Pollution: Next on the Global Environmental Agenda | The JEI

The Positive Health Impacts of Environmental Investing


R.Fuller Richard Fuller

Co-Chairman of the Global Commission on Pollution, Health, and Development; Founder and President of Great Forest, Inc.; and Founder and President of Pure Earth



A.PrekerAlexander Preker, MD, PhD

President and CEO of the Health Investment & Financing Corporation; a Commissioner for the Global Commission on Pollution, Health, and Development




D.-C.SimonDiane-Charlotte Simon, MBM

Associate Investment Analyst; Researcher for the Global Commission on Pollution, Health, and Development





The purpose of this commentary is to describe how environmental investors can generate significant healthcare benefits and reductions in the cost of healthcare. It is possible to produce significant health benefits that have been overlooked until now by investing in renewable energies; energy-efficiency solutions; companies that consider their environmental impacts across operations and product lifecycles as well as from the products themselves; and technologies and processes that reduce pollution. Indeed, the most important causes of pollution-related health effects can be addressed by reducing the use and production of certain pollutants, including those related to the use of fossil energies. This commentary argues that there are both good social impacts and good business/investment opportunities for such actions. Further, this commentary stresses that collaborations between investors, businesses, nonprofit organizations, and governments can lead to greater positive environmental and health impacts.

This commentary also introduces the work of the Lancet, the Global Alliance on Health and Pollution (GAHP) and the Icahn School of Medicine at Mount Sinai in their initiative, the Global Commission on Pollution, Health, and Development, which aims to become for pollution what the Intergovernmental Panel on Climate Change is for climate change.

The Overlooked Effects of Pollution on Health

While the spotlight of both international and domestic attention in recent years has focused mainly on the Climate Change Agenda and is now focused on the aftermath of the 2015 Paris Climate Conference (COP21), another critical environmental issue is the impact of pollution on health and healthcare costs.

The science about environmental impacts on health is still in a nascent phase with many unknowns in terms of the attribution of causes, effects on health and healthcare costs, effective forms of prevention and attenuating actions, and means of redress. Specifically, there is a general lack of public awareness among both the lay population and professionals about the impacts of pollution on health. For many decades, environmental and health departments have been working in silos. Recently, this situation has started to change with the emergence of several new holistic and cross-disciplinary initiatives in this area.

A Department of Public Health, Environmental and Social Determinants of Health (PHE) has recently been created in the World Health Organization (WHO) to address the root causes of environmental and social threats to health. In 2006, WHO made a first attempt to estimate how health is affected by exposure to physical, chemical, and biological risk factors. Within this context, the organization assessed how environmental risk factors affect 85 diseases. To do this, WHO used available scientific evidence along with focus group consultations with over 100 experts. The organization’s study suggested that environmental risk factors play a role in more than 80% of the diseases regularly reported by WHO. The results from this study highlight the major impact that the environment and pollution have on cardiovascular diseases, cancer, and asthma in the developed world and the impact they have on lower respiratory diseases and diarrhea across all income groups (Prüss-Üstün and Corvalán 2006). Indeed, the study stresses that, worldwide, about 19% of all cancers were estimated as attributable to the environment, resulting in 1.3 million deaths each year. Researchers also estimated that 16% of the total burden of cardiovascular disease was attributed to the environment, resulting in 2.5 million deaths per year. Regarding asthma, total environmental exposures were estimated to account for 44% of its development or aggravation.

The World Health Organization has also recently published a report about the impact of climate change on health. The results highlight the health benefits that ensue from reducing climate pollutants such as black carbon, methane, ozone, and hydrofluorocarbons (Scovronick 2015). The reduction of black-carbon emission is expected to have the greatest health impact because it is the air pollutant most associated with premature death and morbidity. Most black-carbon emissions are fine particulate (PM 2.5) due to fuel combustion in transport and the production of building materials, which contribute to over 80% of the black-carbon emitted by humans. These fine particles penetrate deeply into the lungs, and evidence shows that they correlate highly with both cardiovascular and respiratory diseases: “Chronic exposure to particulate matter leads to increased risks of pre-mature mortality from heart attack, stroke, respiratory infections, and lung cancer” (WHO 2015).

