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The prestigious British medical journal The Lancet just released a sobering report on the world’s dangerous problem of pollution.

In an editorial about that report, Lancet editors Pamela Das and Richard Horton accused U.S. Environmental Protection Agency Administrator Scott Pruitt and his agency of “undermining established environmental regulations.”

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This criticism of a climate change denier in bed with the polluting industries his agency is meant to regulate is a shot across the bow, warning that the rest of the world no longer views the United States under the administration of Donald Trump as a leader on world environmental, economic, and health issues.

The Lancet report notes that pollution is the “largest environmental cause of disease and premature death in the world today, responsible for an estimated 9 million premature deaths in 2015, or 16% of all deaths globally. That is “three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence.”

Citing the report, DW notes that environmental pollution kills more people each year than smoking, hunger, or natural disasters. An overwhelming majority of these deaths (92%) occur in low– and middle–income countries. But in countries of all income levels, disease–causing pollution “is most prevalent among minorities” and marginalized communities, the report states. Children, it noted, are at high risk for diseases caused by pollution.

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While pollution also damages the economies of low– and middle–income countries, in higher–income countries like the U.S., it is responsible for 1.7% of annual health spending. This reality is coupled in the U.S. by relentless attempts by the president and the Republican Party to take away healthcare from millions of people, including many who belong to these same demographic groups.

Another highlight of the Lancet’s report is its focus on chemical pollution, including pesticides. Shockingly, about 140,000 new chemicals and pesticides have been manufactured since 1950, and the 5,000 or so that are produced in the greatest volume “have become widely dispersed in the environment and are responsible for nearly universal human exposure.” Yet, fewer than half of these have been tested for safety and toxicity.

“The result is that chemicals and pesticides whose effects on human health and the environment were never examined have repeatedly been responsible for episodes of disease, death, and environmental degradation,” the report states.

In recent years, much of this chemical production has been moved to low– and middle­–income countries “where public health and environmental protections are often scant.”

In the U.S., the effect of Pruitt’s efforts to destroy the nation’s environmental regulatory house from within doesn’t resonate only within this country, however—the impact is global. And this is part of the reason why The Lancet is calling Pruitt out ahead of the upcoming U.N. Environment Assembly in Kenya, in December. The theme of that conference is “Towards a Pollution-Free Planet.” But what, exactly, will Pruitt contribute?

Earlier this month, Pruitt stood before an audience of coal miners in Kentucky and told them he would override the Obama–era Clean Power Plan, which restricts carbon emissions from power plants. “The war on coal is over,” he declared.

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U.S. power plants account for almost 40% of the country’s total carbon emissions. The Clean Power Plan, which has only been in effect for less than two years, would have reduced emissions in the power industry by 32% by 2030.

Before that, last June, Pruitt walked away from a meeting of environment ministers from the Group of Seven who were discussing ways to mitigate climate change. Pruitt left that summit after only a few hours, attending only a single meeting.

At the time of Pruitt’s announcement to rescind the Clean Power Plan, Sierra Club Executive Director Michael Brune said that Trump and Pruitt would “go down in infamy for launching one of the most egregious attacks ever on public health, our climate, and the safety of every community in the United States,” DW reported.

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This latest salvo from The Lancet in light of the upcoming environment ministers’ conference isn’t surprising. But it is deeply troubling, and it should serve as a wakeup call for those left who still view this administration as acceptable or normal.

Read the entire Lancet report here (registration required).