Global Burden of Disease Attributable to Air and Water Pollution: A Systematic Review

This systematic review provides compelling evidence that air and water pollution represent major threats to global public health, with disproportionate impacts on vulnerable populations. The substantial economic burden of pollution-related health effects, combined with demonstrated cost-effectiveness of control measures, supports urgent policy action. However, critical research gaps in mixture effects, low-level exposures, and mechanistic understanding limit the precision of risk assessments and the development of targeted interventions. Future research must prioritize methodological innovations that address exposure misclassification, enhance geographic representation, and elucidate complex exposure-disease relationships. The development of consensus statements for environmental health systematic reviews that are published, well-disseminated, and adopted by journals as guidance would strengthen evidence synthesis. Policy implementation should emphasize environmental justice principles, ensuring that pollution control efforts do not exacerbate existing health inequalities. The integration of environmental health considerations into climate change adaptation and sustainable development frameworks represents an essential step toward achieving health equity and environmental sustainability. The evidence synthesized in this review underscores the urgent need for transformative changes in how societies approach pollution control and environmental health protection. Only through coordinated action across research, policy, and practice domains can we address the substantial and persistent burden of pollution-related disease affecting populations worldwide. Several populations, such as older people and children, face increased harm from air pollution and should become priority groups for action.

1.         Cohen AJ, Brauer M, Burnett R, Anderson HR, Frostad J, Estep K, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. The Lancet. 2017 May 13;389(10082):1907–18. 2.         Prüss-Ustün A, Wolf J, Bartram J, Clasen T, Cumming O, Freeman MC, et al. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. Int J Hyg Environ Health. 2019 June;222(5):765–77. 3.         Sheehan MC, Lam J. Use of Systematic Review and Meta-Analysis in Environmental Health Epidemiology: a Systematic Review and Comparison with Guidelines. Curr Environ Health Rep. 2015;2(3):272–83. 4.         Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. 5.         Orellano P, Reynoso J, Quaranta N, Bardach A, Ciapponi A. Short-term exposure to particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and ozone (O3) and all-cause and cause-specific mortality: Systematic review and meta-analysis. Environ Int. 2020 Sept;142:105876. 6.         Pope CA, Burnett RT, Turner MC, Cohen A, Krewski D, Jerrett M, et al. Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure-response relationships. Environ Health Perspect. 2011 Nov;119(11):1616–21. 7.         Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Guo Y, Tong S, et al. Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. N Engl J Med. 2019 Aug 22;381(8):705–15. 8.         Di Q, Wang Y, Zanobetti A, Wang Y, Koutrakis P, Choirat C, et al. Air Pollution and Mortality in the Medicare Population. N Engl J Med. 2017 June 29;376(26):2513–22. 9.         Air pollution and child health: prescribing clean air [Internet]. [cited 2025 Aug 22]. Available from: https://www.who.int/publications/i/item/WHO-CED-PHE-18-01 10.       Crouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, et al. Ambient PM2.5, O₃, and NO₂ Exposures and Associations with Mortality over 16 Years of Follow-Up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect. 2015 Nov;123(11):1180–6.