Ozone is the second climate pollutant associated with the most significant health effects. There is strong evidence showing the link between ozone and respiratory diseases such as asthma and cardiovascular diseases. There is also some evidence of links between ozone, central nervous system diseases, reproductive diseases, and early childhood development. Since ozone is not emitted directly, there is a need to focus on the precursor emissions, including oxides of nitrogen (NOx), methane, carbon monoxide, and volatile organic compounds. Nitrogen dioxide (NO2), which is one of the major components of NOx, is a product of combustion processes, including vehicle combustion (particularly diesel vehicles), as well as power plants. This deserves particular attention because NO2 also produces adverse respiratory and cardiovascular effects on its own.

The report concludes that decreasing the emission of climate pollutants would not only significantly reduce the burden of disease (which includes both the effects on disease occurrence and related deaths) attributed to air pollution but would also have both direct and indirect positive impacts on health by mitigating the effects of climate change on weather, food production, and access to potable water.

The Lancet, GAHP, and Mount Sinai Global Commission on Pollution, Health, and Development

Yet, pollution related to climate change is just the tip of the iceberg. While a third of the total deaths caused by pollution are attributed to ambient air pollution, which is a broader concept that includes climate change pollution, there is a need to focus much more attention on the overall impact of the different types of pollution—air, water, and soil—on health, mortality, and healthcare costs (Landrigan and Fuller 2014). There is currently a gap in the study of pollution’s full impact on health because most of the research tends to focus on specific correlations rather than on providing the full picture of this critical issue.

Attention is drawn to the work of the Global Commission on Pollution, Health, and Development, which has the ambitious goal of becoming for pollution what the Intergovernmental Panel on Climate Change is for climate change. The commission stresses that pollution is the first cause of worldwide death and that more than one death out of seven is the consequence of environmental pollution (Global Commission 2015). Indeed, 8.9 million deaths were attributed to air, water, and soil pollution in 2012, according to WHO, while only US$100 million in international aid was allocated to this issue in 2013. That same year, in comparison, over US$28 billion in international aid went to the control of infectious diseases, including HIV/AIDS, malaria, and tuberculosis, even though these diseases account for 2.5 million deaths combined. This means that pollution control received almost 300 times fewer resources, even though it contributes to over three times as many deaths. Pollution-attributed diseases increasingly include chronic, non-communicable diseases (NCDs) such as heart disease, stroke, and cancer, in addition to diarrhea and pulmonary diseases that have been historically correlated with pollution.

These striking observations of the issues related to pollution led to the creation of the commission, which aims to overcome this situation and put pollution on the global development agenda. The commission is an initiative of the Lancet, the GAHP (the first coordinated international effort to tackle pollution on a global scale [(GAHP 2015]), and the Icahn School of Medicine at Mount Sinai. The United Nations Environment Programme and the World Bank provided additional coordination and input support. Distinguished leaders from countries around the world have been mobilized in this endeavor. Indeed, the commission is made up of former heads of state; leaders of UN agencies; ministers of health and the environment; members of the European Commission, the World Bank, and the Asian Development Bank; representatives of civil society organizations; leaders in public health and environmental science; economists; and other public figures. The non-profit organization Pure Earth (formerly Blacksmith Institute) is the Secretariat of GAHP and coordinates the work of the Commission. The commission will assess the full health impacts and economic costs of air, water, and soil pollution globally in order raise awareness about the issues and provide actionable solutions to policy-makers. It will comprehensively study pollution-related topics that are usually analyzed separately, such as urban air, chemicals, hazardous waste, toxic chemicals, cook stoves, sanitation, and so on. It will also compare the costs of inaction to the costs of solutions to the problem. It will inform key decision makers around the world about the burden that pollution places on health and economic development. It will also provide cost-effective pollution-control solutions and strategies by using robust and scientifically credible analyses that set out the full magnitude of pollution’s effects. The main report from the commission will be published in December 2016 in the Lancet, one of the most renowned scientific journals in the field of health, ranked second out of 150 scientific journals in terms of impact in the field of medicine, according to Thomson Reuters.

The impacts of environmental pollution are especially important in low- and middle-income countries (LMICs), where it has become the leading risk factor for death. Yet, while seemingly far away, those polluting emissions directly affect wealthy countries as well. Pollution does not stop at borders, and we live in a global economy with consumer goods coming from every part of the world. Indeed, evidence shows that contaminated air from China travels across the Pacific and can be measured in countries around the Pacific, including the United States. In addition, mercury from gold mining and coal plants can be found in global stocks of fish, and arsenic has been found in imported rice. Furthermore, environmental and health issues caused by pollution in poor countries can catalyze war and massive forced immigration. Indeed, pollution threatens societal development and social cohesion and condemns future generations to continuing poverty and poor health, thereby fostering social unrest. An additional argument for prioritizing the prevention and cleanup of toxic pollution is that pollution control helps tackle climate change and reduce threats to biodiversity. (Landrigan and Fuller 2014.)

The Positive Health Impacts of Environmental Investing and the Opportunities Related to Pollution Remediation

Based on these observations, one can conclude that investors who finance clean energy and resources-efficiency solutions and companies that consider environmental impacts across their operations and products lifecycle have a positive impact not just on the environment but also on health and healthcare costs. This is especially true when considering a reduction in the use of coal and oil, which by limiting the amount of harmful particles, ozone, and nitrogen dioxide released into the environment, has an immediate impact on air quality and associated health conditions such as cardiovascular and respiratory diseases. These health benefits, in turn, should be added to the other already known benefits that can help encourage investors and limited partners to invest in more environmentally friendly products and fewer polluting financial instruments. Positive outcomes like these can result either from incremental changes in large organizations, disruptive innovation in early stages companies, or the catalyzing effects of philanthropy while simultaneously reducing tax.

However, pollution remediation, like environmental and sustainability investing, suffers from investors’ lack of understanding of the business opportunities and threats related to it. Indeed, it has a reputation mainly for reducing acute risks while increasing companies’ operating costs as well as passing costs on to the end consumers. However, it can also lead to new profitable opportunities through the development of novel products in new markets or innovative and cost-effective methods of production. Indeed, sustainable initiatives effectively embedded in companies’ strategies can lead to increased revenues, improved productivity, and enhanced risk management like that stressed in the UN Compact Value Driver Model (UN Global Compact 2013). The perspectives of positives outcomes are also driven by the increasing number of responsible and ideologically driven millennial consumers, as well as by large corporations’ willingness to improve their corporate social responsibility (CSR) image and demand for resource-efficiency solutions that allow them to reduce their operating costs.

NewWorld Capital underlines several positive macro-trends in the environmental markets in the United States. First, the firm stresses that, according to its estimates, “environmental opportunities already constitute a large domestic market sector, representing approximately $382 billion in annual turnover in the U.S. market” in 2014, which will grow to $580 billion by 2020 (NewWorld 2014). Within this sector, the firm has identified “high economic opportunity market segments,” such as energy efficiency, clean energy, and water and waste management (NewWorld 2015). Further, the high rate of innovations occurring in the sector presages more growth opportunities (NewWorld 2014). Nonprofit organizations can also play a new role in developing business opportunities. Pure Earth is an interesting example. Among its different projects, the organization has developed some interesting processes, such as a new technique for filtering gold without using mercury in Indonesia or the production of lead-free pottery in Mexico, that could be used by local businesses and social entrepreneurs. These processes could present novel investment opportunities for impact investors. However, environmental investing possesses structural risks that should first be minimized to improve the prospects of success. Indeed, particular attention has to be given to reducing technology risk, regulatory and subsidy risk, hydrocarbon pricing risk, foreign competition, and scaling risk (both for the business and capital, especially when investing in early stages companies). (NewWorld 2014.)

