Indoor Air Pollution (IAP)

Overview

Cooking on open fire, Indonesia, Purwodadi Area

Indoor air pollution (IAP) also called household air pollution (HAP) in developing countries is a major environmental and public health challenge. According to data from the World Health organisation as many as 4.3 million people died in 2012 as a result of it worldwide. This can be compared with one death every 8 seconds. Most of the death occur in middle and low income countries in South East Asia with 1.69 million death, followed by the Western Pacific regions 1.62 million, Africa 600,000, Eastern Mediterranean region 200,000, Europe 99,000, and in the Americas 81,000 death. In high income countries 19,000 people died because of IAP. IAP/HAP has to be distinguished from outdoor ambient air pollution (AAP) which supposedly caused the death of another 3.7 million people in 2012.

The main source of IAP/HAP is inefficient and insufficiently vented cooking and heating with solid fuels (biomass and coal) on simple stoves or open fires. Burning these fuels in inefficient stoves results in poor combustion efficiency and high levels of emissions of helath-damaging pollutants including both fine and coarse particulate matter (e.g., PM_2.5, PM₁₀), carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and a variety of organic air pollutants (e.g., formaldehyde, 1,3-butadiene, benzene, acetaldehyde, acrolein, phenols, pyrene, benzopyrene, benzo(a)pyrene, dibenzopyrenes, dibenzocarbazoles, and cresols). In a typical solid fuel stove, about 6–20% of the solid fuel is converted into toxic emissions (by mass). The exact quantity and relative composition of the emissions is determined by various factors such as the fuel type and moisture content, stove type and the way the stove and fuel is used by the cook.

According to estimations 2.9 billion people used solid fuels (mainly biomass, in the form of wood, charcol, dung, and dung, and crop residue) for cooking and other heating purposes in 2012 . Around 80% of them reside in rural and 20% in urban areas. Because much of the burning of solid fuels is carried out indoors in environments with insufficient ventilation, millions of people, primarily poor women and children face serious health risks.

Indoor burning of solid fuels (e.g., wood, charcoal, coal, dung, and crop residues) by inefficient, often insufficiently vented, combustion devices results in elevated exposures to household air pollutants. This is due to the poor combustion efficiency of the combustion devices and the elevated nature of the emissions. In addition, they are often released directly into living areas.

While many pollutants can evolve, most measurements have been focused on breathing-zone exposure levels of particulate matter (PM) and carbon monoxide (CO), which are the main products of incomplete combustion and are considered to pose the greatest health risks. Indoor PM_2.5 exposure levels have been consistently reported to be in the range of hundreds to thousands of micrograms per cubic meter (μg/m³). Similarly, CO exposure levels have been measured to be as high as hundreds to greater than 1000 milligrams per cubic meter (mg/m³). A recent study of 163 households in two rural Chinese counties reported geometric mean indoor PM_2.5 concentrations of 276 μg/m³ (combinations of different plant materials, including wood, tobacco stems, and corncobs), 327 μg/m³ (wood), 144 μg/m³ (smoky coal), and 96 μg/m³ (smokeless coal) for homes using a variety of different fuel types and stove configurations (e.g., vented, unvented, portable, fire pit, mixed ventilation stove).

The!World!Health!Organization!(WHO)!consequently!revised!its!Air!Quality!Guideline!

(AQG)! for!outdoor! air!pollution! to! an! annual! average!of!10!μg/m3! of!PM2.5,!

Health Effects

According to WHO there is consistent evidence that exposure to household air pollution is a major risk factor leading to acute lower respiratory infections (ALRI) in children under five, and ischaemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD) and lung cancer in adults.

• Pneumonia and respiratory infections: The respiratory and immune systems can be damaged by the particulates from smoke. This again makes those affected more vulnerable to sickness. The biggest health impact known is on kids in the form of acute respiratory infections. A child exposed to smoke in the home is two to three times more likely to catch pneumonia. Globally, pneumonia and other acute lower respiratory infections represent the single most important cause of death in children under five years. Exposure to IAP more than doubles the risk of pneumonia and is responsible for more than 900 000 of the 2 million annual deaths from pneumonia.
  
