The Leading Cause of Death in Developing Countries Might Surprise You

A landfill fire in Fada-Ngourma, Gourma Province, Burkina Faso. Photo by Flickr user lepetitNicolas. CC-BY-NC-SA 2.0

A landfill fire in Fada-Ngourma, Gourma Province, Burkina Faso. Photo by Flickr user lepetitNicolas. CC-BY-NC-SA 2.0

This post by Richard Fuller was originally published on, a magazine that highlights international environmental solutions in action, and is republished here according to a content-sharing agreement.

What’s the leading cause of death in low- and middle-income countries?

A.  malnutrition and undernutrition

B.  tuberculosis, malaria and HIV/AIDS

C.  pollution

If you guessed “C,” you got it. Exposures to polluted soil, water and air (both household and ambient) killed 8.4 million people in these countries in 2012.

Another statistic worth pondering: that 8.4 million is out of about 9 million people killed by pollution worldwide in 2012. In other words, this is not a “rich country” problem. This is a problem contained to the developing world.

To put this in perspective, World Health Organization statistics show that 56 million people died in 2012 — that’s every person who passed away on the planet, whether from car accidents, suicides, old age, cancer, hospital errors, lightning strike, infectious diseases, parachute failures, war or any number of other reasons. So, pollution killed nearly one in seven of them.

Contaminated outdoor air accounted for 3.7 million deaths. Another 4.2 million people died from particulates exposure in indoor air from cooking stoves. About 1 million died from chemicals and contaminated soil and water. And 840,000 succumbed to poor sanitation. All of these data come directly from the WHO’s website and databases, except for the soil statistics, which are sourced from more recent numbers (likely understated) from the Global Alliance for Health and Pollution.

In the same year, 2012, 625,000 people died from malaria, 1.5 million from HIV/AIDS and 930,000 from tuberculosis. That’s one-third the number of people that pollution kills, and yet this troika of terrible diseases attracts over $20 billion per year from international charities and governments.

Slow and indirect

It’s important to note that pollution rarely kills people directly or quickly. Instead, it causes heart disease, chest infections, cancers, respiratory diseases or diarrhea. Pollution acts as a catalyst, increasing the rates of these diseases above normal. For this reason, the WHO considers pollution a risk factor — a threat to human health similar to obesity, smoking, malnutrition or poor exercise. But pollution is the king of all risk factors. Worldwide, its fatality numbers dwarf those caused by any other risk factor in any other context.

It’s hard to imagine just how bad it can be. Try, though, to imagine this scenario:

You wake up each day on the dirt floor of a shack you and your family lashed together with cast-off materials from a nearby construction site for a five-star hotel. Your husband works 70 hours a week sorting chemicals in a badly run pesticides factory. Lately, he’s come home coughing up blood. He looks thinner and more exhausted each week, and you want to tell him to stop, but how can you? The pennies he earns are the only things feeding your kids.

So you head to the local pond with your plastic bucket. The water you scoop from the pond is brown and stinks of human waste, but there’s nothing else to drink. You try straining it through cheesecloth, but it doesn’t do much good. Meanwhile, the factory next door to your slum, the one the government recently shut down, has started operating again — but only at night. Its chimneys pump out serpents of thick smoke, and there’s no way of knowing what’s burning. Last week, your eldest child started coughing through the night. The rest of your children are sickly and slow to learn even the most basic concepts. None of your friends or family can help you since, curiously, almost everyone in your neighborhood has the same problems.

Our economy is global and so are the pollutants it generates.

You are one of the poisoned poor, without voice and without hope. Regulations that might exist to combat the conditions are never enforced. You cannot simply pick up and move to another town — it took you years to establish yourself to this extent. And anyway, where exactly would you go? Every village shares this plight. Like the rest of the world’s underprivileged, you have become cannon fodder in the ongoing war of growth.

How can we fix this problem?

Our economy is global and so are the pollutants it generates. Contaminated air from China can now be measured in other countries. Mercury from gold mining and coal plants can be found in fish, and arsenic has been found in rice.

Many highly polluting industries have moved from developed countries to poor countries with less environmental regulation and technology to manage and remediate chemicals. Clean technologies and green growth are possible for emerging economies and can prevent decades of future contamination that will harm us all. Western nations have had success in cleaning up pollution and can now transfer technology and funding to low- and middle-income countries.

Of critical importance is making sure pollution is included in the United Nations’ Sustainable Development Goals, which look at how to achieve future development sustainably after the current Millennium Development Goals expire this year.

Prioritizing the prevention and cleanup of pollution will not only save lives, but also mitigate climate change and reduce threats to biodiversity. Glancing through the program priorities of major international organizations, the low priority of pollution is startling, given its impact. The likely reason for this is a lack of awareness, as well as not knowing where to begin to address this complex set of problems.

