Solid Fuels For Cooking Research Articles

Applying global cost-benefit analysis methods to indoor air pollution mitigation interventions in Nepal, Kenya and Sudan: Insights and challenges

Indoor air pollution from burning solid fuels for cooking is a major environmental health problem in developing countries, predominantly affecting children and women. Traditional household energy practices also contribute to substantial time loss and drudgery among households. While effective interventions exist, levels of investment to date have been very low, in part due to lack of evidence on economic viability. Between 2004 and 2007, different combinations of interventions – improved stoves, smoke hoods and a switch to liquefied petroleum gas – were implemented in poor communities in Nepal, Sudan and Kenya. The impacts were extensively evaluated and provided the basis for a household-level cost-benefit analysis, which essentially followed the methodology proposed by the World Health Organization. The results suggest that interventions are justified on economic grounds with estimated internal rates of return of 19%, 429% and 62% in Nepal, Kenya and Sudan, respectively. Time savings constituted by far the most important benefit followed by fuel cost savings; direct health improvements were a small component of the overall benefit. This paper describes the methodology applied, discusses the findings and highlights the methodological challenges that arise when a global approach is applied to a local programme.

P2-1 Effect of indoor air pollution from biomass and solid fuel combustion on prevalence of asthma among adult men and women in India

Increasing asthma incidence, prevalence and morbidity over recent decades presents a significant challenge to public health in developing countries. A number of studies have suggested that ambient air pollution can...

Child mortality from solid-fuel use in India: a nationally-representative case-control study

BackgroundMost households in low and middle income countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India.MethodsWe compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609 601 living children living in 1.1 million nationally-representative homes in India. Analyses were stratified by child's gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. We also examined the association of solid fuel to non-fatal pneumonias.ResultsSolid fuel use was very common (87% in households with child deaths and 77% in households with living children). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58). More girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33).ConclusionsChild mortality risks, from all causes, due to solid fuel exposure were lower than previously, but as exposure was common solid, fuel caused 6% of all deaths at ages 0-4, 20% of deaths at ages 1-4 or 128 000 child deaths in India in 2004. Solid fuel use has declined only modestly in the last decade. Aside from reducing exposure, complementary strategies such as immunization and treatment could also reduce child mortality from acute respiratory infections.

INTERNATIONAL ENVIRONMENTAL HEALTH: New MPH Program a First for India

Not often does a new degree program make headline news, but then, in India there is nothing entirely comparable to the new master’s of public health (MPH) program launched 19 January 2010 at Sri Ramachandra University (SRU) in Chennai. With environmental disease constituting roughly half the country’s total disease burden, India has a dire need of the expertise the program will develop with its focus on occupational and environmental health (OEH). “This program is the first MPH [in India] with an exclusive focus on OEH,” says Kalpana Balakrishnan, a professor of biophysics and head of the Department of Environmental Health Engineering at SRU. “These graduates will be trained in recognition, evaluation, and management of OEH risks to serve industry and governmental organizations in addition to assuming roles as teachers of OEH in [this and other] MPH programs.” India faces a double whammy of traditional and modern OEH problems, including indoor air pollution (primarily due to the use of wood, dung, and other solid fuels for cooking); the microbial and chemical contamination of water; chemical, physical, ergonomic, and psychosocial hazards in the workplace; and contamination of food supplies by heavy metals, pesticides, and microbes. Over 37 million people—more than the total population of California—are affected annually by waterborne disease, according to the international nonprofit WaterAid, and the most recent data available—published by James Leigh et al. in the September 1999 issue of Epidemiology—put the number of occupation-related deaths per year at an estimated 121,000. Yet the country, with one-sixth of humanity and a space program, nevertheless has few professionals trained to tackle such problems and inadequate capacity to undertake related research. The 2-year MPH program is the fruit of a collaboration with the University of California, Berkeley, that began in 2002 with support from the International Training and Research Program in Environmental and Occupational Health (ITREOH), an initiative of the Fogarty International Center, National Institutes of Health, in collaboration with the NIEHS and the Centers for Disease Control and Prevention. “A main objective of this collaboration has been to build the capacity of staff at SRU to deliver the MPH program and undertake research,” explains Kirk Smith, a professor of global environmental health at Berkeley and a principal investigator with ITREOH. Fogarty funds have brought 6 SRU faculty to Berkeley to take advanced courses in biostatistics, epidemiology, and other disciplines. Berkeley aims to continue to provide training support over at least the next 2 years. The new MPH program covers topics such as epidemiology, biostatistics, occupational toxicology, industrial hygiene, occupational and environmental safety, exposure assessment and control, health policy and management, behavioral sciences in health, indoor air quality, analysis of airborne chemical contaminants, occupational health clinics, environmental engineering (including the management of hazardous and biomedical waste), and the use of geographic information systems. With initial graduating classes of just 10 students, Balakrishnan says, “The intake will be expanded once a critical mass of teachers is produced from the first few batches.” She believes it could be at least a decade before much of a dent could be made in the subcontinent’s OEH problems and that to truly meet its challenge, India would need dozens more such programs. “It will be difficult in the short term to find students able to pay their own fees to attend until there are jobs available to make it seem worthwhile,” Smith says. “It’s a chicken-and-egg situation, which is one of the main reasons SRU needs to start small and build up slowly to a larger program.” Smith says other Indian universities are now considering offering new courses with OEH content, but one of the major problems they face remains the recruitment of staff capable of teaching in this area. “The production of the first ‘homegrown’ graduates who can specifically fill these positions, who have firsthand experience of India’s OEH problems, and who can begin research to find new ways of quantifying them and dealing with them will be a big step in the right direction,” he says. “Addressing India’s occupational and environmental health concerns is vital in the future of a healthy India,” remarks Sanjay Zodpey, director of the Indian Institute of Public Health and director of public health education for the Public Health Foundation of India, both in New Delhi. “The MPH program in collaboration with Berkeley will not only address the shortfall in trained manpower in occupational and environmental health, but also strengthen indigenous Indian research capacity in these areas.”

Indoor Air Pollution from Unprocessed Solid Fuels in Developing Countries

Approximately half of the world's population relies on biomass (primarily wood and agricultural residues) or coal fuels (collectively termed solid fuels) for heating, lighting, and cooking. The incomplete combustion of such materials releases byproducts with well-known adverse health effects, hence increasing the risk of many diseases and death. Among these conditions are acute respiratory infections, chronic obstructive pulmonary disease, heart disease, stroke, lung cancer, cataracts and blindness, tuberculosis, asthma, and adverse pregnancy outcomes. The International Agency for Research on Cancer has classified the indoor combustion of coal emissions as Group 1, a known carcinogen to humans. Indoor air pollution exposure is greatest in individuals who live in rural developing countries. Interventions have been limited and show only mixed results. To reduce the morbidity and mortality from indoor air pollution, countermeasures have to be developed that are practical, efficient, sustainable, and economical with involvement from the government, the commercial sector, and individuals. This review focuses on the contribution of solid fuels to indoor air pollution.

Indoor air pollution from solid fuels and risk of hypopharyngeal/laryngeal and lung cancers: a multicentric case-control study from India

