Pollution linked to 9 million deaths worldwide in 2015.

The overwhelming majority of pollution-related casualties -- 92% -- occur among people living in low- and middle-income countries. And, one in every four early deaths in nations trying to industrialize rapidly -- such as India, Pakistan, China, Bangladesh, Madagascar and Kenya -- could be connected to filthy air, water, soil or other contamination.
"Pollution disproportionately impacts the poor and the vulnerable," said Dr. Olusoji Adeyi, a commissioner and director of the health, nutrition and population global practice at the World Bank Group.
In countries at every income level, disease caused by pollution is most prevalent among minorities and the marginalized.
"Children face the highest risks," said Adeyi. "It is important to translate awareness into action at the local, national, and global levels."
Dr. Philip J. Landrigan, co-leader of the commission, said the problem is chemicals.
"There are thousands of chemicals out there and we know that people are exposed to them," said Landrigan. "We just didn't know enough about what chemicals are doing to people."
Unlikely case study
In the months leading up to the 2008 Olympics in Beijing, China's air quality became a matter of international concern. Smog obscured the blue sky and distant buildings even on days the nation's Ministry of Environmental Protection reported excellent air quality.
Quietly, the United States Embassy in Beijing acquired a stationary monitor to track particulates and later, three additional hand-held air monitors. Embassy officials "worked closely with the US EPA "to set up the rooftop air monitoring equipment, explained Noel Clay, a spokesperson for the State Department.
To "put it gently," said Landrigan, people saw the US Embassy data as "unbiased" compared to the air quality data being released by Chinese officials. Embassy officials wanted the more reliable data to "make better daily decisions regarding the safety of outdoor activities," said Clay.
Can China fix its mammoth water crisis before it's too late?
Can China fix its mammoth water crisis before it's too late?
Soon, though, the data gained a wider audience than intended.
"There's a lot of kids in China who are very internet savvy," said Landrigan. These kids figured out how to access the data, which was published online by the US Embassy, and once that hurdle was cleared, the Chinese citizens themselves "started buying monitors and doing their own testing and sharing their results over the internet."
Accelerated by the US Embassy in Beijing, air quality data went viral across China.
"It became a very powerful bottom-up influence that I think factored into the Chinese government's decision to do something -- they're actually taking major strides in China to control air pollution now," said Landrigan.
Now he's seeing the same thing happen again in other regions of the globe. With the cost of a reliable air monitor priced around $100, said Landrigan, "more and more people around the world are starting on their own -- citizen scientists if you will -- to collect air pollution data."

Traditional versus modern
The data for this new report comes from "two very credible sources," noted Landrigan: The World Health Organization and The Institute for Health Metrics and Evaluation, which is based at Seattle's University of Washington and is funded by the Gates Foundation. Data is collected by satellites and other monitoring technologies, which, due to increasing sophistication, provide more information today than in the past.
"For the first time, we pulled out and collected in one place all of the information on deaths caused by all forms of pollution combined -- in other words, air pollution, water pollution, chemical pollution, soil pollution, occupational pollution in the workplace -- and put it all together," said Landrigan who is also a professor of preventive medicine and pediatrics at Icahn School of Medicine at Mount Sinai.
The very poorest countries have many fewer deaths from pollution than the people on the next rung up -- the lower-middle income countries, noted Landrigan. "This is not traditional pollution that is killing people in these rapidly industrializing lower middle-income countries, it's urban industrial air pollution -- chemical pollution," he said.
Traditional pollution arises at the household level and is associated with profound poverty, said Landrigan. Household air pollution resulting from poorly ventilated indoor cook stoves and fecal contamination of drinking water are the major forms of traditional pollution.
Modern forms of pollution are outdoor air pollution, chemical pollution, soil pollution and occupational pollution, all associated with modern industry, modern cities, modern lifestyle.
"All of those are going up," said Landrigan, adding that the number of deaths associated with modern pollutions have increased year to year.
Regulation and economics
The other thing that's new about this report is that economists on the commission's team developed a separate analysis to calculate the costs that result from diseases caused by pollution, added Landrigan.
"Just look at the experience within our country," said Landrigan pointing out a graph in the report that shows how pollution decreased by 70% from 1970 to 2015 following passage of the Clean Air Act in 1970. "In that same 45-year period, the GDP has increased by 250%," said Landrigan, who noted this does not support arguments suggesting pollution regulation stifles the economy.
Nicholas Burger, senior economist and director of the Center for Research and Policy in International Development at the RAND Corporation, said the numbers look right but this type of economic analysis is "incredibly difficult." Burger was not involved in the Commission or its report.
"Simply saying we've observed this level of growth and we've observed this level of pollution reduction is not enough to make a strong statement that absent the pollution reduction we would have seen the same level of growth --- or lower growth or higher growth," said Burger.
It is necessary to understand what would have happened absent those regulations, noted Burger. And that's not easy to answer on the macro level.
A spate of deadly disasters for the elderly
A spate of deadly disasters for the elderly
"There's pretty strong evidence that pollution control policy -- pollution regulation -- does not adversely affect growth by as much as people often argue that it does or that we might tend to think that it does," said Burger. He added there are even some instances where researchers believe pollution policy has not harmed economic growth or perhaps even "enhanced growth."
"You put a scrubber on a power plant to remove the harmful pollutants coming out of the stack of that power plant that is going to make that power plant less efficient -- that's basic physics," he noted. But the question is how much less efficient? Industry often comes up with ways to exceed the efficiency requirements of regulators.
One theme that comes out of the regulation research is to never underestimate the efficiency and innovation abilities of Western industries, said Burger.

Even when regulations slow growth of one industry, then, other businesses providing goods and services to accommodate the new regulations may grow. Consider, though, that health care costs are also part of the GDP.
It's extremely complicated trying to calculate "how the economy would reorient itself and reoptimize itself" with or without pollution regulations, said Burger.
Still, Commission Co-leader Richard Fuller of Pure Earth, USA, an international non-profit, maintains that countries can have "consistent economic growth with low pollution" and he bases this opinion on the experiences of Western nations.