The way we live is killing us.

Pollution—whether it comes from a car’s tailpipe, a coal-fired power plant, or a toxic waste dump—claimed more than eight million lives around the world in 2017, fully 15 percent of all deaths. That’s according to a new report published by the Global Alliance on Health and Pollution, a coalition of environmental and health institutions and agencies.

In fact, pollution is the world’s leading cause of death, ahead of tobacco use, drug and alcohol use, and even war. And the United States is one of the leading sources of pollution-induced death. The Global Alliance on Health and Pollution study, drawing on data from the Institute for Health Metrics and Evaluation, frames pollution as one of the world’s largest, yet most neglected public health threats.

On top of mass mortality, pollution in 2017 resulted in the equivalent of 275 million years of Disability-Adjusted Life Years, a measure of the years that individuals lose to illness, disability, or premature death. Roughly five million deaths are attributed to polluted air, mostly from outdoor sources in urban and industrialized areas.

Climate change is exacerbating the problem of dirty air.

Altogether, the estimated health burden of pollution from air, water, lead contamination, and workplaces reflects a cross section of human suffering worldwide, the vast majority concentrated in low and middle-income countries. But one of the top countries for pollution-related death is among the richest: the United States ranks number seven, with some 197,000 deaths due to pollution.

That ranking—just behind Bangladesh, and just ahead of Russia and Ethiopia—is in large part a function of the large U.S. population. When ranked by pollution-related deaths per 100,000 people, the United States drops to 132nd in the ranking. Nonetheless, since about half of those deaths are in China and India, two relatively poor countries, the United States stands out for its extreme wealth and extreme inequality.

And, according to two Natural Resources Defense Council experts, senior advocate Juanita Constible and senior scientist Kim Knowlton, the U.S. pollution-related death will likely “climb in the coming years if the Trump Administration has its way.” Massive deregulation by Trump’s Environmental Protection Agency, they warned, could “reverse decades of progress toward a cleaner environment and healthier people.”

While pollution plagues many regions of the country, the Trump Administration has been steadily dismantling two bedrock laws, the Clean Air and Clean Water Acts. The EPA, now headed by a former coal-industry lobbyist, has dramatically weakened pollution controls for factories and chemical plants, undermined fuel efficiency standards, and is working to repeal long-standing restrictions on hydrofluorocarbons from cooling and refrigeration.

“Many people may assume that because the United States is a wealthy, developed country, that we've somehow moved past the point of thousands of deaths caused by pollution,” Bill Magavern, policy director of the California-based Coalition for Clean Air, tells The Progressive in an interview. But that hasn’t happened because corporations have systematically weakened or co-opted agencies through “regulatory capture.”

Trump has acted as “the lapdog of the fossil fuel industry,” Magavern says. “Unfortunately, we have a President who has really made himself the polluter-in-chief and is making our air and water dirtier rather than cleaner.”

But the pollution epidemic may be even worse than it sounds. The study’s primary data set omits several common toxins: plastics, pesticides, chemicals that act as endocrine disruptors, mercury, and pharmaceutical wastes. Occupational hazards, which are specifically related to the work environment, cause about 800,000 deaths through “occupational carcinogens, second-hand smoke, particulates, gases, and fumes.”

But that figure is a vast undercount, because the occupational pollution data excludes workers in the informal economy, like casual farm laborers, domestic workers, and trash pickers. Informal sectors like small-scale artisanal gold-mining employ millions of people, mostly in Africa, and expose them constantly to illness caused by mercury vapors.

Climate change is exacerbating the problem of dirty air. A 2009 study on the effects of global warming estimated that “as many as 20,000 air-pollution related deaths may occur worldwide each year with each one degree Celsius increase.” Respiratory diseases like childhood asthma, which already costs an estimated $23,573 per case, will worsen.

In addition to increased frequency and severity of climate-related disasters like flooding, droughts, hurricanes, and wildfires, projected long-term ripple effects include rising rates of infectious diseases such as malaria, and aggravate antibiotic resistance, raising the risk of public health crises. Rising temperatures and ocean acidification could alter the chemical composition of some pollutants.

Although the United States ranks shamefully high in pollution-induced death, it also has the technology and financial capacity (if not the political will) to stop the worst impacts of pollution inside and outside its borders.

Fortunately, if there is the political will to address the problem, we already know what works.

Exposure to atmospheric particulate matter has on average declined significantly between 2003 and 2015, and historically, the Clean Air Act has been credited with dramatic reductions in ozone, lead, and the toxins that cause acid rain. And despite Trump’s anti-regulatory crusade, there have been several regional and state-level initiatives aimed at curbing pollution.

A dozen northeastern states and the District of Columbia recently launched the Transportation and Climate Initiative to develop a cleaner, more efficient transit network. The Regional Greenhouse Gas Initiative has linked Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont in a unified cap-and-trade market that is expected to reduce annual emissions from the power sector to 45 percent below 2005 levels by 2020.

But the map of pollution death is also a reflection of social inequality. Black and Latinx populations suffer disproportionately from pollution impacts, especially air pollution, though they individually contribute to very little of it. Communities of color, immigrant workers, and other vulnerable populations often have little recourse when corporations want to heap toxins on their neighborhoods or force them to work in hazardous environments.

The map of pollution death is also a reflection of social inequality.

“Low-income communities of color are suffering from a historic and ongoing discrimination which subjects them to disproportionate burdens from pollution, while at the same time they have the fewest resources with which to address the impacts of that pollution,” Magavern says.

Though previous administrations have moved to incorporate an environmental justice framework into policymaking by targeting interventions toward disadvantaged groups, Trump has drastically reduced enforcement activity under the EPA and is now poised to obliterate basic oversight rules for corporations that threaten to inflict environmental damage on marginalized communities. (These are the rules used by members of the Standing Rock Sioux Tribe to resist plans to build the Dakota Access Pipeline project near their reservation in 2017.)

As those legal protections erode, the nation’s pollution burden will continue to hurt the most vulnerable communities. Around the world, pollution is largely the byproduct of uneven development and lack of resources; in the United States, it’s the byproduct of deliberate policy choices that put profit over public health.