Voir page 1088 le resume en francais. En la pagina 1089 figura un resumen en espanol.
Indoor air pollution can be traced to prehistoric times when humans first moved to temperate climates and it became necessary to construct shelters and use fire inside them for cooking, warmth and light. Fire led to exposure to high levels of pollution, as evidenced by the soot found in prehistoric caves (1). Approximately half the world's population and up to 90% of rural households in developing countries still rely on unprocessed biomass fuels in the form of wood, dung and crop residues (2). These are typically burnt indoors in open fires or poorly functioning stoves. As a result there are high levels of air pollution, to which women, especially those responsible for cooking, and their young children, are most heavily exposed. (Fig. 1).
[Figure 1 ILLUSTRATION OMITTED]
In developed countries, modernization has been accompanied by a shift from biomass fuels such as wood to petroleum products and electricity. In developing countries, however, even where cleaner and more sophisticated fuels are available, households often continue to use simple biomass fuels (3). Although the proportion of global energy derived from biomass fuels fell from 50% in 1900 to around 13% in 2000, there is evidence that their use is now increasing among the poor (1). Poverty is one of the main barriers to the adoption of cleaner fuels. The slow pace of development in many countries suggests that biomass fuels will continue to be used by the poor for many decades.
Notwithstanding the significance of exposure to indoor air pollution and the increased risk of acute respiratory infections in childhood, chronic obstructive pulmonary disease and lung cancer (3,4), the health effects have been somewhat neglected by the research community, donors and policy-makers. We present new and emerging evidence for such effects, including the public health impact. We consider the prospects for interventions to reduce exposure, and identify priority issues for researchers and policy-makers.
Biomass fuel is any material derived from plants or animals which is deliberately burnt by humans. Wood is the most common example, but the use of animal dung and crop residues is also widespread (5). China, South Africa and some other countries also use coal extensively for domestic needs.
In general the types of fuel used become cleaner and more convenient, efficient and costly as people move up the energy ladder (6). Animal dung, on the lowest rung of this ladder, is succeeded by crop residues, wood, charcoal, kerosene, gas and electricity. People tend to move up the ladder as socioeconomic conditions improve. Other sources of indoor air pollution in developing countries include smoke from nearby houses (6), the burning of forests, agricultural land and household waste, the use of kerosene lamps (7), and industrial and vehicle emissions. Indoor air pollution in the form of environmental tobacco smoke can be expected to increase in developing countries. It is worth noting that fires in open hearths and the smoke associated with them often have considerable practical value, for instance in insect control, lighting, the drying of food and fuel, and the flavouring of foods (3).
Many of the substances in biomass smoke can damage human health. The most important are particles, carbon monoxide, nitrous oxides, sulphur oxides (principally from coal), formaldehyde, and polycyclic organic matter, including carcinogens such as benzo[a]pyrene (5). Particles with diameters below 10 microns ([PM.sub.10]), and particularly those less than 2.5 microns in diameter ([PM.sub.2.5]), can penetrate deeply into the lungs and appear to have the greatest potential for damaging health (8).
The majority of households in developing countries burn biomass fuels in open fireplaces, consisting of such simple arrangements as three rocks, a U-shaped hole in a block of clay, or a pit in the ground, or in poorly functioning earth or metal stoves (3) (Fig. …