Exposure to environmental pollution remains a major source of hazard not only for our health but also for our planet. In 2012, WHO estimated that exposures to polluted soil, water, and air contributed to an estimated 8·9 million deaths worldwide. Of these deaths, 94% (8·4 million) were in low-and-middle-income countries. Different pollutants are linked in children to non-communicable diseases (such as asthma), cognitive disorders, and perinatal defects, and, among adults, to heart disease, stroke, and cancer. However, although environmental pollution is reaching disturbing proportions worldwide, it remains a neglected problem in national policies and on international development agendas.
What drives pollution? What strategies can be taken to prevent and control pollution?
Since the industrial revolution, urbanisation and industrialisation, together with economic development, have led to increases in energy consumption and waste production. Exposures to air pollution, toxic chemicals, and pesticides are the main forms of pollution today causing disease in high-income countries. In low-and-middle-income countries, household air pollution and contaminated drinking water are long-established forms of environmental contamination. WHO estimated that ambient air pollution caused 3·7 million deaths, and that unsafe water, poor sanitation, and inadequate hygiene caused 842 000 deaths. Hazardous waste sites and contamination of soil and abandoned mines have killed hundreds of thousands people each year.
However, during the past decade, with the spread of Western lifestyles, and the increasing globalisation of the chemical manufacturing industry, toxic chemicals, highly hazardous pesticides, and chemical wastes that previously were found only in high-income settings have been rapidly penetrating in low-and-middle-income countries too. Exposure of millions of people to asbestos in China, south and southeast Asia, and sub-Saharan Africa, lead intoxication from lead-acid battery recycling, and exposure to mercury from gold extraction are only a few dramatic examples of the growing exposure to toxic chemicals. The recent European scandal in which eggs were contaminated with fipronil (an insecticide commonly used to kill lice in animals) and the discharge of plastic into the sea are further examples of how exposure to toxic substances can pose serious risks to our health for the sake of economic development. Additionally, diseases caused by pollution impose great economic costs on nations around the world. It has been estimated that the cost of pollution in the US alone in 2008 was an astonishing US$76·6 billion.
Yet pollution is preventable. But when compared with the attention given, for example, to AIDS, malaria, and tuberculosis, environmental pollution receives far less attention at the national and international levels, making it hard to put policy interventions and prevention strategies into practice. One reason for the relative lack of action may be the difficulty in establishing causal associations between pollution and illness, together with the fact that various components of pollution—such as air pollution, water pollution, asbestos, and lead—have been considered separate and mutually exclusive problems. This fragmentation in the analysis of pollution as a threat to health means that only fractured interventions are possible, reducing enormously the total impact. A more holistic approach to cost-effective control strategies to address environmental pollution is needed. Successful examples of control strategies in high-income countries have been those that reduce exposure at source, such as removal of lead from gasoline, national bans of asbestos, and policies to reduce water and air pollution. Such strategies have proved to be incredibly cost-effective. Removal of lead from gasoline has returned approximately $200 billion to the US economy each year since 1980. Policies aiming to prevent rather than assess the absolute proof of toxicity of certain types of toxic chemicals should also be implemented if such a holistic approach is to be taken.
In October, 2017, The Lancet, together with the Global Alliance on Health and Pollution and the Icahn School of Medicine at Mount Sinai in New York, will publish a Commission on Pollution, Health, and Development. The Commission will aim to catalyse attention to this escalating planetary danger, increase resources allocated for it, and initiate coordination of policy action at the global level. Environmental pollution should be tackled from multiple perspectives, including social, economic, legislative, and environmental approaches. Initiatives to change our lifestyles to protect health and preserve our planet from the assault of this preventable disease also need to be encouraged. It is time to take action to control the endemic pollution of our world.