Solve pollution. Save lives. Protect the planet.

Research Initiatives

Pure Earth maintains a geo-referenced database of over 3,000 sites in about 50 countries. The organization focuses on quantifying the health impacts and economic burden of toxic pollution in low- and middle-income countries and is particularly interested in researching how various interventions can improve public health and economic outlook. Scientific and scholarly research papers that assess the scope of contaminated sites regionally or on a large scale are complemented with smaller, more targeted case studies. Current research efforts involve quantifying the burden of disease from point source pollution through various well-developed metrics such as Disability-Adjusted Life Years (DALYs) and IQ decrement. Some of our recent and ongoing research projects are listed below.

Major Publications & Reports

Data from Pure Earth’s Toxic Sites Identification Program (TSIP) has been used in the publication of several research papers, as well as quoted in a number of other publications. Click here to see a list of publications and papers (including scientific articles and reports) from Pure Earth (formerly Blacksmith Institute) and partners.

About Population Methodology:

When reviewing TSIP sites that are not yet approved, investigators are asked to review ‘population estimate explanation’ to check that the reasoning behind the population estimate is sound.  Examples of sound population estimate include  census data, satellite data (counting houses and estimating population), other facts/figures (i.e. if a school yard is contaminated, reviewing the number of students who play there on average).  Local knowledge or staff expertise can also be considered valid if other methods have been exhausted. Soil, air, or water migration should be explained.

For sites with populations higher than 20,000, review  will rely on staff expertise (i.e. for Latin America, Daniel in Mexico, Amalia in Uruguay, and Gaspar in Argentina) since they have visited many of the sites. For soil, investigators can use Google Earth or other satellite data to approximate the correct number of people in a ½ km radius of the site (based on numbers of houses), since soil migration can be assumed at no more than 0.5 kms. Water depends on the source (i.e. lake, river, etc) and counting the number of people that are exposed via all pathways (dermal, ingestion, etc). Estimating the number of people at risk from contaminated air is the most difficult because significant migration can occur. However, these represent only a handful of samples in the TSIP database and will rely on best known methods.


Dr. Howard Hu, Pure Earth board member, explains the latest related to the science surrounding lead exposures:
Assessing and Addressing Lead Exposure in Low- and Middle-Income Countries”

Major Publications & Reports

Data from Pure Earth’s Toxic Sites Identification Program (TSIP) has been used in the publication of several research papers, as well as quoted in a number of other publications.


Rapid assessment of mercury contaminated sites

Bovine lead exposure from informal battery recycling in India

Diminishing benefits of urban living for children and adolescents’ growth and development


Reducing disease and death from Artisanal and Small-Scale Mining (ASM)- the urgent need for responsible mining in the context of growing global demand for minerals and metals for climate change mitigation


Piloting Risk Mitigation at a Lead Contaminated Site in Bangladesh Oct. 12, 2021

Child lead exposure near abandoned lead acid battery recycling sites in a residential community in Bangladesh: risk factors and the impact of soil remediation on blood lead levels, Jan. 4, 2021

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019. Lancet Planetary Health. Jan 1, 2021


Consequences of a Mobile Future: Creating an Environmentally Conscious Life Cycle for Lead-Acid Batteries, World Economic Forum, Dec. 16, 2020.

Elevated Levels of Lead (Pb) Identified in Georgian Spices, Annals of Global Health, Sept. 28, 2020, Authors: Bret Ericson , Levan Gabelaia, John Keith, Tamar Kashibadze, Nana Beraia, Lela Sturua, Ziad Kazzi.

Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries, Feb/April 2020. Authors: Lauren Zajac , Roni W Kobrosly, Bret Ericson, Jack Caravanos, Philip J Landrigan, Anne M Riederer


Reporte nacional de niveles de plomo en sangre y uso de barro vidriado en población infantil vulnerable (National report of lead levels in blood and use of lead-glazed potteryin vulnerable children), download pdf, Salud Publica (Public Health Mexico), Dec. 2019. Téllez-Rojo MM, Bautista Arredondo LF, Trejo Valdivia B, Cantoral A, Estrada Sánchez D, Kraiem R, Pantic I, Rosa Parra A, Gómez-Acosta LM, Romero Martínez M, Cuevas-Nasu L, Shamah-Levy T, Fuller R, Tamayo and Ortiz M.

Toxic Site Identification Program in Azerbaijan, Environmental Management, December 2019, Volume 64, by Rovshan Abbasov, Chelsea L. Cervantes de Blois, Petr Sharov, Alena Temnikova, Rovshan Karimov, Gunay Karimova

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors. Environmental Health Perspectives. Shaffer R, Sellers S, Fuller R, et al. Oct 2019; 127(10).

Rethinking Aid Allocation: Analysis of Official Development Spending on Modern Pollution Reduction. Annals of Global Health. Swinehart S, Fuller R, Kupka R, Conte MN. 2019; 85(1): 132, 1–11. DOI:

Poster: Education and Remediation Efforts to Reduce Mercury Use and Contamination in the ASGM sector of Puno and Madre de Dios, 2019.

Remediation of soil contaminated with persistent organic pollutants in Sumgait, Azerbaijan. Environmental Monitoring Assessment. Sharov P, Abbosov R, and Temnikova A. June 2019; 191.

Assessment of the prevalence of lead-based paint exposure risk in Jakarta, Indonesia. Science of The Total Environment.  Ericson B, Hariojati N, Susilori B, Fisher Crampe L, Fuller R,  Taylor MP,  and Caravanos J. March 2019; 657.

Pollution and children’s health. Science of the Total Environment. Landrigan P, Fuller F, et al. Feb 2019; 650(2).

Pollution Knows No Borders. Pure Earth Report. Jan 2019.


Editorial: Pollution, the health scourge of the 21st century. World Hospitals and Health Services. Fuller R, Landrigan R, Preker A. 2018; 54(4).

Pollution and global health: A time for action. World Hospitals and Health Services. Fuller R, Landrigan R and Preker A. 2018; 54(4).

Pollution prevention and climate change mitigation: measuring the health benefits of comprehensive interventions. Lancet Planetary Health. Landrigan P,  Fuller R, Haines A, Watts N and McCarthy G. Dec 2018; 2.

A meta-analysis of blood lead levels in India and the attributable burden of disease. Environmental International. Ericson B, Dowling R, Dey S, Caravanos J, Mishra N, Fisher S, Ramirex M, Sharma P, McCartor A, Guin P, Taylor M and Fuller R. Dec 2018; 121(1).

Lead intoxicated children in Kabwe, Zambia. Environmental Research. Bose-O’Reilly S, Yabe J, Makumba J, Schutzmeier P, Ericson B, Caravanos J. Aug 2018; 165.

Pollution and non-communicable disease: time to end the neglect. The Lancet Planetary Health. Fuller R, Rahona E, Fisher S. March 2018; 2(3).

Cost effectiveness of environmental lead risk mitigation in low‐ and middle‐income countries. (download pdf) GeoHealth. Ericson B, Caravanos J, et al. Feb 2018: 2(2).

Improving human health outcomes with a low-cost intervention to reduce exposures from lead acid battery recycling: Dong Mai, Vietnam. Environmental Research. Ericson B, Duong T, et al. Feb 2018; 161.


Lancet Commission on Pollution and Health. The Lancet. Oct 2017; 391(10119).

A meta-analysis of blood lead levels in India and attributable burden of disease Conference Paper: International Conference of the Public Health Foundation of India and the Pacific Basin Consortium. New Delhi, India. Nov 2017.

Pérdida de coeficiente intelectual en hijos de alfareros mexicanos (Intelligence quotient loss in Mexican pottery artisan’s children). Revistamedica. May 2017

Global burden of disease of mercury used in artisanal small-scale gold mining. Annals of Global Health. Stecking N, Tobollik M, Plass D, et al. Mar 2017; 83(2).

Disability weights for chronic mercury intoxication resulting from gold mining activities: Results from an online pairwise comparisons survey. Environmental Research and Public Health. Steckling N, Devleesschauwer B, Winkelnkemper J, et al. Jan 2017; 14(1).


Estimating the prevalence of toxic waste sites in low- and middle-income countries. Annals of Global Health. Dowling R, Caravanos J, Grigsby P, Rivera A, Ericson B, et al. Sept 2016; 82(5).

The global burden of lead toxicity attributable to informal used lead-acid battery sites. (download pdf) Annals of Global Health. Ericson B, Landrigan P, Taylor MP, Frostad J, Caravanos J, Keith J, Fuller R. Sept 2016; 82(5).

Risk factors for children’s blood lead levels in metal mining and smelting communities in Armenia: a cross-sectional study. BMC Public Health. Grigoryan R, Petrosyan V, Melkomian D, et al. Sept 2016; 16.

Burden of disease resulting from lead exposure at toxic waste sites In Argentina, Mexico and Uruguay. Environmental Health. Caravanos J, Carrelli J, Dowling  R, Pavilonis B, Ericson B, Fuller R. June 2016; 15(72).  (Infographic)

  • Though lead contaminated waste sites have been widely researched in many high-income countries, their prevalence and associated health outcomes have not been well documented in low- and middle-income countries.

Protecting communities by remediating polluted sites worldwide. Institution of Civil Engineers – Civil Engineering. Hanrahan D, Ericson B, Caravanos J. May 2016; 169(5). (pdf)

Pollution, health and development: The need for a new paradigm. Reviews in Environmental Health. Landrigan J, Fuller R. Mar 2016; 1.

The prevalence of toxic hotspots in former soviet countries. Environmental Pollution.  (Sharova P, Dowling R, Gogishvili M, Jones B, Caravanos J, McCartor A, Fashdan Z, Fuller R. Apr 2016; 211.

  • Pollution in eight former Soviet countries poses a health risk to 6.2 million residents. The most commonly found key pollutants are pesticides, lead, arsenic, and cadmium. The majority of sites can be traced to Soviet legacy pollution.

An assessment of the potential presence of carcinogenic materials at non-military industrial sites In Vieques, Puerto Rico. Jack Caravanos, DrPH, CIH Professor, Environmental Health City University of New York, School of Public Health.


Spatial Associations Between Contaminated Land And Socio Demographics In Ghana,” International Journal of Environmental Research and Public Health (Oct 2015). Russell Dowling, MPH, Bret Ericson, MSc, Jack Caravanos, DrPH, CIH, Patrick Grigsby, BBA, and Yaw Amoyaw-Osei, MSc.

Global Health and Environmental Pollution International Journal of Public Health (2015). PDF. Philip J. Landrigan , Richard Fuller

  • This was part of the special issue “Driving the Best Science to Meet Global Health Challenges” edited on the occasion of the 9th European Congress on Tropical Medicine and International Health 2015.

Children’s Health in Latin America: The Influence of Environmental Exposures.” Environmental health perspectives (2015). Laborde, Amalia, et al.

  • Industrial development and urbanization are proceeding rapidly in Latin America, and environmental pollution has become widespread. Environmental threats to children’s health include traditional hazards such as indoor air pollution and drinking-water contamination; the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury, arsenic, and pesticides; hazardous and electronic waste; and climate change.

Exposición a plomo: una tarea pendiente en México.” Salud Pública de México 2 (2015): 115-116.  Téllez-Rojo, Martha and Caravanos, Jack.

  • This article is a letter to the editor of the Journal of Public Health of Mexico that cites data from the 2014 publication “Blood Lead Levels in Mexico and Pediatric Burden of Disease Implications” in order to raise awareness of the issue of lead exposure and child health in Mexico.