• Chronic diseases: Women exposed to indoor smoke are three times as likely to suffer from chronic obstructive pulmonary diseases (e.g. chronic bronchitis) than women who cook and heat with electricity, gas and other cleaner fuels. IAP is responsible for approximately 700 000 out of the 2.7 million global deaths due to chronic obstructive pulmonary diseases.
• Lung cancer: To be exposed to smoke from coal fires doubles the risk of lung cancer, in particular among women who tend to smoke less than men in most developing countries. Every year, more than one million people die from lung cancer globally, and indoor air pollution is responsible for approximately 1.5% of these deaths.
• In addition, there are indications, that indoor smoke is also causing asthma, tuberculosis, cataracts, low birth weight and high infant mortality.

Most of the victims are women and children, they are exposed to the indoor smoke and the large associated health risks the most.

Indoor smoke is the fourth most risk to death and disease in the world's poorest countries (only malnutrition and underweight, unsafe sex and the lack of clean water cause more victims then cooking indoor on open fires.)

Indoor smoke hits women and small children the hardest, they are exposed to very high levels of IAP and inhale significant amounts of seriously health-damaging pollutants on a daily basis. Often they are exposed to levels of smoke more than 100 times above accepted safety levels. According to the World Energy Assessment, the smoke produced from indoor fires is the equivalent to smoking two packs of cigarettes a day. Especially newborns and infants are often spending many hours breathing polluted air during their first year of life because they are carried on their mother‘s back while she is cooking. Over 10 million children aged under five years die every year – 99% of them in developing countries.

These women self spend daily three to seven hours near the fire with their kids. At that early age of the children their immature lungs and immune systems make them particularly vulnerable.

Fuels like wood, dung, crop waste, coal and charcoal typically burn in the house as open fires or in stoves with incomplete combustion. Particles with diameters less than 10 micron (PM10) deeply enter into the lungs. Such particles include carbon monoxide, nitrous oxides, sulphur oxides, formaldehyde, and polycyclic organic matter, including carcinogens accordingly IAP can have a cruel impact on health.

The annual average PM10 limit agreed upon by the European Union is 40 micrograms per cubic meter (ig/m³⁾, while the typical 24-hour levels of PM10 in biomass-using homes in Africa, Asia or Latin America range from 300 to 3,000ig/m3. Peaks during cooking may be as high as 10,000ig/m³ especially during the beginning ignition process when combustion is especially incomplete.

The!GBD!2010!Project!developed!an! integrated!PM2.5!exposureLresponse! (IER)!model! to!

estimate! these! health! effects! by! using! relative! risk! (RR)! information! from! studies! of!

ambient! PM2.5! air! pollution,! second! hand! tobacco! smoke,! household! solid! fuel! use,! and!

active! tobacco! smoking! (Burnett! et! al,! 2014).! ! The! model! was! developed! for! causes! of!

mortality!in!adults:!ischemic!heart!disease!(IHD),!cerebrovascular!disease!(stroke),!chronic!

obstructive!pulmonary!disease! (COPD),! and! lung! cancer! (LC);! and! in! children! under! five!

years:!acute!lower!respiratory!infections!(ALRI).!!!

!

The!model! is! applicable! to! the! entire! exposure! range! of! PM2.5! concentrations! observed!

globally!in!the!outdoor!and!household!environment.!!The!exposureLresponse!relationships!

in! the! IER! model! are! highly! nonLlinear! with! declining! marginal! relative! risks! of! health!

outcomes!at!higher!PM2.5!exposure!levels.!!This!has!major!implications!for!health!benefits!

that!may!be!expected!from!controlling!air!pollution!at!high!exposure!concentration!levels.!!

Status Quo

The problem with polluted indoor air has been around since men had fire in caves. But there has been very little evidence of the IAP health impact. Compared with the enormous damages caused to people’s health and actions on the other main risks there has been extremely limited funding and activities to dam up this issue.

