Every year, the American Lung Association compiles a list of the top cities with the most polluted air in the U.S.

These 23 cities contain dangerously high levels of ozone and particle pollution, a leading cause of serious health conditions and potential death.

Bakersfield currently ranks second on the list.

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In fact, a 2013 study from MIT found that around 200,000 early deaths in the U.S. were caused by polluted air. The World Health Organization estimates that 4.6 million people die each year from causes directly attributable to air pollution, according to Science Daily.

“We drink clean water, we try to eat clean food. Why would you breathe dirty air?” says Alen Corporation CEO Warburg Lee on the importance of clean air. “Life is too precious to breathe bad air.”