Environmental pollution: An enormous and invisible burden on health systems in low- and middle-income countries. World Hospitals and Health Services. Landrigan P, and Fuller R. 2014; 4.

  • We find that diseases caused by pollution increase health care costs, especially for high-cost NCDs. They impose an unnecessary load on health care delivery systems and undermine the development of poor countries by reducing the health, intelligence and economic productivity of entire generations. Pollution is highly preventable and pollution prevention is highly cost-effective.

The pediatric burden of disease from lead exposure at toxic waste sites in low and middle income countries. Environmental Research Chatham-Stephens K, Caravanos J, Ericson B, Landrigan P,  Fuller R. July 2014; 132.

  • This paper found that elevated soil and water lead levels at 200 toxic waste sites are affecting nearly 800,000 children under age 4, and predicted blood lead levels that lower intelligence levels, likely resulting in limited individual and country development.

A Simplified Risk-Ranking System for Prioritizing Toxic Pollution Sites in Low-and Middle-Income Countries. Annals Of Global  Health.  Caravanos J, et al. 2014; 4.

  • The aim of this study was to describe the simple but effective approach taken by Blacksmith Institute’s Toxic Sites Identification Program to quantify and rank toxic exposures in low- and middle-income countries.

Blood Lead Levels in Mexico and Pediatric Burden of Disease Implications. Annals Of Global Health.  Caravanos J, et al. 2014; 4.

  • This article provides an extensive historical review and analysis of available blood lead levels in Mexican populations. Reviewing all relevant studies, the geometric means of Mexican BLLs in urban and rural areas were found to be 8.85 and 22.24 ug/dL, respectively. Since the phase-out of leaded gasoline, the mean in urban areas was found to be 5.36 ug/dL and the average in rural areas is expected to be much higher.

Niveles de Plomo en Sangre en México y su Implicación para la Carga Pediátrica de la Enfermedad. Annals Of Global Health. Caravanos J, et al. 2014; 4.

  • Este artículo proporciona una extensa revisión histórica y análisis de los niveles de plomo de sangre disponibles en poblaciones mexicanas. Una media geométrica calculada entonces fue utilizada para evaluar el efecto del plomo sobre la carga de morbilidad pediátrica.

A comparison of burden of disease from toxic waste sites with other recognized public health threats in India, Indonesia and the Philippines. Journal of Health Pollution. Caravanos J, et al. 2014;4.

  • We compared the burden of disease from toxic waste sites expressed in disability-adjusted life-years (DALYs) with the same measurement for other threats in India, Indonesia and the Philippines. We used Blacksmith Institute for a Pure Earth’s DALY estimates for chemical exposure at 373 toxic waste sites in the 3 countries and World Health Organization (WHO) DALY estimates for different health conditions in the same countries.

Environmental pollution and occupational health in a changing world. Annals Of Global Health. Landrigan P,  Fuller F.2014.

  • Environmental pollution is the main cause of disease and death in the developing world. In 2012, exposures to polluted soil, water, and air resulted in an estimated 8.4 million deaths worldwide. By comparison, HIV/AIDS is responsible for 1.5 million deaths annually and malaria and tuberculosis less than 1 million each. More than 1 in 7 deaths globally are the result of environmental pollution.

Notes from the field: Severe environmental contamination and elevated blood lead levels among children—Zambia, 2014. Morbidity and mortality weekly report. Caravanos J, Fuller R, Robinson S. 2014; 63(44).

  • This article reviews the extent of lead exposure and contamination in Kabwe, Zambia by analyzing blood lead levels of local children. The researchers used capillary blood from children’s fingers. The mean blood lead level (BLL) was 48.3 micrograms per deciliter (µg/dL) of whole blood. The lowest BLL measured was 13.6 µg/dL. The upper BLL of detection by the testing system is 65.0 µg/dL; 26.5% of readings exceeded that limit. The upper value for the CDC reference range for BLLs in children is 5 µg/dL.

