Every day, about 18,000 people around the world die prematurely due to indoor and outdoor air pollution. In a year, that’s 6.5 million deaths, according to a first-of-its kind report released yesterday (June 25) by the International Energy Agency.

The independent energy security organization, which works with 29 countries including the United States, makes a connection between our reliance on fossil fuels, air pollution and serious illnesses including lung cancer, heart disease and even pneumonia for children younger than 5. When burnt, fossil fuels such as oil and coal release toxic fine particulate matter, sulfur dioxide and nitrogen oxides into the atmosphere.

People in developing regions, especially throughout Asia and sub-Saharan Africa, face the worst of it because they rely on outdated fuel sources that create smoky environments such as wood. Around 3.5 million premature deaths a year are linked to this kind of pollution.

While the United States is a rich, infrastructure-heavy country, air pollution remains rampant. Forty-one percent of the U.S. population has lower air quality than federally mandated. While air pollution is on the decline in the country, the report says the U.S. still needs to push its fossil-fuel based energy sector toward solar and renewable energy.

In the report, air pollution is listed as the “fourth greatest overall risk factor for human health worldwide”—after high blood pressure, dietary risks and smoking. And at 6.5 million deaths per year, air pollution kills more people than HIV/AIDS, tuberculosis and road injuries combined. 

Read the full report here.