Pollution kills at least nine million people and costs trillions of dollars every year, according to the most comprehensive global analysis to date, which warns the crisis “threatens the continuing survival of human societies”.

Toxic air, water, soils and workplaces are responsible for the diseases that kill one in every six people around the world, the landmark report found, and the true total could be millions higher because the impact of many pollutants are poorly understood. The deaths attributed to pollution are triple those from Aids, malaria and tuberculosis combined.

The vast majority of the pollution deaths occur in poorer nations and in some, such as India, Chad and Madagascar, pollution causes a quarter of all deaths. The international researchers said this burden is a hugely expensive drag on developing economies.

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Rich nations still have work to do to tackle pollution: the US and Japan are in the top 10 for deaths from “modern” forms of pollution, ie fossil fuel-related air pollution and chemical pollution. But the scientists said that the big improvements that have been made in developed nations in recent decades show that beating pollution is a winnable battle if there is the political will.

“Pollution is one of the great existential challenges of the [human-dominated] Anthropocene era,” concluded the authors of the Commission on Pollution and Health, published in the Lancet on Friday. “Pollution endangers the stability of the Earth’s support systems and threatens the continuing survival of human societies.”

Prof Philip Landrigan, at the Icahn School of Medicine at Mount Sinai, US, who co-led the commission, said: “We fear that with nine million deaths a year, we are pushing the envelope on the amount of pollution the Earth can carry.” For example, he said, air pollution deaths in south-east Asia are on track to double by 2050.

Landrigan said the scale of deaths from pollution had surprised the researchers and that two other “real shockers” stood out. First was how quickly modern pollution deaths were rising, while “traditional” pollution deaths – from contaminated water and wood cooking fires – were falling as development work bears fruit.

“Secondly, we hadn’t really got our minds around how much pollution is not counted in the present tally,” he said. “The current figure of nine million is almost certainly an underestimate, probably by several million.”

This is because scientists are still discovering links between pollution and ill health, such as the connection between air pollution and dementia, diabetes and kidney disease. Furthermore, lack of data on many toxic metals and chemicals could not be included in the new analysis.

The researchers estimated the welfare losses from pollution at $4.6tn a year, equivalent to more than 6% of global GDP. “Those costs are so massive they can drag down the economy of countries that are trying to get ahead,” said Landrigan. “We always hear ‘we can’t afford to clean up pollution’ – I say we can’t afford not to clean it up.”

Facebook Twitter Pinterest Children with respiratory diseases receive treatment at a hospital in Hangzhou, Zhejiang province, China. Photograph: China Daily/Reuters

The commission report combined data from the World Health Organisation (WHO) and elsewhere and found air pollution was the biggest killer, leading to heart disease, stroke, lung cancer and other illnesses. Outdoor air pollution, largely from vehicles and industry, caused 4.5m deaths a year and indoor air pollution, from wood and dung stoves, caused 2.9m.

The next biggest killer was pollution of water, often with sewage, which is linked to 1.8m deaths as a result of gastrointestinal diseases and parasitic infections. Workplace pollution, including exposure to toxins, carcinogens and secondhand tobacco smoke, resulted in 800,000 deaths from diseases including pneumoconiosis in coal workers and bladder cancer in dye workers. Lead pollution, the one metal for which some data is available, was linked to 500,000 deaths a year.

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Low-income and rapidly industrialising countries are worst affected, suffering 92% of pollution-related deaths, with Somalia suffering the highest rate of pollution deaths. India, where both traditional and modern pollution are severe, has by far the largest number of pollution deaths at 2.5m. China is second with 1.8m and Russia and the US are also in the top 10.

In terms of workplace-pollution related deaths, the UK, Japan and Germany all appear in the top 10. The report was produced by more than 40 researchers from governments and universities across the globe and was funded by the UN, the EU and the US.

“This is an immensely important piece of work highlighting the impact that environmental pollution has on death and disease,” said Dr Maria Neira, the WHO director of public health and the environment. “This is an unacceptable loss of lives and human development potential.”

Facebook Twitter Pinterest A villager crosses a canal carrying highly toxic water contaminated with lead and other mining byproducts through the neighborhood of Chowa in Kabwe, Zambia. Photograph: Larry C Price/The Guardian

The editor-in-chief of the Lancet, Dr Richard Horton, and the executive editor, Dr Pamela Das, said: “No country is unaffected by pollution. Human activities, including industrialisation, urbanisation, and globalisation, are all drivers of pollution. We hope the commission findings will persuade leaders at the national, state, provincial and city levels to make pollution a priority. Current and future generations deserve a pollution-free world.”

Richard Fuller at Pure Earth, an international pollution clean-up charity and co-lead of the commission, said: “Pollution can be eliminated and pollution prevention can be highly cost-effective, helping to improve health and extend lifespan, while boosting the economy.” Since the US clean air act was introduced in 1970, levels of the six major pollutants have fallen by 70% while GDP has gone up by 250%, said Landrigan: “That puts the lie to the argument that pollution control kills jobs and stifles the economy.”

Gina McCarthy, former head of the US Environmental Protection Agency, criticised the rollback of pollution controls under the Trump administration: “Now is not the time to go backwards in the US,” she said. “Environmental protection and a strong economy go hand in hand. We also need to help other countries, not only for the benefit it will bring them, but because pollution knows no boundaries.”

Rolling out new regulations, ending subsidies for polluting industries and deploying technology like smokestack filters could tackle pollution, the researchers said. But more research on the impact of pollution is also urgently required, said Fuller: “Available data does not include lead’s impact from toxic sites like Flint, in Michigan, US, or Kabwe, Zambia. Yet these populations experience enormous health impacts.”

Landrigan said his biggest concern was the unknown impact of the hundreds of industrial chemicals and pesticides already widely dispersed around the world: “I worry we have created a situation where people are exposed to chemicals that are eroding intelligence or impairing reproduction or weakening their immune system, but we have not yet been smart enough to make the connection between the exposure and the outcome, because it is subtle.” On Wednesday, a horrific plunge in the abundance of vital insects was reported, with pesticides a possible cause.

“Pollution has not received nearly as much attention as climate change, or Aids or malaria – it is the most underrated health problem in the world,” he said.