Nine million people worldwide died prematurely from pollution in 2019. Polluted outdoor air is the biggest contributor, causing about 4.5 million premature deaths, according to a new report in The Lancet Planetary Heath. This means that air pollution is more deadly than drug and alcohol abuse, malnutrition or diseases such as AIDS, tuberculosis and malaria.

Deaths from polluted outdoor air have increased since 2015, while remaining at the same level for overall pollution. Environmental impacts counted include polluted water, toxic lead, and indoor air pollution from burning wood and other solid fuels.

“The health impacts of pollution remain enormous, and low- and middle-income countries bear the greatest burden,” said lead author Richard Fuller of the Geneva-based Global Alliance on Health and Pollution. “Despite the massive health, social and economic consequences, the international development agenda neglects the prevention of environmental pollution.”

For their study, the researchers analyzed data from the Lancet study “Global Burden of Disease” (GBD) from 2019 – one of the largest studies on health in the world population.

The scientists looked at six countries or regions of the world. In China, India and Nigeria, pollution, including particulate matter, claimed more lives in 2019 and cost about 1 percent of their total economic output. That’s more deaths and higher costs than in 2000, the analysis shows.

Barbara Hoffmann, environmental epidemiologist at Heinrich Heine University Düsseldorf, does not find the results surprising: “The economy in China, India and Nigeria has grown since 2015 – this means more energy consumption and therefore more polluted air from the burning of coal and oil or gas.”

In addition, there would be significantly more exhaust gases from industry or from the exhaust of diesel or petrol engines in road traffic. “Because countries have not implemented sufficient measures to reduce emissions, the burden of disease in their populations has also increased, resulting in more deaths,” she says.

According to the report, however, the situation is better in the USA, Ethiopia and 15 European countries, including Germany: Fewer people fell victim to a polluted environment or fine dust than in 2000.

According to Hoffmann, however, this is no reason to sit back: “In Europe, 400,000 people still die prematurely every year because of polluted air – and then we have millions more cases of illness in the form of asthma, pneumonia, heart attacks or strokes.”

This is still an enormous burden for health systems and society. “Many people, including in Germany, still mistakenly consider polluted air to be a luxury problem. The European Union must now take countermeasures and adopt stricter limits for air quality based on the guidelines of the World Health Organization.”

Hoffmann, an environmental doctor, worked on these guidelines as an expert. They include pollutants such as particulate matter, nitrogen oxides and sulfur oxides. If these stricter and scientifically reliable guide values ​​also applied in the EU and thus in Germany, they would be exceeded at almost all measuring stations, as far as fine dust with a particle size of up to 2.5 micrometers is concerned. So far, limit values ​​have been in force in the EU and Germany that are far above the scientifically reliable guideline values.

The authors of the Lancet report call for a “World Pollution Council” due to the lack of progress in the global fight against pollution. Based on the model of the Intergovernmental Panel on Climate Change, this is intended to compile scientific findings and show governments how polluted air or contaminated water can be prevented in the long term.

The authors place great hopes in the fight against polluted air in the expansion of renewable energies: “A decisive and rapid transition to wind and solar energy will reduce air pollution and at the same time slow down climate change,” says the current study.

The fact that China and India suffer particularly from polluted air also has something in common: Both countries operate the most coal-fired power plants in the world, led by China with more than 1000 plants and India in second place with almost 300 plants. The exhaust gases from the combustion of the coal massively pollute the air in the countries.

According to epidemiologist Barbara Hoffmann, for governments to be able to combat environmental pollution effectively in the future, responsibilities would also have to change. Environment ministries are often responsible for polluted air, which are often less well equipped and less powerful than health, transport or economic ministries.

“We can improve our health if we change our behavior and eat better or exercise more,” she says. “But in order to combat air pollution and its associated diseases, conditions and living conditions must change, above all through better environmental laws.”