Collateral Damage
The Hidden Cost of Living in a Toxic World
When I was a 23-year-old physician at the VA hospital in Little Rock, Arkansas, I became friends with two patients who I had diagnosed with lung cancer. Both died from an entirely preventable disease. That was the first time I questioned how we talk about disease. We blame the patient—bad habits, bad luck, bad genes. Meanwhile—industries pollute, market harm, and call it business. This article is for those two veterans, and for the millions who have died from causes we’d rather not name. It’s a theme I’ll return to often.
Ask any search engine, “What are the leading causes of death?” and you'll get a tidy list of clinical diagnoses: heart disease, cancer, stroke, diabetes, and so on. As if life were a neutral biological experiment that ends when a part malfunctions.
But what if these aren't really causes—just conclusions? What if cancer isn’t the villain, but the final chapter in a much longer story that began with pesticides or factory fumes? What if a heart attack is just the final punctuation mark at the end of a long sentence written in polluted air or a diet of heavily processed foods?
In truth, millions of people die each year from causes that aren’t mysterious or random. They’re just uncomfortable to talk about. They’re the collateral damage of how we live.
Ella’s Story: A Breath Taken
Consider Ella Kissi-Debrah, a bright 9-year-old girl from southeast London. She lived 25 meters from a major road and died in 2013 after a series of severe asthma attacks.
Her mother, Rosamund, fought for seven years to get the cause of death properly recognized. In a landmark ruling, a UK coroner finally identified air pollution as a cause of her death—the first such ruling in British history.
Ella’s lungs didn’t just give out. They failed in a city that allowed illegal levels of nitrogen dioxide and particulate matter. And while she was the first to have air pollution officially listed on her death certificate, she is far from alone. Around 40,000 people in the UK die every year from polluted air.
Their deaths, like Ella’s, are not just personal tragedies. They are public failures.
Reframing the Real Causes
We call them “chronic diseases”, as if they’re the price of living too long. Or we chalk them up to weak genes, or poor choices. But most of these diseases aren’t natural—they’re manufactured. We just dress them up as lifestyle choices and quietly shift the blame onto individuals.
We rarely say this person died because of toxic exposures, or aggressive marketing, or unjust policies. Instead, we reach for the downstream diagnosis and ignore the upstream system that caused it. Maybe it’s easier that way.
The Price of Denial
Now imagine saying,
“My father died because of air pollution.”
“My daughter’s asthma was caused by our zoning policies.”
“My mother died from breast cancer caused by her in utero DDT exposure.”
Uncomfortable, isn’t it? It’s easier to say, “heart failure” or “chronic illness”. That way we can keep spending trillions treating diseases we could have prevented—if only we’d been honest about what caused them.
We build the hospitals, prescribe the medications, celebrate the survivors—but never fix the systems that made them sick.
It’s as if the bathtub overflowing, and instead of turning off the tap, we grab a mop.
We tell ourselves people die from diseases of aging or genetic roulette. But the truth is more disturbing.
Toxic air. Processed food. Unsafe water. Predatory marketing to children.
These deaths aren’t random. They’re regulatory failures. They are, quite literally, collateral damage.
The Top 10 Actual Causes of Death
Out of 60 million deaths worldwide each year, 64% are linked to preventable diseases.
Let that sink in: two out of every three people aren’t dying from fate. They are dying from choices—just not their own.
Naming What Really Kills
Some will say this oversimplifies things. “It’s complicated, they’ll insist. And sure, complexity is real. Ella’s asthma didn’t arise from just one source.
But using complexity as an excuse for inaction is dishonest. It’s like saying, “Sure, the bullet hit the heart—but there were preexisting conditions.”
Naming upstream causes doesn’t ignore nuance. It brings clarity—and accountability.
A Path Forward
The good news? We know what to do.
Regulate air and water quality.
Ban or limit toxic exposures.
Design healthier, walkable cities.
Hold polluters accountable.
Protect children from junk food and cigarette marketing.
Yes, it means disrupting industries that profit from pollution. Yes, it means challenging political systems that protect them. And yes, it means reimagining the modern world from the sidewalk up.
It’s Not Just About Dying
It’s about what we’re willing to tolerate—and who we’re willing to sacrifice—for comfort, for profit, or convenience.
In his poem, The Questionnaire, Wendell Berry asked:
How much poison are you willing
to eat for the success of the free
market and global trade? Please
name your preferred poisons.
Ella didn’t choose her street. Most people don’t choose the air they breathe or the water they drink. But they live—and often die—with the consequences.
Let’s stop calling these “natural causes.”
Let’s start calling them what they are: collateral damage.