A recent monograph by the International Agency for Research on Cancer (IARC) has identified indoor air pollution from coal usage as a known human carcinogen, while that from biomass as a probable human carcinogen. Although as much as 74% of the Indian population relies on solid fuels for cooking, very little information is available on cancer risk associated with these fuels in India. Using data from a multicentric case-control study of 799 lung and 1062 hypopharyngeal/laryngeal cancer cases, and 718 controls, we investigated indoor air pollution from various solid fuels as risk factors for these cancers in India. Compared with never users, individuals who always used coal had an increased risk of lung cancer [odds ratio (OR) 3.76, 95% confidence interval (CI) 1.64-8.63]. Long duration of coal usage (>50 years) was a risk factor for hypopharyngeal (OR 3.47, CI 0.95-12.69) and laryngeal (OR 3.65, CI 1.11-11.93) cancers. An increased risk of hypopharyngeal cancer was observed among lifelong users of wood (OR 1.62, CI 1.14-2.32), however this was less apparent among never-smokers. Increasing level of smokiness inside the home was associated with an increasing risk of hypopharyngeal and lung cancer (P(trend) < 0.05). This study showed differential risks associated with indoor air pollution from wood and coal burning, and provides novel evidence on cancer risks associated with solid fuel usage in India. Our findings suggest that reducing indoor air pollution from solid fuels may contribute to prevention of these cancers in India, in addition to tobacco and alcohol control programs.

India needs a great sanitary awakening

Dear sir, I read the article titled “Environmental sanitation: An ignored issue in India” published in the April 2008 issue of your esteemed journal with keen interest. The author has chosen a vital subject that needs to be addressed urgently. Environmental sanitation is indeed still an ignored issue in India. This is evident from the facts available from the report of the National Family Health Survey-3 (NFHS-3), which throws light on some of the household characteristics like the type of house, safe drinking water and sanitation, cooking fuel and overcrowding.[1] It is reported that more than half of the households in India live in kachha/semipucca (14% kachha, 40% semipucca) houses. The proportion of households living in pucca houses is lowest in Manipur (10.7%). In 34% of the households, three to four persons and in 29% of the households, five or more persons share a single room for sleeping. Ninety percent of the rural households and 31% of the urban households use solid fuels for cooking, which generate smoke and unhealthy conditions when inhaled. About 90% of the households that use solid fuels cook on an open fire without diverting the smoke through a chimney. Although 88% of the households have access to an improved source of drinking water, only half the households reported having drinking water on their premises (51% urban, 28% rural). For 37% of the households, it takes up to 30 min and for the remaining 12% more than half an hour to fetch drinking water. Transportation and storage is known to cause contamination of water, but only 33%of the households treat their drinking water to improve its potability. More than half (55%) of the households (74% rural, 17% urban) have no toilet facility, the figure varying from 2% for Mizoram to 81.3% for Chhatisgarh. Only 29% of the households have toilet facilities that are improved and not shared with any other household. The survey about disposal of household (solid and liquid) and animal waste, which form a significant source of illness, is silent. Control of these factors has been responsible for a considerable improvement in the health of people during the past century in the developed countries. On the other hand much of the illness in India is due to poor environmental sanitation, i.e., unsafe drinking water, polluted soil, unhygienic disposal of human excreta and refuse, poor housing, insects and rodents.[2] The National Water Supply and Sanitation Programme was launched as early as 1954 and was supported by the Accelerated Rural Water Supply Programme (1971-72), the International Drinking Water Supply and Sanitation Decade (1981-90), the Rajiv Gandhi National Drinking Water Mission (1986), the Central Rural Sanitation Programme, the Total Sanitation Campaign and the Millennium Development Goals(2000) and similar programs. But, it is evident from facts reported by the NFHS-3 that the sanitary conditions have not changed much. The unsanitary conditions are appalling in India and[3] perhaps India also needs a great sanitary awakening like that which took place in London in the mid-nineteenth century.

Indoor Air Quality at Rural and Urban Sites in Pakistan

In the developing world, the vast majority of people rely on solid biomass fuels for cooking and heating which results in poor indoor air quality. The present study determined indoor air quality in some rural and urban areas of Pakistan. Measurements were made of particulate mass (PM10, PM2.5 and PM1), number concentration and bioaerosols in different micro environments. PM10 concentrations of up to 8,555 μg/m3 were observed inside the kitchens where biofuels were used as energy source. Cleaning and smoking was identified as a major source of indoor particulate pollution and concentrations of more than more than 2,000 μg/m3 were recorded in the living room during these activities. Indoor number concentrations in Lahore were typically greater than those observed outdoors in European cites. At a rural site the highest Colony Forming Units (CFUs) were in the 0.5 μm–2 μm size fraction, while at the urban location CFUs were dominant for 2 μm–16 μm. It was observed that CFUs(Colony Forming Units) counts were higher inside living rooms than kitchens. It is important to note that women and children were exposed to extremely high levels of particulates during cooking. Overall, indoor air quality in Pakistan was poor and there is a dire need to take a serious step to combat with it.

Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000.

To estimate the burden of respiratory ill health in South African children and adults in 2000 from exposure to indoor air pollution associated with household use of solid fuels. World Health Organization comparative risk assessment (CRA) methodology was followed. The South African Census 2001 was used to derive the proportion of households using solid fuels for cooking and heating by population group. Exposure estimates were adjusted by a ventilation factor taking into account the general level of ventilation in the households. Population-attributable fractions were calculated and applied to revised burden of disease estimates for each population group. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. South Africa. Black African, coloured, white and Indian children under 5 years of age and adults aged 30 years and older. Mortality and disability-adjusted life years (DALYs) from acute lower respiratory infections in children under 5 years, and chronic obstructive pulmonary disease and lung cancer in adults 30 years and older. An estimated 20% of South African households were exposed to indoor smoke from solid fuels, with marked variation by population group. This exposure was estimated to have caused 2,489 deaths (95% uncertainty interval 1,672 - 3,324) or 0.5% (95% uncertainty interval 0.3 - 0.6%) of all deaths in South Africa in 2000. The loss of healthy life years comprised a slightly smaller proportion of the total: 60,934 DALYs (95% uncertainty interval 41,170 - 81,246) or 0.4% of all DALYs (95% uncertainty interval 0.3 - 0.5%) in South Africa in 2000. Almost 99% of this burden occurred in the black African population. The most important interventions to reduce this impact include access to cleaner household fuels, improved stoves, and better ventilation.

Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions

ObjectiveNearly all China’s rural residents and a shrinking fraction of urban residents use solid fuels (biomass and coal) for household cooking and/or heating. Consequently, global meta-analyses of epidemiologic studies indicate that indoor air pollution from solid fuel use in China is responsible for approximately 420,000 premature deaths annually, more than the approximately 300,000 attributed to urban outdoor air pollution in the country. Our objective in this review was to help elucidate the extent of this indoor air pollution health hazard.Data sourcesWe reviewed approximately 200 publications in both Chinese- and English-language journals that reported health effects, exposure characteristics, and fuel/stove intervention options.ConclusionsObserved health effects include respiratory illnesses, lung cancer, chronic obstructive pulmonary disease, weakening of the immune system, and reduction in lung function. Arsenic poisoning and fluorosis resulting from the use of “poisonous” coal have been observed in certain regions of China. Although attempts have been made in a few studies to identify specific coal smoke constituents responsible for specific adverse health effects, the majority of indoor air measurements include those of only particulate matter, carbon monoxide, sulfur dioxide, and/or nitrogen dioxide. These measurements indicate that pollution levels in households using solid fuel generally exceed China’s indoor air quality standards. Intervention technologies ranging from simply adding a chimney to the more complex modernized bioenergy program are available, but they can be viable only with coordinated support from the government and the commercial sector.

