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Top Ten Toxic Threats 2013

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About the Report


The 2012 World’s Worst Pollution Problems Report sets out to quantify the human health impacts from major sources of hazardous pollution in low to middle-income countries. In particular the focus is on sites in the developing world where toxic pollution has occurred because of industrial activity.[1] This evaluation of industries and pollutants is based on data collected by the Blacksmith Institute and Green Cross Switzerland through investigations of pollution hotspots around the world, principally abandoned (“legacy” or “orphan”) sites and informal artisanal activities. This report is compiled using analysis of the Blacksmith Institute’s site database and a review of industry research, statistics and peer-reviewed studies.

In 2011, the Blacksmith Institute and Green Cross Switzerland published a report that began to quantify the burden of disease from industries using a single site, beginning the process of measuring health impacts. This report revisits that process but goes a step further. Using additional data the 2012 report estimates the total health impact from toxic industrial pollutants in 49 countries in the developing world, extrapolating health impacts to provide a better understanding of the true scope of the issue. Within the last year the Blacksmith Institute has investigated and analyzed hundreds of additional sites around the world and initiated in depth research on the process of estimating the global burden of disease from hazardous waste sites.[2] That information and research has produced increasingly more accurate estimates that get closer to reflecting the impact of toxic substances on people in the developing world.

The goal of this report is to identify and quantify the contribution to the global burden of disease of the most significant pollutants and industry sectors in low and middle-income countries.

Scope of the Project

Blacksmith Institute currently estimates that the health of some 125 million people is at risk from toxic pollution globally. Previous estimates had indicated that this number was in the range of 100 million, but the investigation of hundreds of additional sites over the past year has expanded the estimation of the impact.

Hazardous waste sites in the U.S. and around the developed world have been extensively documented and are now closely monitored by national agencies such as the U.S. Environmental Protection Agency (EPA). Similarly, mining and industrial processes and their related wastes and emissions are typically tightly regulated. However, in the developing world, the prevalence of hazardous pollutants and their resulting adverse health impacts have generally not been investigated in depth. There are many toxic contaminated sites from previous industrial or mining activities as well as many active industrial and mining sites that continue to pollute the surrounding environment.

Based on Blacksmith Institute’s investigations and observations, as well as the research of others, it is clear that the impact on health in low and middle-income countries from these sites is very significant. For example, 98% of adults and 99% of children affected by exposure to lead live in low- and middle-income countries.[3] To exacerbate the problem, the expanding production of high-volume chemicals is increasingly being transferred to developing countries. The Organization for Economic Cooperation and Development (OECD) has estimated that the global output of chemicals in 2020 will be 85% higher than in 1995, and nearly one-third of the production will take place in developing countries, compared to about one-fifth in 1995.[4]

Populations of developing countries are particularly vulnerable to toxic pollution resulting from industrial processes. At the local level, participants in small-scale industries often do not have knowledge of best practices or may not be aware of the toxicity of the chemicals and processes they use. Poor communities, in which small-scale industries are often located, have little ability, either financially or culturally, to take measures to reduce their risk of exposure. Additionally, these communities have limited or no health care infrastructure that can address the health effects of toxic pollution. To further exacerbate the health risk, poor communities often have low overall standards of health, due to poor nutrition and other causes, which increase health risks and impacts from toxic substance exposure, particularly for children.

At the governmental level, the reasons are more complex. The World Health Organization (WHO) and UN Environment Programme (UNEP) Health and Environment Linkages Initiative project found that barriers to addressing environmental pollution are economic, institutional, political and social in nature and include trade globalization, market liberalization, debt burdens and structural adjustment policies.[5] Governments may view environmental regulation as a barrier to development and environmental systems supporting livelihoods are not necessarily considered in economic equations. As more research is published and links between health impacts and environmental pollution are better understood, the connection between poorly managed economic growth and human health needs to be appropriately accounted for. Making the connection between economics and human health is easy – the cost of illness and the loss of productivity due to disease and death is a huge and preventable economic burden.

In order to make this connection, it is essential to begin the process of quantifying the public health burden. This report examines the health burden that toxic pollutants put on human populations, specifically covering those pollutants associated with the contaminated sites that are the focus of Blacksmith Institute and Green Cross. Broadly, air and water pollution from sources such as urban emissions and poor sanitation are not considered. Additionally, occupational exposures and risks are not addressed, since these are the mandate of local regulatory agencies. While these other sources contribute greatly to human health risks, they are well recognized and being addressed by other agencies and groups. The work summarized here on pollution and health is not being undertaken by other agencies and is intended to fill a very important knowledge and research gap.

