Nearly 11 million people died from diet-related diseases last year, according to a new study published in the international medical journal The Lancet. That amounts to 22 percent of all deaths among adults.

The researchers analyzed data from 195 countries over the past three decades and found that high intake of unhealthy foods, such as red meat and sugary drinks, combined with low intake of healthy ones, such as fruits, vegetables, legumes, and whole grains, proved more harmful to human health than tobacco, high blood pressure, air pollution, or any other risk factor. This sort of diet may call to mind the standard American diet, but it’s not unique to the United States (which came in 43rd place in the study’s ranking of countries by lowest rates of diet-related deaths).

“Poor diet affects everybody, regardless of age, gender, or socioeconomic status,” says lead author Ashkan Afshin, an assistant professor at the Institute of Health Metrics and Evaluation (IHME) at the University of Washington. “We did not find a single country that consistently performs better in all aspects of diet. The challenge is, even if people want to eat healthy foods, there might be other factors that limit access to them.”

Indeed, dietary habits are rarely simple matters, notes Afshin. Research shows that the less affordable fruits and vegetables are, the more people tend to forgo them. Meanwhile, massive marketing campaigns promote processed foods high in sodium, sugar, and fat, with few government policies in place to educate and advocate for more nutritious options. “This is not just about individual choices,” says Afshin. “Different groups—the government, the food industry, the stakeholders—need to work together to address this problem.”

The takeaway: Improving nutrition worldwide will undoubtedly require large-scale coordinated efforts to increase accessibility and affordability, but you can take action at home by eating more fruits, vegetables, and other good-for-you staples of a whole-food, plant-based diet.

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