In 2015, 9 million people died prematurely as a result of pollution. That’s 16% of all human deaths worldwide for the year — three times more than deaths from AIDS, tuberculosis and malaria combined, and 15 times more than from all wars and other violence.

The data come from a new report released Thursday by U.K. journal The Lancet and its commission on pollution and health.

To no one’s surprise, the poor and the vulnerable suffer the most. According to the report, nearly 92% of deaths in low- and middle-income countries, and in countries of every income level, pollution-caused disease is most common among minorities and marginalized peoples. Children have the highest risk of pollution-related disease, again, no particular surprise.

The Lancet’s report notes that the situation is not improving:

In many parts of the world, pollution is getting worse. Household air and water pollution, the forms of pollution associated with profound poverty and traditional lifestyles, are slowly declining. However, ambient air pollution, chemical pollution, and soil pollution—the forms of pollution produced by industry, mining, electricity generation, mechanised agriculture, and petroleum-powered vehicles—are all on the rise, with the most marked increases in rapidly developing and industrialising low-income and middle-income countries.

Diseases caused by pollution also reduce gross domestic product GDP in low- and middle-income countries by 2% annually and are responsible for from 1.7% of health care spending in high-income countries. Pollution-caused welfare losses worldwide total $4.6 trillion a year, 6.2% of global economic output.

The better news is that pollution can be cost-effectively eliminated. High-income countries have invested in cleaner air and water, lower blood lead levels in children and hazardous waste remediation while increasing their total GDP by 250%. In the United States, an estimated investment of $65 billion since 1970 to reduce air pollution has resulted in an aggregate estimated benefit of $1.5 trillion, according to The Lancet’s report.

The commission makes six key recommendations “to raise global awareness of pollution, end neglect of pollution-related disease, and mobilise the resources and the political will needed to effectively confront pollution”:

• Make pollution prevention a high priority nationally and internationally and integrate it into country and city planning processes.
• Mobilise, increase, and focus the funding and the international technical support dedicated to pollution control.
• Establish systems to monitor pollution and its effects on health.
• Build multi-sectoral partnerships for pollution control.
• Integrate pollution mitigation into planning processes for non-communicable diseases.
• Research pollution and pollution control.

The full report is available (with free registration) at The Lancet website.

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