REDUCING RESPIRATORY ILLNESS THROUGH ALLEVIATING KITCHEN SMOKE

IRISH FORUM FOR GLOBAL HEALTH (IFGH)BIENNIAL CONFERENCE November 29th 2010

Liz Bates

Outline• Health impacts• Limitations - health data• Need for proxy• Monitoring• Interventions – including

examples – discussing benefits and constraints

• Future actions

Worldwide deaths from indoor smoke from solid fuel include...

• 64% occur in low-income countries, especially in South-East Asia and Africa.

• 28% of global deaths caused by indoor smoke from solid fuels occur in China.

21% Lower respiratory infections

35% Chronic obstructive pulmonary diseases

3% Lung cancers

*GLOBAL HEALTH RISKS: WHO Mortality and burden of disease attributable to selected major risks 2009

Mortality low-income countries* 10 leading risk factor causes of death by income group 2004

* low-income < US$825

10th in the world

DALYs low-income countries* 10 leading risk factor causes of DALYs by income group, 2004

* low-income < US$825

9th in the world

Environmental risk factorsPercentage of deaths / DALYs in low-middle income countries

Indoor smoke

from so

lid fu

els

Unsafe w

ater, s

anita

tion, hyg

iene

Urban

outdoor a

ir pollu

tion

Lead

exposu

re

Global cli

mate ch

ange

0.0

1.0

2.0

3.0

4.0

5.0

% Deaths% DALYs

Data included in these figures

Based on data for which there is solid evidence• ALRI• COPD• CancerLess evidence• Tuberculosis• LBW & Prematurity – (cause of 29% of all

newborn deaths)• Cardio-vascular diseases

WHO 24hr air quality guidelines for particulate matter

Interim targets

PM2.5 & (PM10)

Rationale

1 75 (150) 15% higher long-term mortality risk relative to the AQG

2 50 (100) Lowers risk from (1) by ~6%

3 37.5 (75) Lowers risk from (2) by (2% - 11%)

AQG* 25 (50) Cardiopulmonary and lung cancer mortality risks not seen to increase (95% confidence level)

*AQG = Air Quality Guidelines (WHO)

Monitoring for PM and CO

PM CO

Typical results for CO woman & room

0 200 400 600 800 1000 1200 1400 16000

10

20

30

40

50

60

CO_rm CO_wm

Approaches to alleviation of IAPBehavioural changes• Cook and child keeping

away from smoke• Cooking in a separate

room • Cutting food small• Cooking outdoors• Transferring ownership

of the problem to the cook and her family

Approaches to alleviation of IAP

Not creating pollution - using clean fuels

• LPG• Ethanol• New fuels such as

plant oils

Approaches to alleviation of IAP

Venting smoke out of the house

• Smoke hoods• Chimney stoves• Eaves spaces

Approaches to alleviation of IAP

Burning fuel efficiently• Using an improved

stove• Using dry fuel• Using a pressure

cooker

Approaches to alleviation of IAP

Burning fuel efficiently• Using an improved

stove• Using dry fuel• Using a pressure

cooker

Reductions achieved in PM, Kenya, Nepal & Sudan – 30households

Kenya 24hr PMMean values

0

100

200

300

400

500

600

700

Rounds

Part

icu

late

s (

ug

/m3)

Nepal 24hr PMMean values

0

200

400

600

800

1000

1200

1400

Rounds

Part

icula

tes (

ug/m

3)

Sudan 24hr PMMean values

0

200

400

600

800

1000

1200

1400

Rounds

Part

icula

tes (

ug/m

3)

Issues....if people do not like a stove, or cannot afford it – the efficiency of the intervention to

remove smoke is NIL

Good or bad changes in family life

0 2 4 6 8 10 12

Only use LPG occasionally due to condition of kitchen

Smoke is bad for the eyes - LPG minimises problem

Smoke is bad for you

Need money to f ix kitchen

LPG kisra sag needs fixing - have to use w ood

Daughter does not use LPG

Health /w ell-being deteriorates w hen LPG runs out

Does not use LPG

Improved family health

No change

No money to refill bottle

No smoke / Less smoke

Time saving

Kitchen is good /clean / healthy / relaxing

Quality of life benefits - Kenya

What are the major benefits?

0 20 40 60 80 100

Husband now helps with cookingFood stays clean

Reduces the amount of laundryPersonal cleanliness improved

No excessive heat in roomImproved status / confidence

Saves moneyPots & utensils stay clean

Can get on with other things whilst cookImproved health for self and/or family

Improved cooking conditions / well-beingHouse stays cleaner

Keeps food warmLess / No smoke in house

Uses less fuelSaves time cooking

Number of responses

Quality of life benefits - Nepal

0 20 40 60 80 100 120 140

Improved eyes

Reduced access for vermin

Easier to dry meat

Easier to work

Cleaner clothes

Improved safety

Cleaner roof

Faster cooking

Cleaner home

Improved health

Fuel saving

Reduced smoke

Number of responses

Quality of life benefits - Sudan

What works?• Start project with self-sustaining perspective• Starting with people where the are – not

where we want them to be• Encourage people to ‘own’ the problem• Develop a range of options with community• Develop finance systems that suit them• Treating people as customers

New initiatives: Global Alliance for Clean Cookstoves

• Coordinated through the UN Foundation (UNF) - $250 goal• Founding partner organizations signed up to 100 million

clean cookstoves by 2020• Primary focus on development of robust global stove

industry / market• Unproven hypothesis -biomass stoves exist that are

o clean enough to have major health/climate benefits o affordable by world's poorest half, to sustain sales -

$US10

NO such device is available today

Smith KR, What's Cooking? A Brief Update, Energy for Sustainable Development (2010), doi:10.1016/j.esd.2010.10.002

New initiatives:Global Cookstove Accelerator Facility

• Developing mechanism to make it easier for cookstove programmes to tap funds through CDM, or the voluntary carbon market using Gold Standard

• guaranteeing a price floor on future carbon credits low interest loans

Smith KR, What's Cooking? A Brief Update, Energy for Sustainable Development (2010), doi:10.1016/j.esd.2010.10.002

New initiatives National Biomass Cookstove Initiative (NCI)

• Explicitly aiming to provide every household in India with combustion comparable to LPG in cleanliness and efficiency, whether from modern fuels or biomass

• Competition to increase efforts on R&D• Carbon finance is ‘the icing on the cake’ – they

are after ‘the cake’

Traditional kitchen

Improved kitchen

Thank you...questions?