Academic journal article Environmental Health Perspectives

Health and Household Air Pollution from Solid Fuel Use: The Need for Improved Exposure Assessment

Academic journal article Environmental Health Perspectives

Health and Household Air Pollution from Solid Fuel Use: The Need for Improved Exposure Assessment

Article excerpt

Introduction

Nearly 3 billion people worldwide, and a great majority of households in developing countries, rely on solid fuels (such as wood, dung, crop residues, coal, and charcoal) with little or no access to modern fuels for cooking and other household energy needs (Lim et al. 2012; Smith et al. 2012). In these households, solid fuels are often burned in inefficient, poorly vented combustion devices (open fires, traditional stoves). The incomplete combustion of these solid fuels results in much of the fuel energy being emitted as potentially toxic pollutants, including particles of varying sizes, carbon monoxide (CO), nitrogen dioxide, volatile and semivolatile organic compounds (e.g., formaldehyde and benzo[a]pyrene), methylene chloride, and dioxins (Naeher et al. 2007). Combustion of coal, in addition to the above pollutants, releases sulfur oxides, heavy metals such as arsenic, and fluorine [World Health Organization (WHO) 2006]. The use of solid fuels, primarily for cooking, has been estimated to be responsible for > 3.5 million premature deaths per year (plus an additional 0.5 million deaths from outdoor air pollution due to household fuel use) and 110 million disability-adjusted life years (DALYs) (Lim et al. 2012).

Several large-scale initiatives are under way for the dissemination of cleaner-burning stoves (Martin et al. 2011); however, the stoves being disseminated may not achieve the desired exposure reductions and health benefits given the lack of robust exposure-response information. These high-profile efforts are building needed momentum and bringing financial support and attention to this important global health issue. For example, the Global Alliance for Clean Cookstoves (GACC) is a public-private partnership led by the United Nations Foundation whose goal is for 100 million homes worldwide to adopt clean, efficient stoves and fuels by 2020 (GACC 2012). In the face of immense practical and cultural barriers to sustainable and effective cookstove interventions, for this effort and others like it to be successful in the design and dissemination of cleaner-burning cookstoves that will meaningfully improve health, the fundamental question "How clean is clean enough?" must be answered. Despite this knowledge gap, an international workshop consisting of 91 stakeholders (cookstove manufacturers, disseminators, researchers, and academics) from 23 countries developed a guidance policy on emissions testing and voluntary standards for improved cookstoves (International Standards Organization 2012). Although the policy relies on a set of tiers for exposure reduction rather than specifying a health-based emissions standard, it does note the need to incorporate the results of future studies to specify such a health-based standard.

The extreme variability within and between personal exposures to cookstove-related air pollution, as well as multiple sources of exposure measurement error, are major sources of uncertainty around the exposure-response curve. For example, Smith et al. (2011) reported the first exposure-response evaluation within a cookstove intervention study; the results illustrated the difficulty in estimating health outcome improvements from specific intervention-related exposure reductions. A 50% reduction in personal CO exposure comparing group means for the control and intervention arms of the trial was associated with an estimated 18% reduction in risk for physician-diagnosed pneumonia in children; however, the 95% confidence interval (CI) suggests that these data are consistent with a risk reduction that ranges from 2% to 30% (Smith et al. 2011).

In May 2011, an international workshop, "Health Burden of Indoor Air Pollution on Women and Children in Developing Countries," led by the National Institutes of Health, convened > 150 participants to review the state of the science regarding the health impacts of exposures to air pollution from the household use of solid fuels including indoor, near household, and outdoor environments [household air pollution (HAP)]. …

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