There are several reasons which indicate why this problem has not received more attention:

• Lack of recognition of the weight of challenge by policy-makers.
• Lack of funds, at government level, to address the scale of the problem.
• Low status of women and children in many poor communities.
• Failure to recognize that fuel-efficient stoves do not always alleviate smoke.
• Many households that use biomass are often overlooked in favor of electrification.
• Affected people are very poor and regularly biomass can be obtained at no monetary cost. Time cost is often not considered.

According to Practical Action (PA)cleaning up the air in people’s homes will cost as little as $500m each year, less than 1% of what the West spends on aid to poor countries. The total cost of providing 3 billion people with access to healthy indoor air would be in the region of US$2.5 billion annually over the next 12 years. To set in motion an effective market in low cost smoke solutions, it is estimated that government spending and international development aid would be in the region of 20% this total - $500m.

Awareness by the international community about the quality of indoor air has improved initial in the last years. There is now sufficient data to start action and to tackle the problem.

Recent launches of new initiatives and several programs in different Organizations:

• World Health Organization’s Healthy Environments for Children Alliance (HECA),

• United States Environmental Protection Agency-led Partnership on Clean Indoor Air,
• United Nations Development Program’s LPG Challenge,
• World Bank Energy Sector Management Program (ESMAP), significant research and development program
• Shell Foundation (established by the Shell Group in 2000 as an independent, UK registered charity operating with a global mandate)
• and many research institutions and non-governmental agencies around the world.

A lot of research and field work is done already to find solutions and to raise awareness of the problem.

Reducing Indoor Air Pollution (IAP)

Measures to reduce IAP in developing countries:

• Changes in energy technology, switching to cleaner alternatives (kerosene, liquid petroleum gas, biogas, electricity or solar energy)
• Improving the design and construction of traditional stoves (improved stoves or smoke hoods that vent pollutants to the outside
• Behavioral changes using a pot lid when cooking to speeds up the cooking, drying wood before burning it, awareness-raising activities)
• Change the living environment (kitchen ventilation)

Cleaner Fuels / Improved Cookstoves

The most effective way to reduce smoke in the home is to switch to cleaner fuels (liquid petroleum gas, kerosene or biogas). It’s also possible to improve the air quality and promote energy efficiency and environmental sustainability by promoting improved cooking stoves.

Smoke Hoods

The huge majority of people in developing countries who are still cooking on open fires are often too poor to change to improved stoves and cleaner fuels or have no access to modern combustibles. Where the use of biomass, wood or charcoal remains predominant, and the indoor environment remains subject to high levels of smoke, other alternatives have to be found to improve air quality and related health issues.

The installation of a smoke hood can be extremely effective in improving the air quality in houses. This applies especially, when traditional biomass burning stoves are being used without a chimney. In addition, some efficient stoves may not be clean and therefore employing a smoke hood allows for health benefits coupled with lower operating costs. Moreover, in some cultures, an open fire plays a special social role as a place around which the family gathers, traditional meals are cooked or other important rituals. As a resultthe introduction of improved cookstoves is difficult and a smoke hood serves as the best alternative for improving indoor air quality.

Impacts

Reaching this goal to reduce this extremely harmful IAP would significantly help to achieve several of the internationally agreed Millennium Development Goals, especially Goal 4. Reduce child mortality with the target to decrease by two thirds, between 1990 and 2015, the under-five mortality rate. Since 1990, the mortality rate for children under age five in developing countries dropped by 28% (from 100 deaths per 1,000 live births to 72 in 2008), but not quickly enough to reach the target by 2015. Many organizations are already working on this field to make improvements in this issue.

Further Information

• Smoke Hoods - "Healthy Hoods" Project
• Indoor air pollution in developing countries: a major environmental and public health challenge
• Indoor air pollution (IAP) Measurements
• Health Hoods, Smoke Hoods for developing countries Video(Project by Practical Action and BSH)
• HEDON Hompepage with Video - THese Women's stories tell the cookstoves story