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An extensive study carried out by environmental experts found an alarmingly high percentage of all global premature deaths are linked to pollution, specifically airborne pollution. In 2015, nine million premature deaths or roughly 16 percent of all deaths can be attributed to pollution, according to the findings published in The Lancet. That’s one-and-a-half times more than the number of people killed by smoking, three times the number killed by AIDS, tuberculosis, and malaria combined, more than six times the number killed in road accidents, and 15 times the number killed in war or other forms of violence.

“There’s been a lot of study of pollution, but it’s never received the resources or level of attention as, say, AIDS or climate change,” said epidemiologist Philip Landrigan, dean of global health at the Icahn School of Medicine at Mount Sinai, New York, and the lead author on the report.

The elephant in the room no one’s talking about

The international collaboration that included over 40 scientists from leading research instituted around the world examined data on premature mortality from Global Burden of Disease dataset, which estimates mortality from major diseases and their causes across populations. Researchers gauged the effects of air pollution (particle matter, toxic compounds), water pollution (contamination, unhygienic sanitation), and workplace pollution (toxins and carcinogens).

The investigation revealed a harrowing landscape where pollution is causing a massive death toll, especially in the developing world which is burning fossil fuels at an alarming rate.

• Air pollution was linked to 6.5 million premature deaths;
• Water pollution was linked to 1.8 million premature deaths;
• Workplace pollution was linked to 1 million premature deaths;
• Premature deaths resulting from pollution-related diseases like heart disease and cancer outnumbered AIDS, tuberculosis, and malaria combined 3 to 1;
• About 92% of all premature deaths linked to pollution occur in low and middle-income countries.
• Up to one in four deaths can be attributed to pollution in countries like China, India, Pakistan, or Bangladesh.
• In absolute numbers, China (1.8 million) and India (2.5 million) had the most pollution-related deaths for the year 2015.
• The United States, home to the world’s biggest economy, saw 155,000 premature deaths linked to pollution in 2015.

In reality, the scope of pollution may be even worse since the researchers used conservative data which likely underestimates the burden of pollution on people’s livelihoods. For instance, the study didn’t take into account the effects of endocrine disruptors, pesticides, or flame retardants, all of which are widely used and known to contribute to premature death.

Most of these premature deaths occur in developing countries and disproportionately affect the poor. Nations like India or China have grown their economies at full throttle using cheap fossil fuels as gas but in doing so they’ve sacrificed the health of their population. Yet this isn’t an indispensable trade-off. The United States or the European Union have shown that pollution can be curbed without sacrificing economic output through legislation that protects the environment and regulates water use.

The findings serve as a wakeup call to policymakers but also to the public which is often unaware of the full scope of pollution and how it affects livelihoods for generations to come.