Investment case for air and water pollution reduction in Uganda

Background The World Health Organization estimates that 99% of the population breathes polluted air, while 2 billion people live in water-stressed countries. Uganda faces environmental health risks linked to population growth, urbanisation, and dependence on biomass fuels. Ambient air pollution (AAP) and water pollution contribute to morbidity and premature mortality, yet their economic impacts remain inadequately quantified. Methods A static pollution–disease model combined PM₂.₅ monitoring data, disease burden estimates, and meta-regression exposure–response functions. Water pollution impacts were derived from Summary Exposure Values for unsafe water, sanitation, and hygiene. Economic costs included healthcare expenditure, productivity losses, and premature mortality valued using the value of a statistical life. Six intervention scenarios were evaluated over a 15-year horizon. A ROI was estimated for one scenario, while break-even thresholds were derived for remaining scenarios. Results AAP was associated with 608,907 incident cases and 7,378 deaths annually, costing USD 1.48 billion annually. Water pollution caused 45.8 million cases and 8,961 deaths, costing USD 2.86 billion annually. Replacing biomass cookstoves with electric stoves for 20% of households yielded an ROI of 19.5. Conclusion Pollution imposes a major, preventable burden. Investments in clean energy and WASH infrastructure could mitigate high economic and public health costs.