The financial threats related to pollution crisis tend to be more frequently discerned by investors than the upsides do. Indeed, it is commonly understood that pollution-related risks can have a considerable impact on company brand image and market value, as exemplified when BP’s stock price plummeted after the Gulf of Mexico oil spill. Indeed, pollution involves material financial risks for companies and should be taken seriously by any investor. In particular, focus has to be given to pollution by investors while they are performing any investment due diligence, in the same way it is commonly done in real estate. Indeed, in real estate, pollution-related risks could imply regulatory sanctions and a considerable decrease in asset value. According to Dr. Robert Pojasek, an expert in risk management and sustainability and an instructor at the Harvard Extension School, the inclusion “of an international management system standard such as the recently revised ISO 14001 (which includes risk management with its opportunities and threats) is evidence of good environmental management together with a positive predictive value for potential investment.” Understanding the impact of environmental matters on intangible assets is especially crucial for companies because of the increasing weight of intangible assets in the company’s market valuation. This increase can be observed in the declining ratio of net assets to enterprise value. James E. Malackowski, Ocean Tomo’s Chairman, explains that “within the last quarter century, the market value of the S&P 500 companies has deviated greatly from their book value. This ‘value gap’ indicates that physical and financial accountable assets reflected on a company’s balance sheet comprises less than 20% of the true value of the average firm”(Ocean Tomo 2010).

However, the current market is imperfect, and the environmental and health externalities are not correlated to the market. For this reason, the economic, financial, and legal environments still have to be improved to ensure that businesses that are polluting the environment and harming health have an incentive to change the way they do business. In this respect policy prescriptions, including regulation, tax incentives, fines, and goals-aligned subsidies allocation, constitute tools that can create a good environment for responsible companies and business models. Still, it is not enough. Real commercial incentives are necessary, including tangible economic gains for groups that shift to non-polluting forms of production, distribution, and disposal of waste. Indeed “it is the promise of attractive economic returns—not societal co-benefits—that will draw sufficient amounts of private capital into” environmental markets (NewWorld 2015). It is this that will allow the environmental and health problems to be overcome; governments and philanthropic capital are not sufficient alone. For this reason, governments, NGOs, and the private sector have to work hand-in-hand to tackle these life-threatening environmental and health issues.


To conclude, even though it may initially be difficult for environmental investors to identify the financial benefits of a particular investment, they can nonetheless promote significant healthcare benefits by investing in private companies, the public market, and philanthropic initiatives that make smart environmental decisions. The health impacts of pollution, as identified by the Global Commission on Pollution, Health, and Development, constitute another good reason to invest in financial instruments that take environmental impacts into consideration, along with renewable energies and energy-efficiencies solutions. Yet, not only do the environmental markets lead to high social benefits, but they also present considerable opportunities for attractive returns driven by macro trends, especially in the areas of energy efficiency, clean energy, and water and waste management (NewWorld 2015). Indeed, these already large subsectors are growing and are innovative. Further, they match the demands of both increasingly ideologically driven consumers and large corporations that are aware of the opportunities the areas represent, in terms of cost reductions and reputational impact. However, some policy initiatives are still required to overcome the market inefficiencies and externalities. As a result, the Global Commission on Pollution, Health, and Development will propose a set of actionable measures to be implemented by policymakers in its final report to be published in the Lancet in December 2016.



Prüss-Üstün, A., and C. Corvalán. WHO. 2006. “Preventing Disease through Healthy Environments: Towards an estimate of the environmental burden of disease.” Accessed on December 10, 2015. Available from http://www.who.int/quantifying_ehimpacts/publications/preventingdisease/en/.

Scovronick, N. WHO. 2015. “Reducing global health risks through mitigation of short-lived climate pollutants.” Accessed on December 10, 2015. Available from http://www.who.int/phe/publications/climate-reducing-health-risks/en/.

WHO. Database on source apportionment studies for particulate matter in the air (PM10 and PM2.5). 2015. Accessed on December 10, 2015. Available from http://www.who.int/quantifying_ehimpacts/global/source_apport/en/ ; and http://www.who.int/phe/health_topics/outdoorair/databases/cities/en/.

Landrigan, P., and R. Fuller. 2014. “Environmental pollution: An enormous and invisible burden on health systems in low- and middle-income counties.” IHF Journal World Hospitals and Health Services 50(4): 35–40.

Global Commission on Pollution, Health, and Development. Accessed on December 10, 2015. Available from http://www.commissiononpollution.org.

