Publication date: 
April 17, 2018

One in Three Globally Face a “Double Burden”:
Exposed to Household Burning and Outdoor Air Pollution
Air Pollution Leading Environmental Cause of Death Worldwide

(Boston, MA) - Seven billion people, more than 95% of the world’s population, live in areas of unhealthy air, according to a new global study.

Air pollution is the leading environmental cause of death worldwide according to the State of Global Air 2018, the annual report and interactive website published today at by the Health Effects Institute (HEI1).

All told, long-term exposure to outdoor and indoor air pollution contributed to 6.1 million premature deaths from stroke, heart attack, lung cancer, and chronic lung disease. That makes air pollution the fourth highest cause of death among all health risks, exceeded only by high blood pressure, diet, and smoking.

For the first time this year’s report and website include worldwide estimates of exposure to and health burdens of burning of solid fuels in homes; in 2016 a total of 2.5 billion people — one in three global citizens — were exposed to household air pollution from the use of solid fuels (for example, coal, charcoal, wood, dung, or other biomass) for cooking and heating. Most live in low- and middle-income countries in Asia and Africa, and face a double burden: exposure to both indoor and outdoor air pollution.

And household air pollution can be a major source of impact on outdoor air: indoor pollution emitted to the outdoor air is the largest cause of health impacts from among all sources in India, contributing to one in four air pollution related deaths India, and nearly one in five such deaths in China.

“Air pollution takes a huge personal toll worldwide, making it difficult to breathe for those with respiratory disease, sending the young and old to hospital, missing school and work, and contributing to early death” said Bob O’Keefe, Vice President of HEI. “The trends we report show real progress in some parts of the world – but serious challenges remain to eliminate this avoidable affliction,” he added.

The analysis found that China and India together were responsible for over half of the total global attributable deaths. The study also finds that increasing exposure and a growing and aging population have meant that India now rivals China for among the highest air pollution health burdens in the world, with both countries facing some 1.1 million early deaths from outdoor air pollution in 2016. China has made initial progress, beginning to achieve air pollution declines; in contrast, Pakistan, Bangladesh, and India have experienced the steepest increases in air pollution levels since 2010.

The State of Global Air 2018 annual report and accompanying interactive website are designed and implemented by the Health Effects Institute in cooperation with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and the University of British Columbia. IHME is an independent population health research center that coordinates the annual Global Burden of Disease (GBD2) study, a systematic, scientific effort to quantify the magnitude of health loss from all major diseases, injuries, and risk factors in populations across the world. Its results are published each year in the international medical journal The Lancet. HEI provides leadership for the air pollution portion of the GBD; HEI’s is the only report and website where all of the estimates of exposure to air pollution and their burden of disease included in the GBD air pollution analyses are made available for full public access.

“The Global Burden of Disease leads a growing worldwide consensus – among the WHO, World Bank, International Energy Agency and others – that air pollution poses a major global public health challenge,” said Dan Greenbaum, President of HEI. “Nowhere is that risk more evident than in the developing world, where a third of the world’s population faces a double burden of indoor and outdoor air pollution,” he added.

For more information on the contact: Dr. Katherine Walker at HEI [email protected] +1 617 488 2310.

1 The Health Effects Institute is an independent, nonprofit research institute funded jointly by the US Environmental Protection Agency, industry, foundations, and development banks to provide credible, high-quality science on air pollution and health for air quality decisions.

2 The Global Burden of Disease is an international effort to estimate the number of deaths and lost years of healthy life due to about 300 diseases in 195 countries, and how much of this burden is caused by 84 different risk factors, including diet, high blood pressure, tobacco smoking, and air pollution. The Institute for Health Metrics and Evaluation (IHME) leads an international team of over 2,000 scientists from 130 countries in conducting the analysis. The latest estimates of deaths and lost years of healthy life from air pollution, diet, smoking, and other risk factors for all countries can be found in the latest GBD analysis, published in 2017 (GBD 2016 Risk Factors Collaborators, and others. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 The Lancet, Vol. 390, No. 10100, p1345–1422 Published September 16, 2017). Available at: