Academic journal article Environmental Health Perspectives

Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions

Academic journal article Environmental Health Perspectives

Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions

Article excerpt

OBJECTIVE: Nearly all China's rural residents and a shrinking fraction of urban residents use solid fuels (biomass and coal) for household cooking and/or heating. Consequently, global meta-analyses of epidemiologic studies indicate that indoor air pollution from solid fuel use in China is responsible for approximately 420,000 premature deaths annually, more than the approximately 300,000 attributed to urban outdoor air pollution in the country. Our objective in this review was to help elucidate the extent of this indoor air pollution health hazard.

DATA SOURCES: We reviewed approximately 200 publications in both Chinese- and English-language journals that reported health effects, exposure characteristics, and fuel/stove intervention options.

CONCLUSIONS: Observed health effects include respiratory illnesses, lung cancer, chronic obstructive pulmonary disease, weakening of the immune system, and reduction in lung function. Arsenic poisoning and fluorosis resulting from the use of "poisonous" coal have been observed in certain regions of China. Although attempts have been made in a few studies to identify specific coal smoke constituents responsible for specific adverse health effects, the majority of indoor air measurements include those of only particulate matter, carbon monoxide, sulfur dioxide, and/or nitrogen dioxide. These measurements indicate that pollution levels in households using solid fuel generally exceed China's indoor air quality standards. Intervention technologies ranging from simply adding a chimney to the more complex modernized bioenergy program are available, but they can be viable only with coordinated support from the government and the commercial sector.

KEY WORDS: burden of disease, cancer, household fuels, improved stoves, indoor air pollution, poisonous coals, respiratory disease. Environ Health Perspect 115:848-855 (2007). doi:10.1289/ehp.9479 available via [Online 27 February 2007]


Although some areas of China are becoming more urban, more than 60% of the population is still rural, most of which still uses biomass (mainly wood and crop residues) and coal fuels that produce substantial pollution in simple stoves. In 2003 approximately 80% of the energy consumed by rural households was in the form of biomass and almost 10% as coal. Furthermore, although most Chinese cities have plans to eliminate coal for households, many urban communities continue to rely on coal. The combustion of biomass and coal (collectively called "solid fuels") is the dominant source of indoor air pollution (IAP) in the country and contributes significantly to the total burden of ill health.

In the most recent global analysis of the health effects of major risk factors, the World Health Organization (WHO) estimated that solid fuels used in Chinese households cause approximately 420,000 premature deaths annually; this is 40% more than the approximately 300,000 premature deaths attributed to outdoor air pollution in Chinese cities with populations of more than 100,000 (Cohen et al. 2004; Smith et al. 2004). Household use of solid fuels is thus estimated to be the largest single environmental risk factor and ranks sixth among all risk factors examined for ill-health (Figure 1; Smith et al. 2005). These risk estimates, however, were based primarily on studies in other countries because, as discussed in this review, few epidemiologic studies have been conducted in China on biomass smoke compared with those conducted on coal smoke.

In the 1980s China conducted more IAP measurements focused on household combustion than all other developing countries combined. Indeed, by the early 1990s, the results of more than 100 published studies were combined into a WHO database (Sinton et al. 1996). In contrast, the Chinese environmental health community conducted few IAP measurements in the 1990s (Saksena et al. 2003), but epidemiologic studies of coal smoke, mainly on cancer end points, continued and have resulted in a large body of evidence. …

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