The demand for more food is increasing fertilizer and land use, and the demand for more energy is increasing fossil fuel combustion, leading to enhanced losses of reactive nitrogen (N
r
) to the environment. Many thresholds for human and ecosystem health have been exceeded owing to N
r
pollution, including those for drinking water (nitrates), air quality (smog, particulate matter, ground-level ozone), freshwater eutrophication, biodiversity loss, stratospheric ozone depletion, climate change and coastal ecosystems (dead zones). Each of these environmental effects can be magnified by the ‘nitrogen cascade’: a single atom of N
r
can trigger a cascade of negative environmental impacts in sequence. Here, we provide an overview of the impact of N
r
on the environment and human health, including an assessment of the magnitude of different environmental problems, and the relative importance of N
r
as a contributor to each problem. In some cases, N
r
loss to the environment is the key driver of effects (e.g. terrestrial and coastal eutrophication, nitrous oxide emissions), whereas in some other situations nitrogen represents a key contributor exacerbating a wider problem (e.g. freshwater pollution, biodiversity loss). In this way, the central role of nitrogen can remain hidden, even though it actually underpins many trans-boundary pollution problems.