Global Alliance on Health and Pollution (GAHP). Accessed on December 10, 2015. Available from http://www.gahp.net.

Pure Earth. Accessed on December 10, 2015. Available from http://www.pureearth.org/.

UN Global Compact. 2013. “The Value Driver Model.” Accessed January 17, 2016. Available from https://www.unglobalcompact.org/take-action/action/value-driver-model.

NewWorld Capital Group, LLC. 2014. “The Rise of Environmental Business Markets.” Accessed January 23, 2016. Available from http://www.newworldcapital.net/resource-library/publications-and-speeches-by-the-newworld-team/.

NewWorld Capital Group, LLC. 2015. “Impact Investing: Trading Up, Not Trading Off.” Accessed January 23, 2016. Available from http://www.newworldcapital.net/resource-library/publications-and-speeches-by-the-newworld-team/.

Ocean Tomo. 2010. “Components of S&P 500 Market Value.” Accessed January 17, 2016. Available from http://www.oceantomo.com/2013/12/09/Intangible-Asset-Market-Value-Study-Release/.



Richard Fuller is leading the Global Commission on Pollution, Health, and Development with Philip Landrigan (Dean for Global Health and professor of preventive medicine and pediatrics, Icahn School of Medicine at Mount Sinai). Richard is the founder and president of Great Forest, Inc., a leading sustainability consultancy in the United States, and is an environmentalist best known for his work in global pollution remediation. He led the formation of the Global Alliance on Health and Pollution and is also the founder and president of Pure Earth (formerly the Blacksmith Institute), which is considered one of the world’s leading experts on toxic issues. To date, Pure Earth has remediated more than 75 toxic sites worldwide, changing the lives of over four million people, including one million children. In 2011, he received the UN-backed Green Star Award on behalf of the NGO. In 2014, the UN Dispatch stressed Fuller’s work in helping to shape the Sustainable Development Goals and broaden the scope of toxic pollution recognized by the goals. He recently published The Brown Agenda, in which he details the importance of the overlooked problem of pollution, his journey to the creation of Pure Earth, and specific ways in which anyone can help combat brown sites all over the world. Fuller created a number of initiatives that established a model for global pollution cleanup.

Alexander Preker is the president and CEO of the Health Investment & Financing Corporation in New York. Mr. Preker is one of the commissioners for the Global Commission on Pollution, Health, and Development and is the chair of the External Advisory Committee for the WHHSJ of the International Hospital Federation. From 2007 to 2012, Mr. Preker was head of the Health Industry Group and Investment Policy for the International Finance Corporation. Previously, he was chief economist for the health sector in the World Bank Group. Mr. Preker has published extensively, having written many scientific articles and over 15 books. Mr. Preker is an executive scholar and adjunct associate professor at the Icahn School of Medicine at Mount Sinai in New York, an adjunct associate professor of public policy at New York University’s Robert F. Wagner Graduate School of Public Service, and an adjunct associate professor for Health Care Management at the Mailman School of Public Health at Columbia University. His training includes a PhD in economics from the London School of Economics and Political Science, a fellowship in medicine from University College London, a diploma in medical law and ethics from King’s College London, and an MD from University of British Columbia/McGill.

Diane-Charlotte Simon is an associate investment analyst with a particular expertise in the environmental and health sectors at a firm investing in private companies in New York. She gained an extensive understanding of the various concepts related to sustainability and their related financial opportunities and threats while preparing for the certification on the Fundamentals of Sustainability Accounting, (FSA level 1), developed by the Sustainable Accounting Standards Board (SASB), and while writing her thesis. In this context, she interviewed 15 sustainability experts, including nine senior executives of Fortune 500 companies in the United States, France, and India. She is an advocate for impact investing, and contributed to the organization of the Conscious Investor Summit. She has also developed a good knowledge of the dynamics of both advanced economies and emerging countries, having worked in finance and for start-ups in the United States, Europe, and Asia. Simon graduated summa cum laude from two Master’s in Business Management programs, one in the United States (City University of New York) and one in France (Ipag Business School). She is a teaching assistant in economics, competition, and emerging markets at Columbia University and is part of the research team involved in the Global Commission on Pollution, Health, and Development.



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