Pollution was responsible for nine million deaths in 2019 – equivalent to one in six deaths worldwide – and India leads with nearly 2.4 million deaths, according to a study published on Wednesday in The Lancet Planetary Health.

Of the nearly 2.4 million deaths in 2019, air pollution accounted for 16.7 lakh deaths – the highest by any country. Further, more than 5 lakh lives were lost in the country due to water pollution, followed by occupational pollution (more than one lakh) and lead exposure (over 2 lakh).

Globally, of the nine million pollution – attributable deaths in 2019, air pollution (both household and ambient) remains responsible for the greatest number of deaths at 6.67 million worldwide.

Water pollution was responsible for 1.36 million premature deaths. Lead contributed 9,00,000 premature deaths, followed by toxic occupational hazards at 870,000 deaths.

The report states that although the number of deaths from pollution sources associated with extreme poverty (such as indoor air pollution and water pollution) have decreased, these reductions are offset by increased deaths attributable to industrial pollution (such as ambient air pollution and chemical pollution).

“The health impacts of pollution remain enormous, and low- and middle-income countries bear the brunt of this burden. Despite its enormous health, social and economic impacts, pollution prevention is largely overlooked in the international development agenda,” said Richard Fuller, from Global Alliance on Health and Pollution, Geneva, Switzerland.

“Preventing pollution can also slow climate change – achieving a double benefit for planetary health – and our report calls for a massive, rapid transition away from all fossil fuels to clean, renewable energy,” added co-author Professor Philip Landrigan, Director, Global Public Health Programme and Global Pollution Observatory at Boston College.

The decline in deaths from traditional pollution since 2000 (household air pollution from solid fuels and unsafe water) is most evident in Africa. This can be explained by improvements in water supply and sanitation, antibiotics and treatments, and cleaner fuels.

However, this mortality decrease has been offset by a substantial increase in deaths from exposure to industrial pollution – such as ambient air pollution, lead pollution, and other forms of chemical pollution – across all regions over the past 20 years.

This is particularly evident in Southeast Asia, where rising levels of industrial pollution are combined with ageing populations and increasing numbers of people exposed.

Ambient air pollution was responsible for 4.5 million deaths in 2019, up from 4.2 million deaths in 2015 and 2.9 million in 2000. Deaths from hazardous chemical pollutants increased from 0.9 million in 2000, to 1.7 million in 2015, to 1.8 million in 2019, with 900,000 deaths attributable to lead pollution in 2019.

Overall, deaths from modern pollution have increased by 66 per cent in the past two decades, from an estimated 3.8 million deaths in 2000 to 6.3 million deaths in 2019. Figures on deaths from chemical pollutants are likely to be underestimated as only a small number of manufactured chemicals in commerce have been adequately tested for safety or toxicity, the report noted.

Excess deaths due to pollution have also led to economic losses totaling $4.6 trillion in 2019, equating to 6.2 per cent of global economic output.

The study also notes pollution’s deep inequity, with 92 per cent of pollution-related deaths, and the greatest burden of pollution’s economic losses, occurring in low-income and middle-income countries.

The study also provided recommendations such as the need for an independent, Intergovernmental Panel on Climate Change (IPPC)-style science/policy panel on pollution, alongside increased funding, and improved pollution monitoring and data collection.