Global Pollution: A Silent Killer

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By Susan Blumenthal, M.D. and Rachel Gardner, B.A.

Pollution is now the leading killer of people worldwide, linked to an estimated 9 million premature deaths in 2015. This means that 16% of all deaths globally are associated with this environmental cause of mortality. In 2015, pollution in the soil, air, and water killed three times more people than died of AIDS, tuberculosis, and malaria combined and 15 times more individuals than lost their lives as a result of war and other forms of violence (See chart below).

The Lancet, with data from the Global Health Data Exchange

Pollution affects the health of people in all nations, but 92% of deaths linked to this environmental killer occur in middle and low-income countries. In America and around the world, diseases associated with pollution disproportionately affect the poor and the marginalized. Additionally, children are especially vulnerable to pollution-related diseases, even at low-dose exposures, and especially when exposed as a fetus or infant. Pollution has been linked to cognitive delays, developmental disorders, and premature births. All of these conditions can affect subsequent health across the life cycle, contributing to shorter life spans, and in some cases, abruptly ending lives.

Diseases linked to pollution also have an enormous economic impact, accounting for an estimated 1.7% of annual health care costs in high-income countries and as much as 7% of health care costs annually in middle-income countries. These illnesses also result in productivity losses that reduce gross domestic product (GDP) in middle and low-income nations by up to 2% annually. Overall, pollution-related deaths and illnesses account for $4.6 trillion in annual losses, representing 6.2% of global economic output.

Currently, industry-wide pollution is occurring at a scale never seen before in history. As a result, many of the chemical pollutants now found in the atmosphere have not been fully tested for safety or evaluated for their effects on the health of people globally. Scientists do know, however, that fossil fuel combustion and biomass burning in cook stoves, open fires, brick kilns, and forest burnings account for 85% of airborne particulate pollution globally. These particulates are some of the major contributors to climate change and many are linked with human illnesses, including heart attacks, aggravated asthma, allergies, decreased lung function, irregular heartbeats, and difficulty breathing. In fact, according to a Global Burden of Disease Study published in Lancet, exposure to ambient fine particulate matter was ranked as the seventh most significant risk factor for global mortality.

Pollution is a major concern in the United States as well. A recent study published in the New England Journal of Medicine has linked long-term exposure of particulates in the United States’ atmosphere to an increased risk of death, even at levels below the National Ambient Air Quality Standard (NAAQS). This past year’s “State of the Air” report issued by the American Lung Association, found that 40% of the U.S. population resides in counties with unhealthy levels of either ozone or particle pollution making the air dangerous to breathe. A recent report published in the Journal of the American Medical Association estimates that pollution contributes to more than 20,000 deaths a year in America. The researchers discovered that death rates increased almost linearly as air pollution rose. Any level of air pollution, no matter how low, was found to be harmful to human health. The study found that several subgroups were especially affected by pollution in their communities. For Medicaid recipients, the increase in death rates was three times higher than it was for those people who were not eligible for this program serving low income Americans. Among Medicaid recipients, women and non-whites had a 25% higher risk of death, compared to males and whites. Seniors are also very vulnerable to the health damaging effects of pollution. However, it should be noted that these statistics represent a significant improvement from an earlier “State of the Air” report; one-quarter fewer people now live in areas where the air quality was deemed unhealthy compared to those regions studied from 2012-2014. The greatest improvements came from continued progress in reducing pollution from power plants and transportation sources in the U.S., which contributes to high ozone days and year-round particle pollution. This year’s “State of the Air” report provides evidence for the continuing success of regulatory actions passed to protect the health of Americans and the environment as a result of the Clean Air Act of 1970.

However, the report also identified areas of growing concern, particularly a continued increase in dangerous spikes of particle pollution in the United States. In fact, many cities experienced their highest number of spikes since monitoring for particle pollutants began, with 43 million people living in counties with unhealthy levels of pollution. Increased heat, changes in climate patterns, drought and wildfires—all related to climate change—contributed to the extraordinarily high number of days with unhealthy particulate matter in the atmosphere. As climate change continues, cleaning up these pollutants will become even more challenging, but all the more important, not only from a health perspective, but also from a social justice standpoint globally.

For example, pollution linked to biomass fuels is associated with gender inequality in developing nations. In Sub-Saharan Africa, poor women and children living in rural areas, cook and study by the light of toxic smoky open fires. Internationally, indigent women and children living in urban areas are disproportionately harmed by pollutants from cook stoves where their fumes circulate in cramped indoor living spaces. Water pollution also exacerbates the gender gap in developing countries. Globally, an estimated 844 million people lack access to safe water and 2.3 billion people don’t have access to adequate sanitation. This problem disproportionately affects women and girls because it is often the role of females to fetch household water in many developing countries. Girls and women must walk long distances to access safe water, taking away time from their day that could be spent pursuing an education or a job.

From Evidence to Action

A recent Lancet report underscores that pollution endangers planetary health, destroys ecosystems, and is closely linked to global climate change. The article provides importance evidence that reducing pollution and moving towards cleaner energy sources is critical for improving human health, achieving gender equality, and protecting the environment.

