The new study, published in the journal The Lancet and written by more than 40 international health and environmental experts, uses data from the the Global Burden of Disease, an international study that examines trends across populations and estimates mortality from major diseases and their causes. To estimate the number of people who died from pollution-related causes, i t looked at the effects of air pollution, or air contaminated with things like gases and the burning of wood, charcoal and coal; water pollution, which includes contamination by things like unhygienic sanitation; and workplace pollution, where employees are exposed to toxins and carcinogens like coal or asbestos.

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Air pollution was linked to 6.5 million deaths in 2015, water pollution was linked to 1.8 million deaths and workplace pollution was linked to nearly one million deaths. Deaths from pollution-linked diseases, like heart disease and cancer, were three times higher than deaths from AIDS, tuberculosis and malaria combined, the researchers found.

The authors also found that 92% of pollution-related deaths happen in low- and middle-income countries. In growing countries like India, China, Pakistan, Bangladesh, Madagascar and Kenya, the researchers say that up to one in four deaths can be tied to pollution. China and India had the greatest number of pollution-related deaths in 2015. That year, pollution in China was linked to 1.8 million deaths, and pollution in India was linked to 2.5 million deaths. But air pollution is also killing people in the United States. More than 155,000 U.S. deaths in 2015 were related to pollution, the researchers found.

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“When I was a kid in school, we were all worried about pollution,” says report leader Richard Fuller, president of Pure Earth, an international nonprofit devoted to pollution cleanup. “Then I think it dropped off the radar for us in the West, and we’ve been worried more about climate change and other things. But overseas, they haven’t looked at this issue much at all.”

The researchers note that their data are likely underestimates and do not reflect the entire burden of disease from pollution. For instance, the researchers didn’t look at other contaminants, like the effects of endocrine disruptors, flame retardants and pesticides on human health and early deaths. Fuller says there isn’t data of high enough quality or quantity on those health issues.

The countries that bear the greatest burden of disease from pollution are also those that are rapidly expanding economically. The authors note that both water and air pollution can be more common in countries in the early stages of industrial development, but that significant increases in pollution do not need to be the norm. “The mindset of a lot of people is that it’s either pollution or jobs, and you have to let an economy go through this stage of being dirty until you can clean it up later,” says Fuller. “But the idea that there is a tradeoff is not borne out by the reality and facts. Well-managed pollution mitigation programs can create a healthy economy and longterm growth.”

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The effects of pollution tend to disproportionally affect poor populations, since they tend to be more exposed to toxic chemicals in air and water at sources near their homes or at work.

This, too, is not inevitable, the report authors argue. Several high- and middle-income countries, including the U.S., have put in place legislation and regulation for cleaner air and water. “Their air and water are now cleaner, the blood lead concentrations of their children have decreased by more than 90%, their rivers no longer catch fire, their worst hazardous waste sites have been remediated, and many of their cities are less polluted and more livable,” the authors write.

The report offers recommendations, including making pollution a priority both nationally and internationally, mobilizing funding dedicated to pollution control, establishing monitoring systems, building multi-sector partnerships to tackle the issue, integrating pollution mitigation into non-communicable disease combatting strategies and conducting more research into pollution and pollution control.

“I hope that the people who are looking to set agendas for development are paying some attention,” says Fuller. “I hope they have a wake-up call.”

This article originally appeared on Time.com