiversity, and air pollution contributes to noncommunicable diseases (NCDs). Such growing public and political attention provides an opportunity for collaborative action to improve health and grow economies.
Let’s be clear: Findings from The Lancet Commission on pollution and health that I chaired concluded that pollution is a major, overlooked global health threat. All forms of pollution were responsible for an estimated 9 million premature deaths — 16% of all deaths worldwide — as well as for 268 million disability adjusted life-years (DALYs) in 2015. Pollution is thus the world’s largest environmental cause of disease and premature death (Landrigan et al. 2017). The majority — 71% — of the deaths attributed to pollution are caused by NCDs. The Lancet Commission also noted that many countries, especially high-income and some upper middle-income countries, have developed robust, cost-effective and politically viable pollution-control strategies based on law, policy, science and technology (U.S. EPA 2011; Samet et al., 2017; Suk et al. 2018). These strategies may very well be ready to be taken off-the-shelf, brought to global scale, and applied in cities and countries at every level of income (Landrigan et al. 2017).
Still, the international development and global health agendas as well as the planning strategies of many countries neglect combatting pollution. The foreign aid budgets of bilateral development agencies direct only meager resources to controlling pollution from industrial, automotive and chemical sources and to preventing diseases caused by these forms of pollution. (Greenberg et al. 2016; Nugent 2016). It’s time to begin including modern pollution investments in Development Assistance Committee (DAC) metrics. Only then will we understand the size of the opportunity to save lives.
Some efforts are already underway to convene for solutions. Founding members and observers, the World Bank, the European Commission, UN Environment, the ministries of environment or health of more than 25 low- and middle-income countries, and other agencies responded to Pure Earth’s call in 2012 to form the Global Alliance on Health and Pollution (GAHP) to address pollution and health at scale. By 2018, GAHP grew to 80 members and dozens of observers that advocate on behalf of its low- and middle-income country members for resources and solutions to pollution problems. GAHP assists its members prioritise and address pollution through Health and Pollution Action Planning (HPAP) and other development planning processes, in coordination with national and international stakeholders. The group also identified key areas for investment, both where official development assistance (ODA) is lacking and where reducing the impact of pollution can benefit as many people as possible. These areas include:
Reducing crop burning: Open burning of crop residues decreases soil productivity by destroying the humus and soil consistency. It also releases large quantities of particulate matter into the air, harming local communities and, sometimes, large cities, like Delhi, India). The soot (black carbon) can travel large distances. Burning in the Ukraine, for example, has a substantial impact on air quality throughout Europe during March and April. Black carbon from open burning also contributes to climate change.
Reducing industrial wastewater in agriculture: With water tables dropping, and pressure from climate change affecting agriculture, many farming regions are using untreated industrial wastewater to water their crops. Heavy metals and chemicals impair crop yields, but more concerning, grains and food crops absorb the toxins. Once shipped to markets, they enter the global food chain and are a growing source of toxic exposure for people worldwide. For example, arsenic has been found in baby food, lead in spices and grains, and pesticides in fruit and vegetables at significant levels in European and US supermarkets.
Preventing lead poisoning: While lead is no longer used as a gasoline additive, significant lead exposures occur from a variety of other sources — pottery, battery recycling, paint and cosmetics being amongst the largest. Lead is currently responsible for an estimated 1 million premature deaths, but the real number is likely several times larger as the cardiovascular risks are underestimated and baseline assessments are lacking. These are additional risks to the well-known impact lead has on IQ and developmental disorders in children.
Cleaning up toxic hotspots: Toxic sites, including contaminated agricultural land, need to be identified to limit their risks to local populations and the global food chain. Identifying and categorising the worst toxic hotspots is the first step. A programme to work collaboratively with governments in this regard has had success and could be further expanded, providing evidence-based data on chemicals and pollution in the soil.
Moving to bottled gas: Nearly 3 million people die each year worldwide from pollution caused by cooking with solid fuels. Most of these deaths occur in rural kitchens in Africa, South and Southeast Asia, and the Western Pacific. While efforts to promote cleaner cookstoves have helped, experience in China, Indonesia and India suggests that cleaner fuels — especially liquefied petroleum gas (LPG) — is a more scalable solution.
Planning for health and pollution action: Workshops are assisting countries review their key pollution problems and prioritise interventions. They bring together all sectors – environment, health, transport, industry, agriculture – and thus create a platform for integrated action to reduce pollution.
Expanding research and monitoring: Significant gaps exist in pollution knowledge. Areas in need of attention include understanding the burden of disease from newer health issues (such as the link between Alzheimer’s and air pollution).The disease impact of chemicals other than lead need to be calculated. And country-based analyses are needed on the economic impact of interventions and the cost of inaction.
Since these areas are where we can make the most difference in health, let’s make them priorities in addressing the global pollution crisis.