Worldwide air pollution caused 5.5 million deaths in 2013 from lung cancer stroke, bronchitis and other diseases -- more than malaria or AIDS; And the cost of pollution-related illness and deaths is $255 billion in lost labor last year, the World Bank said in a new report on Sept 8.
One tenth of all deaths in 2013 came from air pollution, said the World Bank.
But the real cost is even higher - more than $5 trillion in 2013 a year - when the Bank economists included what they call "welfare costs" - the money people would be willing to pay to prevent an early death.
One in ten deaths around world is from air pollution, said the Bank's report authors.
And even if London, New York and other wealthy cities have greatly cut pollution in recent decades, the toxic fumes have greatly increased in China, India and other growing economies.
Regarding outdoor pollution, some 87 percent of world population lives in areas above World Health Organization guidelines, said the Bank report.
About half the deaths are from outdoor air pollution, often from cars, industry and clearing forestland. The other half comes from indoor pollution, mainly from billions of people cooking with wood, dung and other smoke-producing biomass, said Urvashai Narain, senior environmental economist at the World Bank and one of the report authors, in an interview.
U.S. and other aid agencies have pushed for many years for people to shift from biomass to gas and electricity; or to adopt efficient cook stoves with metal or clay vents to expel smoke.
For example, U.S. foreign aid delivered to rebuild homes in Pakistan after a 2005 earthquake included a sheet metal cooking stove plus a few feet of exhaust pipe per family.
However, all the improvements from such new technology has been swallowed up, said the World Bank official, by the continued increase in population in developing countries. The planet is set to surge from seven billion today to 10 or even 15 billion in coming decades - depending on whether donor nations are willing to invest in family planning or not. In the United States and in Catholic countries such as the Philippines, providing birth control is a controversial political move.
Pollution causes respiratory disease, especially among children who stay close to their mothers in those smoky kitchens, as well as chronic bronchitis and lung cancer said the report authors said.
"We need to get the private sector to provide technology," said Ms. Narain. "Previous cheap fixes did not penetrate the market, or the technology breaks down and there is no support to maintain it."
The Bank works with a number of governments to develop policies and has made $6.5 billion in loans to cut all forms of pollution between 2009-2016. But the report does not say how to reduce air pollution and save those millions of lives lost each year.
"The report just shows the cost of pollution. It is a call to action," she said.
"We hope the report will lead to more resources to fight pollution."
However, the report confines itself to air pollution and ignores the huge number of toxic waste sources poisoning the soil and water.
In addition, the Bank report should have made a plan of action that could begin to reduce pollution, said Richard Fuller, head of the non-governmental organization Pure Earth, which cleans up toxic waste sites in developing countries.
"What is needed is a plan that varies from city to city to fix this nonsense," said Fuller in an interview.
"For example, city X needs those three power plants converted. City Y needs to shut down burning biomass in winter. Another city needs to convert to stringent European diesel standards.
"We have got to move way from hand-wringing and move to specific actions," Fuller said. "It is not rocket science. It is easy. We won't need to reinvent anything."