ARI And Indoor Air Pollution: Its Burden And Correlation

Most of the disease burden in India is due to the respiratory disorders namely acute respiratory infections (ARI), asthma, chronic obstructive pulmonary disease (COPD), tuberculosis (TB) and lung cancer. These diseases are mainly attributed with exposure to indoor pollution, solid-cooking fuels, smoking, poor housing and malnutrition. NATIONAL BURDEN OF DISEASE (NBD) Those disease categories that cause at least 1% of the NBD or at least 1% of all deaths constitute the national burden. Although commonly used, number of deaths is not a very informative indicator of ill health. Better is some measure of the loss of healthy life such as the disability adjusted life year (DALY), which basically indicates the amount of healthy life expectancy lost because of a disease, including both mortality and morbidity. It can be seen that it is the children less than five years, who bear the largest overall illhealth burden of any age group with the major contribution made by ARI. Respiratory diseases such as ARI,TB, COPD and Cancer all contribute to atleast 1% of DALYs and Deaths1. ARI is the largest contributor to the NBD with 12% DALYs and 13% deaths1. INDOOR AIR POLLUTION Four components of indoor pollution are combustion products, chemicals, radon, and biologic agents. Out of the four components, combustion-generated pollutants, principally those from solid-fuel (wood, charcoal, crop residues, dung, and coal) cooking and heating stoves, have been the major culprit. Thus the major source of indoor air pollution is exposure to biomass fuel cooking2It is considered positive if the individual gives the history of regularly cooking at home. STATUS OF HOUSEHOLD FUEL USE IN INDIA The types of cooking fuels used at home included liquefied petroleum gas (LPG), kerosene, or the solid fuels i.e. coal, dried wood, dung and other products of animal or plant origin (biomass fuels). Degree of pollution strongly depends on type of fuel used. . Solid fuels are substantially more polluting per meal than the liquid and gaseous fuels further up on the ‘‘energy ladder.’‘ The amount of important health-damaging pollutants (e.g., PM10, CO, PAH, HCHO, VOC) breathed by a cook during a typical meal is about 2 orders of magnitude lower when burning bottled gas than burning wood or crop residues. Thus, as a first approximation, the use of unprocessed solid fuels in the household is an indicator of the potential for excessive air pollution exposures. In this way, access to clean fuels is parallel to the often-cited statistic on access to clean water as an indicator of disease risk. MAGNITUDE OF PROBLEM Air pollution has become a major concern in India in recent years both because it is now clear that large parts of the Indian urban population are exposed to some of the highest pollutant levels in the world. Annual concentrations reported at urban monitors in India for PM10, particles less than 10 microns in diameter, is of range 90–600 μg/m3, with a population mean of about 200 μg/m3. The 1991 National Census included for the first time a question about the primary household fuel used and reflected that about 95% of the rural population still relied primarily on biomass fuels (dung, crop residues, and wood). A small fraction uses coal, which means about 97% of households relied principally on these unprocessed solid fuels. Nationwide, some 81% of all households relied on these fuels; 3% used coal and 78% used biomass. However recent data as revealed by NFHS-33found that 71 percent of India's households use solid fuels for their cooking and that 91 percent of rural households do so. A study done by SK Jindal etal,4 showed history of exposure ARI And Indoor Air Pollution: Its Burden And Correlation 2 of 5 to combustion of cooking fuels in 36% of subjects but there were large variations at different centers where study was carried out. Majority of subjects at Delhi and Chandigarh used LPG whereas almost similar numbers used LPG or dried solid fuels at Bangalore and Kanpur.

