In one year, a population the size of New York City is exterminated through a global epidemic that is within our power to prevent: dirty air and water.

According to a major new study published in The Lancet, there were an estimated 9 million deaths worldwide in a single year, 2015, resulting from air and water pollution. Roughly 6.5 million of the deaths were due to airborne pollution, including emissions and toxins linked to respiratory and heart disease. The rest were primarily due to water pollution, resulting from both waterborne disease and poor sanitation.

While air and water pollution are reaching epidemic levels, the pathology at the root of the crisis isn’t medical but social: Poverty and inequality drive the industries that create poisoned habitats, unbreathable air, and catastrophic weather. According to the study, “92 percent of pollution-related deaths occur in low-income and middle-income countries.” What’s more, the study found that “the health effects of pollution are most frequent and severe among the poor and the marginalised.”

According to researcher Philip Landrigan, the main factors driving pollution are typically viewed as the cost of doing business in rapidly developing countries: “globalization of industry coupled with uncontrolled urbanization, the global spread of petroleum-powered motor vehicles and the proliferation of industrial, chemically intensive agriculture.” So the heaviest price for the pursuit of growth falls on the people who arguably benefit the least from their country’s drive for development.

Historically, pollution’s health and disease impacts have been tied to multinational investment in industries that pollute poorer regions through extractive oil and mining operations and export-driven manufacturing, such as South Africa’s toxic mining pits or monocrop plantation agriculture. Today, Landrigan observes, as “rapidly industrializing middle-income countries are aspiring to advance their own standard of living…a substantial fraction of their industrial production is for domestic consumption.” As more Chinese and Indian households adopt “Western” lifestyles, with rich diets and fast cars, they also generate more homegrown pollution.

On balance, however, global data shows that the populations that suffer the most are simply too poor to afford the resources and technology that rich (and high-polluting) countries have developed to insulate themselves from pollution’s worst effects.

Internally stratified economies reflect the same divides, and the United States is a microcosm of global environmental inequality. The overall US death rate from water and air pollution ranks in the middle among industrialized nations; here pollution causes about 483 deaths per million (a total of about 155,200 people in 2015)—a higher rate than Colombia’s, 413 per million, but lower than Germany’s and the United Kingdom’s, which each have more than 750 pollution-induced deaths per million.

But America’s landscape of environmental health risks is highly polarized, reflecting our society’s divisions in race, class, and geography. Often, demographics and ZIP code heavily influence when and how people will die. Poor communities of color, especially those with high unemployment and low education levels, face much higher exposure to disease from particulate air pollutants. According to the NAACP’s research, the percentage of African Americans in the fenceline zones near chemical plants is 75 percent greater than for the country overall; for Latinos, 60 percent.

So if you live near Columbus airport in Georgia, the local air is about four times dirtier than what you’d breathe on Martha’s Vineyard. And while most Americans safely enjoy clean tap water, children in Flint, Michigan, continue to face an epidemic of lead poisoning, much like many poor households in the Global South.

The watchdog organization Corporate Accountability (CA) argues that the study of pollution-death trends around the world mirrors patterns of corporate malfeasance. Writing from the UN climate talks in Bonn, CA Communications Director Jesse Bragg said the study shows that “those who did the least to create the climate crisis often pay the highest price, sometimes with their lives.”

The power asymmetry also played out in Bonn: adding insult to injury, the Trump administration dispatched coal-industry representatives to shill for “clean coal.” The “sick irony” of Trump’s intervention, Bragg adds, shows the United States is “ignoring not only the environmental impacts of coal and other fossil fuels but also disregarding the steep human toll…. The evidence is clear, fossil fuels are cooking our planet and taking lives in the process.”

But while carbon emissions keep soaring, polluters continue their hard sell for dirty fuels around the world, circumventing regulators in the process. Just in the United States alone, the Trump administration’s regulatory rollbacks have put the country on track to add the equivalent of about 63 new coal-fired power plants in a year. Calculating the total social cost of those rollbacks’ damage to soil and water, much less forcing them to pay for it, is a Sisyphean challenge.

But since emerging in the United States over 30 years ago, the environmental-justice movement has continually expanded the realm of possibility in holding polluters accountable: grassroots actions like petition drives to shut down local power plants and campaigns by frontline communities to tighten limits on waste dumping have reshaped the national regulatory framework. Meanwhile the Global South has exploded with movements led by indigenous communities, unions and farmers, using mass actions to pressure multinationals and governments to rein in polluting facilities, restore poisoned and deforested habitats, and drive investment in sustainable-energy sources.

The future of the global environmental-justice movement hinges on scaling up the “polluter pays” concept to meet the public-health pandemic of pollution for the next generation. While the Paris climate agreement offers a blueprint for coordinated global action on fossil fuels, the deal’s current rules and targets are generally framed around business interests, but neglect the disproportionate impacts of carbon emissions on marginalized groups that are most vulnerable to extreme weather and climate disruption.

Beyond the long-term challenge of global warming, the Lancet study also shows that today’s pollution-related death rates are typically the result of more immediate harms posed by industry, especially smog from local factories and congested traffic in cities.

To clean up both local and global pollution, social movements must radically restructure the whole environmental policy-making infrastructure to move toward an independent international regulatory regime, which can enforce rules across borders. Some environmental advocates are using the courts to invoke domestic and international laws against firms to ensure that, wherever they produce or pollute, they’re never beyond the reach of justice.

But justice also starts at home. Following Hurricane Harvey in September, which revealed Houston’s stark racial and class segregation, environmental-justice scholar Robert Bullard told Democracy Now! that a just recovery for frontline communities requires organizing and educating residents to redress their disparate environmental burdens:

We have to have strong community-based organizations on the ground with the capacity to assist and support families and households [to demand that] “…just because you don’t have a big bank account doesn’t mean that you should not be safe, that your community should not come back and that you should not have the same level of protection and the same level of importance as if you were a middle-class white neighborhood.”

The global pollution crisis is reaching a new flashpoint as the lethality of industrial pollution intersects with unbridled corporate growth. But the environmental-justice movement is evolving to meet the challenge as well, as movements converge around the objectives of economic advancement, democracy, and environmental equity as goals that have to be reached together, lest we end up with none. Achieving a sustainable balance of these elements requires a revolution in the way we govern our communities, and reimagining where our backyards and the global commons meet.