“Hazardous Waste and Toxic Hotspots.” Textbook of Children’s Environmental Health. New York: Oxford, 2014. 254-61. Fuller, Richard.


Rapid assessment of environmental health risks posed by mining operations in low- and middle-income countries: Selected case studies. Environmental Science and Pollution Research. Caravanos J, Ericson B, Ponce-Canchilhuaman J, Hanrahan D, et al. Nov. 2013.

Approaches to systematic assessment of environmental exposures posed at hazardous waste sites in the developing world: the Toxic Sites Identification Program.  Caravanos J, Ericson B, Chatham-Stephens K, Landrigan P, Fuller R. 2013; 185(2).

  • This paper discussed the TSIP approach and was instrumental in lending credibility to the TSIP project and its data.

Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010 Environmental Health Perspectives. Chatham-Stephens K, Caravanos J, Ericson B, Sunga-Amparo J, Susilorini B, Sharma B, Landrigan P, Fuller R. 2013.

  • This article found that the burden of disease, measured in Disability Adjusted Life Years (DALYs) at 373 toxic sites assessed in India, Philippines, and Indonesia was similar to that of malaria, or outdoor air pollution.

How to mitigate mercury pollution in Tanzania. Journal of Environmental Protection. Appel P, Na-Oy L. May 2013; 4(1).


The burden of disease from pediatric lead exposure at hazardous waste sites in 7 Asian countries. Environmental Research.  Caravanos J, Chatham-Stephens K, Ericson B, Landrigan P,  Fuller R. 2012.

  • This paper published data on pediatric lead exposures in three south Asian countries, using TSIP data.

Outbreak of fatal childhood lead poisoning related to artisanal gold mining in Northwestern Nigeria, 2010. Environmental Health Perspectives. Apr 2012.pdf


Regulatory Best Practices for Remediation of Legacy Toxic Contamination. A Roadmap for Latin America. (Spanish version) Cyrus R. Vance Center for International Justice.

  • The report highlights policies and practices in Latin America that work to facilitate the clean up of toxic pollution, and offers six governing principles as models. It is available in English and Spanish.

Annual Report Series on the World’s Worst Polluted Places, released by Blacksmith Institute/Pure Earth and Green Cross Switzerland.  Access all reports at

  • 2016: The Toxics Beneath Our Feet
  • 2015 – The New Top Six Toxic Threats: A Priority List for Remediation
  • 2014 – Top Ten Countries Turning The Corner On Toxic Pollution
  • 2013 –  The World’s Top 10 Toxic Threats: Cleanup, Progress and Ongoing Challenges
  • 2012 – The World’s Top 10 Toxic Pollution Problems by Global Burden of Disease
  • 2011- The World’s Top Ten Sources of Pollution.
  • 2010 – Top Six Toxic Threats
  • 2009 – 12 Cases Of Cleanup and Success
  • 2008 – The World’s Worst Pollution Problems
  • 2007 – Top Ten Most Polluted Places

GAHP papers

Pure Earth/Blacksmith Institute summary for governments, NGOs and agencies (two-pages)

Pure Earth/Blacksmith Institute summary for for corporations (two-pages)

Borax:  Summary of health risks associated with using borax in artisanal and small-scale gold mining2013

Artisanal Gold Mining:  A Dangerous Pollution Problem

Environmental Contaminants and the Immune System (summary by Bruce D. Forrest, MD MBA)

The Effects of Toxic Pollution in the Developing World (1-page summary)

Economic Benefit of Pollution Clean-up (2-page summary), Jan. 2010

The Effects of Lead on Maternal and Child Health, 2009

Cost Effectiveness of Pollution Cleanup in Developing Countries, May 2007

China Country Strategy Document 2011-2014

Blacksmith Health and Pollution Fund Feasibility Study, 2011, Study, Annexes

Guixi Rice Paddy Remediation Pilot Study, Jianxi Province, China, Fall 2012