Of critical importance is making sure pollution is included in the United Nations’ Sustainable Development Goals, which look at how to achieve future development sustainably after the current Millennium Development Goals expire this year and include topics such as ending poverty, promoting sustainable agriculture, ensuring equitable education and more. The current draft does not include a goal for pollution on its own, although pollution is included in the health goal. That text — sub-goal 3.9 — currently calls to reduce death and disability from all types of pollution. This language needs to stay in the final text, because the SDGs will define international and national efforts for the coming years.

The Global Alliance on Health and Pollution is galvanizing resources to help low- and middle-income countries address priority pollution problems. In addition to education on all forms of pollution, GAHP helps countries:

  • identify and assess toxic pollutant threats, especially for contaminated sites
  • create a planning process to prioritize action for problems posing the greatest risk to human health
  • implement solutions to save lives.

The technology and knowledge exists in wealthy countries to address this health and economic threat. Solutions can be implemented in low- and middle-incomes countries for a fraction of the cost spent in the West addressing legacy toxic pollutants from industrialization.

Which means pollution is not inevitable. It is a problem that is solvable in our lifetime.

Richard Fuller is president of Pure Earth (formerly Blacksmith Institute) and a founding member of the Global Alliance for Health and Pollution. He tweets from @BlacksmithInst.


  • It’s a shocking number and it reinforces, I think, Laura Westra’s point (‘Environmental Justice and the Rights of Ecological Refugees’) about changing our understanding of the term refugee to include environmental refugees. Obviously that’s a stopgap measure when what we really have to do is reduce then stop the toxic effects of industrialization (including the West using the rest of the world – and its oceans – as a toxic waste dump).
    It reminds me of another sobering statistic – ‘it was estimated that there were 163 million people who had been forcibly displaced by conflict, persecution, disasters and development. At 65% ‘development-induced displacement’ accounted for more forced evictions than all other causes combined.’ (from Human Tide: The Real Migration Crisis, 2007,)

  • Gypsy Roberts

    I’d have like to have seen a more in-depth exploration of industrialized nations shipping their pollutants to third-world countries in this article; the Third World has become the planet’s dumping grounds.
    Does anyone recall the “piracy” that was rampant off the coast of Somalia a few years back? Those “pirates” were once fishermen, who turned to piracy because Somalia lacked a Coast Guard; the dumping of the eastern hemisphere’s trash off its coastline resulted in the death of the fishermen’s potential catch, and these unfortunates embraced the only other option they had.
    There was also a horrifying article in National Geo a few months back which described the so-called “shipwreckers” of Bangladesh. Apparently it’s the choice of industrialized nations to send their decommissioned ships to be scrapped, and the Bangladeshi, desperate for employment, work in the most horrifyingly contaminated conditions one can imagine in order to do so; both they and their environment are placed at grave risk.
    Desperate human beings will work at ANY job in order to provide for their families, and the West has been more than complicit in seeing that it is the poorest nations that bear the brunt of the dirtiest, most dangerous jobs.

  • Prosperity

    The USA has a lot of social problems but thankfully our citizens and our government do a somewhat good job preventing polluters from harming people. Articles like this make me thankful to live in a developed country where the government is somewhat responsive to the demands of the people. It would be interesting to analyze why the governments of developing countries are less effective at regulating polluters.

    • -idril

      Because the United States and other so called “first world” countries can afford to replace all their dirt and heavy industry into these poor countries.

  • Vara Sue Tamminga

    This is an important issue provided the word pollution is not a code word for politics or Democracy. In 2000, I realized that some environmental groups were using dehumanization language to cage or exterminate their opposition. If we consider a person or a political group as pollution that we “clean up” meaning murder, cripple, or spay and neuter, then we are using Hitler’s or Stalin’s tactics to purge our opposition. I welcome our focus on environmental threats to life as long as we are not using a coded language to exterminate politically minded people in order to usher in a totalitarian dictatorship or a new aristocracy. People are not dirt or pollution or garbage. We cannot clean them up by murder or zoos. Environmental groups must also uphold human rights for all people in their efforts to address pollution and help the poor.

  • Jeremy Wessel

    “4.2 million people died from particulates exposure in indoor air from cooking stoves.” This seems to be the biggest single problem. We need to get these people less polluting ways of cooking so they don’t need to burn wood or peat.

  • […] environmental impact assessments prior to human activity in the oceans. 4. So here is a little quiz about what you might think the leading cause of death is in low and middle income countries […]

  • […] the World Health Organization, pollution is the world’s largest killer in the developing world. 8.4 million out of the 9 million people killed in 2012 due to exposure to polluted soil, water, and air were in […]

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