A new report on global air pollution shows that 95 percent of the world’s population are breathing polluted air, with low air quality hitting poorer populations the hardest. The annual Global Air Report, from the US Health Effects Institute (HEI), also shows the clean air gap broadening between the most polluted and least polluted nations, according to Science Alert.

The report also documents the tangible health effects of the air pollution crisis, with 6.1 million deaths in 2016 linked to air pollution, from lung disease, heart attacks, strokes, and cancer. Together, these diseases make air pollution the fourth leading cause of death on the planet, behind diet, high blood pressure, and smoking.

According to Bob O’Keefe, the HEI’s vice president:

“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. The trends we report show real progress in some parts of the world – but serious challenges remain to eliminate this avoidable affliction.”

The report measured air pollution by the level of ambient particulate matter 2.5 micrometers or less in size.

This year’s study was the first to consider indoor air quality measurements in addition to outdoor. According to the report, half the total deaths from air pollution were a result of household pollution, from the use of coal, wood, and dung for cooking and heating in homes.

These measurements were paired with information about population density to determine how many people are affected by low air quality in a given region.

The most severe levels of air pollution were found in North and West Africa, as well as the Middle East and India, which the report attributes to solid fuel burning in homes, and to windblown mineral dust. Many nations in Asia and Africa see a combination of indoor and outdoor pollution.

Countries like Australia, New Zealand, Canada, Iceland, Finland, and Sweden enjoyed the lowest levels of air pollution documented in the report.

The report noted an 18 percent average increase overall between 2010 and 2016. It also notes that levels of pollution have notably stabilized in China in the last several years.

The report recommends addressing the fundamental causes of air pollution which vary from place to place, including overworked transport networks in urban areas, fuel burning in homes, and wildfires:

“Actions to reduce air pollution should address not only the larger-scale burning of coal by power plants and industries, but also the use of coal or different forms of biomass for heating and cooking in millions of small households around the world.”

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