Over the past several decades, national and international efforts to reduce pollution have yielded significant returns for safeguarding human health. China, for example, has made strides in minimizing pollution and improving environmental conditions. In 1987, China adopted The Air Pollution Prevention and Control Law, which acknowledged the dangers of air pollution and set specific targets for environmental improvements. According to the report, this change in policy resulted in a 10% decline in atmospheric particulate matter across the country between 2014 and 2016. China also implemented a National Improved Stove Program, which distributed 180 million cooking stoves with chimneys and some with blowers for more efficient combustion. An epidemiological study demonstrated a more than 30% reduction in the incidence of lung cancer in China ten years after new cooking stoves were installed across the country. Nonetheless, much more work needs to be done. The United States has undertaken many actions to reduce pollution. For example, the EPA began phasing out lead from gasoline in the 1970s and then fully prohibited it after 1995. Consequently, average lead levels in the air decreased by 94% between 1980 and 1999, with average human blood lead levels falling significantly as well. However, problems with lead poisoning have far from disappeared. The recent public health crisis of lead in the water found in Flint, Michigan issued a wakeup call to other cities underscoring the importance of remaining vigilant about cleaning up environment pollution to protect human health.

Countries have also worked together to better manage pollution in the environment. One such international effort includes the Global Alliance for Clean Cookstoves. Launched in 2010, the United Nations Foundation leads this group with over 1,000 public and private sector partners. This initiative fosters a global clean cook stove industry by encouraging investment and lowering barriers that impede the production, distribution, and use of cook stoves. The Alliance calls for 100 million households to have clean and efficient stoves and fuels by 2020. Achievement of this goal would help to empower women, combat climate change, improve health, and save lives.

National and international efforts to reduce pollution have yielded important economic returns as well. For example, the United States has gained an estimated $30 in economic benefit for every dollar invested in air pollution control since 1970. Additionally, the U.S. government’s efforts to remove lead from gasoline is linked to an increase in the American population’s IQ, as severe lead poisoning has been associated with mental retardation and behavioral disturbances in children. This increase in productivity has returned an estimated $200 billion per year to the U.S. domestic economy since 1980.

Additionally, national and international efforts to address air pollution have significantly improved knowledge about the chemistry and physics of atmospheric composition. The development of new measurement instruments including novel analysis methods and models has led to “revolutionary progress” in the characterization of air pollution. However, despite these advancements, measurement techniques used for routine monitoring are still imperfect. Increased investments are needed in environmental science and technology to better characterize pollution so that its health and economic effects can be more effectively addressed.

Countries must also focus on issues of environmental social justice. For example, many bus depots in New York City, where these vehicles idle their engines for hours, are located in minority, mostly disadvantaged neighborhoods. Additionally, high income countries often export pollution to middle and low-income countries. For example, developed countries have been known to ship pesticides, industrial wastes, and toxic chemicals that are not permitted in North America or the European Union into developing countries’ territories. In response, concentrations of air pollutants have generally decreased in North America and Europe and increased in developing countries. The Basel Convention, an international treaty established in 1989, sets limits on the international trade of toxic wastes, often from wealthier to poorer countries. To date, the U.S. is the only developed country that has not ratified it.

Additionally, high and middle-income countries must invest in 21st century renewable energy sources including hydropower, geothermal, wind, and solar. Coal and natural gas plants emit air and water pollution that has been linked to neurological damage, heart attacks, cancer, respiratory conditions such as asthma, and other diseases in people. Renewable energy sources produce substantially less pollution than fossil fuels. Research has found that replacing fossil fuels with renewable energy sources reduces premature mortality, lost workdays, and health care costs. While geothermal and biomass sources still generate some air pollution (though considerably less than those of fossil fuels), solar, wind, and hydroelectric sources do not produce any air pollutants. Renewable energies provide unlimited energy supplies, create new job opportunities, and are linked to significant health benefits as well. Thus, it makes sense that switching to the use of these sources of energy should be accelerated in the United States and worldwide.

Governments, foundations, international development organizations, businesses, health professionals, communities, and citizens must provide leadership to elevate pollution prevention and mitigation to the forefront of national and global policy agendas. To reduce the damaging effects of pollution on people’s health and on economies, governments must incorporate environmental protection strategies into their development plans. Successful plans will establish targets and timetables for pollution control, track environmental quality and public health outcomes, establish chemical management programs, create transparent systems that hold stakeholders accountable, enforce environmental laws and regulations, and engage with organizations in both the public and private sectors to implement pollution action plans. To reduce pollution and its harmful health and economic effects, it is critical that developed and developing nations work together to share information and implement best practices. Increased resources are also needed to fight pollution worldwide. Agencies like the EPA in the United States must be empowered to enforce regulations to protect the air, water, and land. In recent months, Federal actions that impede the EPA’s regulatory authorities, rollback pollution standards, relax enforcement against illegal pollution, and decrease funding for the agency’s work are endangering the health of Americans and jeopardizing environmental resources in the United States. The public and civil society organizations must raise their voices about the health damaging effects of pollution as this can serve as a powerful catalyst for governments to take action.

Failure to act swiftly and decisively to counter the effects of global pollution, a silent killer, will further imperil the health, economies, and future of people in America and around the world.

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is a Senior Fellow in Health Policy at New America and a Clinical Professor at Tufts and Georgetown University Schools of Medicine. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women’s Health, and as Senior Global Health Advisor in the U.S. Department of Health and Human Services. She also served as a White House Advisor on health. Prior to these positions, Dr. Blumenthal served as Chief of the Behavioral Medicine and Basic Prevention Research Branch and Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health (NIH). She has chaired numerous national and global commissions and conferences and is the author of many scientific publications. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal was named the Health Leader of the Year by the Commissioned Officers Association and as a Rock Star of Science by the Geoffrey Been Foundation. She is a recipient of the Rosalind Franklin Centennial Life in Discovery Award.

Rachel Gardner served as a Health Policy Fellow at New America in Washington D.C. She graduated from Cornell University in 2017 with a degree in government and plans to attend medical school this fall.

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