Dr. Roger I. Glass, Director of
the Fogarty International Center
Opinion by Dr. Roger I. Glass
Director, Fogarty International Center
The problem of indoor air pollution has been around for decades but we have never viewed it as a single and critically important risk factor for poor health in the developing world. The challenge is immense because nearly 3 billion people worldwide use indoor cookstoves and are exposed daily to the pollution that this yields. This includes the products of incomplete and inefficient combustion of biomass fuels such as wood, charcoal, dung and crop residues, which produces particulate matter, carbon monoxide and other toxic fumes.
We now recognize that the risks from indoor air pollution range widely from low birth weight of children to chronic conditions in the elderly and everything in between - acute respiratory disease, cancer, asthma, cardiovascular disease, eye disease, lung disease and chronic pulmonary obstructive lung disease. Women and children are mainly affected because they are at home much of the time. It’s comparable to the long-term risks from smoking, except more concentrated.
Much research has been focused on developing cleaner cookstoves that use alternative sources of energy and burn more efficiently. Yet we really don’t know how much cleaner the household environment has to be in order to achieve a better health impact. The WHO has estimated that about 2 million lives are lost per year from the problem of indoor air pollution and this is clearly a troubling estimate. We don’t know how accurate this is or whether the introduction of clean cookstoves could make a major impact on this, so there’s clearly a research agenda that needs to be pursued to address this fundamental question.
In an article recently published in Science, A Major Environmental Cause of Death, my co-authors and I conclude that although the problems of indoor air pollution are well established, there remains a critical research agenda to determine how much these emissions must be reduced by cleaner cookstoves and improved fuels to achieve substantial health benefits. This unresolved question has created some controversy over whether health benefits must be documented before new technologies for cookstoves - already moving forward - should be implemented.
At Fogarty we’ve looked at this issue in the past through our International Training and Research in Environmental and Occupational Health (ITREOH) program. Investigators like Dr. Kirk Smith at Berkeley, who have been clear leaders in understanding and evaluating the health impact of cookstoves, have used grants for studies in Bangladesh, India and other locations where indoor air pollution is common.
We are transitioning ITREOH to a program we call Global Environmental and Occupational Health, or GEOHealth, and indoor air pollution will be included as a key topic. We also have a fellows and scholars program where we place young medical students and residents in different specialties in developing countries to pursue research. Some of them are working in the area of lung disease, child health and birth outcomes and we’d love to see the interventions of clean cookstoves become part of their research agenda.
This is a huge global problem to address, since to solve it, we must change the cooking habits of nearly half the women in the world. In many countries, the cookstove is the central hearth of the family and to replace a traditional stove with a cleaner device may be akin to taking out the heart of the home. We are actually attempting to change behavior.
Many groups are leading the introduction of clean cookstoves in developing countries. Pilar Nores, the former First Lady of Peru, writes in an editorial accompanying our article about her program to introduce these new cookstoves in the highlands of her country. A health evaluation impact could tell us whether this is really improving the health of recipients in a way that justifies the investment.
Clean air is clearly better for health. But while we believe the interventions we’re promoting are highly effective, we really need to develop the evidence that will allow for the global investment as a major intervention project to improve the health of women and children.