Other considerations have also narrowed the scope of the report. The investigated sites making up the Blacksmith Institute’s database are located only in countries where political and logistical considerations allow for routine and safe access for investigators. The discussion of impacted geographic regions in the report is by no means complete and only represents the current sites investigated by Blacksmith Institute. Financial limitations constrain our ability to investigate sites in all countries as well; so the countries that are chosen are considered to be representative of similar low to middle-income countries. In addition, the current lack of reliable human-based studies on the health impacts of pollutants has limited our ability to quantify the health effects of certain toxic pollutants. Despite the intent to achieve wide coverage for low and middle-income countries, these constraints have led to some important omissions. These geographic, financial, political and information limitations mean that the global burden of disease represented in this report is almost certainly underestimated.

Toxic Pollution and Human Health

The WHO has estimated that environmental exposures contribute to 19% of cancer incidence worldwide.[6]  Additionally, a WHO Global Health Risks report looked at five environmental exposures, (unsafe water, sanitation and hygiene, urban outdoor air pollution, indoor smoke from solid fuels, lead exposure and climate change), and estimated they account for nearly 10% of deaths and disease burden globally and around one quarter of deaths and disease burden in children under the age of five.[7]

The connection between pollution, notably toxic substance pollution, and human health has long been made in the developed world. Incidents such as Love Canal, a hazardous waste site in New York causing illness in the 1970s, brought industry pollutants and their effect on human health to prominence in public health studies. However, these connections between toxic pollution and human health have largely not been made as clearly in the developing world.

The lack of investigation and quantification of the human health impacts of contaminated sites have left an often-marginalized population with few resources to address this growing problem. Sadly, health impacts from environmental pollution often affect the most vulnerable, especially children, within these already neglected populations. The objective of the work of the Blacksmith Institute and Green Cross Switzerland and one goal of this report is to give a voice to this marginalized population that is in danger from toxic pollutants.

What can be done?

Mining and industrial production are critical drivers of global GDP. According to 2012 data from the CIA World Fact Book, these industries currently contribute over 30% to world GDP. Industries also contribute greatly to the improvement of the human condition and advance society as a whole. However, it should be recognized that the amount of pollution produced in these processes is unsustainable unless great efforts are taken to minimize and control pollution and waste; particularly in developing countries where advanced control technologies and “green” manufacturing practices are less prevalent. Major toxic environmental pollution problems are generally preventable and markedly easier and more economical to prevent than to clean up. This report is intended not only to identify the problems, but also to explore some of the solutions that currently exist, as they are many and varied.

While many countries and many industries have made great strides to reduce and prevent hazardous pollution, there remains a vast, dispersed and tragic legacy of toxic waste and a continuing problem of hazardous substance pollution. More can and should be done. Governments in developing countries are often constrained by political and economic forces, reducing their ability to address environmental pollutants. The Blacksmith Institute and Green Cross Switzerland endeavor to partner with local entities and industry leaders to implement cost effective solutions that rely upon proven technologies, both to prevent and to remediate pollution problems. For each industry sector discussed in the report, a typical example of remediation solutions and a discussion of preventative actions are presented. These solution examples show that these quantified risks can be reduced; and our intent is to move people, governments and industries to action.


[1] Neither this report nor Blacksmith Institute evaluates all forms of hazardous pollution. Many serious forms of hazardous pollution, such as indoor air pollution and carbon pollution are not addressed in the report and are outside the scope of Blacksmith’s work.
[2] Ericson et al 2012. “Approaches to systematic assessment of environmental exposures posed at hazardous waste sites in the developing world: the toxic sites identification program.” Environ. Monit. Assessment, May 17. (Epub ahead of print). Environmental Monitoring and Assessment. 7
[3] “Global health risks: mortality and burden of disease attributable to selected major risks.” World Health Organization. 2009.
[4] Health & Environment: Tools for effective decision-making.” The WHO-UNEP Health and Environmental Linkages Initiative. World Health Organization and United Nations Environment Programme. 2004. Available at:
[5] Ibid.
[6] Vineis, P. and W. Xun. “The emerging epidemic of environmental cancers in developing countries.” Annals of Oncology 20: 205–212, 2009.
[7] Global health risks: mortality and burden of disease attributable to selected major risks.” World Health Organization. 2009.8 9