Household Energy, Exposure and Health in China

P-318 Abstract: Indoor air pollution from solid fuel use is estimated to be responsible for more than 1.6 million annual deaths worldwide. In China, 60% of the population lives in rural areas, where most people rely on solid fuels for cooking and heating. We investigate the health impact that is associated with household combustion of solid fuels for the Chinese population. The China 2000 Census gives comprehensive data on main cooking fuel in the Chinese households along with population data and other demographic characteristics. In a previous study we estimated, for different demographic groups in Shanxi province in the North of China, the exposure to PM10 using indoor pollution levels in several microclimates and average time activity patterns. We use these exposure estimates, including estimates for biomass users, as typical exposure for the northern population, and make a similar exposure estimate for the southern population. We assume that similar demographic groups in China experience similar exposure. The demographic groups are divided in age/gender, urban/rural north/south and fuel use in the households. Based on the exposure estimates we estimate Population Weighted Exposure (PWE) in the 2871 mainland counties of China, and exposure reduction, ΔPWE, that can be anticipated based on interventions. The interventions that we analyse are replacing solid fuel with clean fuels like gas, district heating and electricity, improving the stoves in use to gain better combustion, and installing a chimney to ensure ventilation. Based on the ΔPWE and dose-response functions we estimate health gains. We expect to find the highest PWE is in the counties with the highest rate of biomass combustion. We also expect to conclude that there is large health gains associated with an improvement in the household fuel situation in China. This work is a screening of the exposure to indoor PM10 in China, and large uncertainties are involved. Nevertheless we think that this screening shows the importance of household fuels as environmental burden for the Chinese population. Detailed studies both of the indoor pollution levels, and the time activity patterns would be interesting future work. More work is also needed to identify the most feasible and cost-efficient abatement measures. The fuel use in China is much more complex than presented here, with multiple fuels in the households. It would also be of great interest to link the current work with emissions related to climate change.

Indoor Air Pollution in Coastal Houses Using Solid Cooking Fuels: a Pilot Study in Mindanao, the Philippines

P-322 Abstract: Under cooperative agreement with USAID/Washington, Winrock International undertook an exploratory study on household energy, indoor air pollution, and perceptions of health impacts in Southern Philippines, with two primary objectives: to determine the extent to which indoor air pollution from cooking practices represented a serious problem meriting consideration of a household energy intervention; and to pilot survey and monitoring instruments for use in the design and evaluation of household energy interventions, in the Philippines and/or in other country contexts. The study involved 120 households across three areas in which Winrock is implementing the USAID/Manila-supported Alliance for Mindanao Off-grid Rural Electrification Project (AMORE). The results of the study suggest that indoor air pollution from cooking does not represent a serious health risk to women, despite the fact that the vast majority of women surveyed cook with biomass over open fires. The indoor air pollution (IAP) monitoring conducted in a subset of 30 households revealed very low area concentrations of particulate matter (PM4) – 72 micrograms/m3 and carbon monoxide – 1 ppm. PM4 was measured using the gravimetric technique with a Higgins-Dewell type of cyclone (manufactured by BGI Inc.). CO was measured using the T82 real-time potentiometric monitor manufactured by the Industrial Scientific Corporation. This cyclone provides a 4 microns median cut off with an air flow rate of 2.2 L/min. Personal exposure monitoring of CO, which is commonly measured as a proxy for personal PM from biomass smoke, also revealed very low 24-hour averages (1 ppm); however, peaks of acute exposure were evident during cooking times. The results of this study highlight the fact that low 24-hour averages of PM can mask the acute exposure that women have to PM during cooking periods. It was observed that the number of meals cooked in a day had a significant effect on PM4. CO area levels were influenced significantly by kitchen location and number of doors in the kitchen. This is one of the few studies that highlights the critical role of ventilation related factors in determining indoor exposures in such homes.

Potential health benefit of reducing household solid fuel use in Shanxi province, China

Indoor air pollution from solid fuel use has severe health effects. 60% of the Chinese population lives in rural areas, where most people rely on solid fuels for cooking and heating. We estimate exposure by combining information on the amount of time spent in different microenvironments and estimates of the particle concentrations (PM(10)) in these environments. According to our estimates, 70% of the exposure experienced by the rural population is due to indoor air pollution (IAP). The urban coal using population experience a 17% increase in exposure from IAP. We apply Monte Carlo simulations to quantify variability and uncertainty in the exposure, morbidity and mortality estimates. We find that applying Monte Carlo simulations reduces the estimated uncertainty compared to analytical methods based on approximate distributions and the central limit theorem. We find that annually about 4% (geometric S.D. sigma(g), 3.2) and 35% (sigma(g), 2.6) of the deaths in the urban and rural populations, respectively, could be avoided by switching to clean fuels. Upgrading the stoves in rural areas to the standard found in urban areas is estimated to reduce mortality by 23% (sigma(g), 3.1). Moreover, we estimate that chronic respiratory illness (CRI) in children can be reduced by, respectively, about 9% (sigma(g), 2.5) and 80% (sigma(g) 1.9) by switching to clean fuels in the urban and rural areas. Upgrading the stoves in rural areas is estimated to reduce CRI in children with about 58% (sigma(g) 2.3). For adults the reduction in CRI was estimated to be 6% (sigma(g) 2.4) and 45% (sigma(g) 1.8) for the urban and rural population following a fuel switch, and 31% (sigma(g) 2.4) for the rural population from stove improvements. Contrary to our expectations we find small gender differences in exposure. We ascribe that to comparable kitchen and living area concentrations and similar indoor occupation times for the genders. Young children and the elderly spend the most time indoors, and have the highest daily exposure in the coal using population. The rural population experience higher exposure than the urban population, even though the outdoor air is significantly cleaner in rural areas.

Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.

A global clean cooking fuel initiative

This article calls for engaging the public and private sectors of developing and industrialized countries in a global clean cooking fuel initiative (GCCFI) to bring about a worldwide shift to clean fluid fuels for cooking and heating in 10-15 years' time – with an emphasis on providing clean fuel to the poorest households. This initiative is crucial to implementation of the Millennium Development Goals and the Plan of Implementation of the World Summit on Sustainable Development. The article builds on (1) analyses in this special issue of Energy for Sustainable Development of challenges to sustainable development posed by use of solid fuels for cooking and water heating (and for space heating in temperate climates) and opportunities for addressing them by bringing about a shift to clean fluid fuels, and (2) an extensive and compelling literature on the problems posed by this reliance on solid fuels.

Evolution of particulate regulation in China--prospects and challenges of exposure-based control.

China's urban and rural populations face very serious health risks from combustion particles. Major sources of exposure to inhalable particulates include the burning solid fuels (biomass and coal) for household cooking and heating, coal-fired industrial and residential boilers, tobacco smoking, and diesel motor vehicles. China began to address particulate pollution problems over 25 years ago and has implemented a series of progressively more aggressive policies. This paper reviews the successes and limitations of past and existing policies for particulate controls, as well as the effects of China's economic reforms and energy policies on particulate exposure and pollution management. We examine the challenge of emissions reporting, required as part of both China's pollution levy system and emerging system for "total emissions control." Finally, we discuss practical steps toward exposure-based regulation of particulates, which would take advantage of the high cost-effectiveness for lifesaving of controlling particulate exposure from household and neighborhood sources relative to that of controlling exposure from industrial sources.

Biomass-derived liquid cooking fuels for household use in rural China: potential for reducing health costs and mitigating greenhouse gas emissions

Given the prevalence of solid cooking fuels and their highly polluting nature, a large number of people worldwide -- and more than half of China’s total population -- receive enormous doses of particulate matter (PM) from cooking with solid fuels in indoor environments. In China, hundreds of millions are routinely exposed to indoor pollutant concentrations that exceed any international or domestic standard by an order of magnitude. Accordingly, significant health benefits could be realized if solid fuels were replaced by cleaner-burni ng fuels in rural China. Moreover, emissions of health-damagi ng air pollutants (HDPs) from rural indoor use of solid fuels are concomitant with a significant share of China’s greenhouse gas (GHG) emissions. Thus, parallel assessments of the magnitude of health benefits and GHG emission mitigation associated with large-scale substitution of solid cooking fuels are warranted. This paper explores the plausible scope, potential health benefits, and possible GHG emission reduction of replacing a major portion of China’s rural household solid fuel combustion with liquid cooking fuels derived from agricultural residues. Health endpoints are not limited to mortality, but include several morbidity outcomes, and are assessed using the World Health Organization’s yardstick of disability adjusted life years (DALYs). A range of values is presented to reflect uncertainty associated with epidemiologic dose-response functions. If biomass-deriv ed liquid fuels were employed on a large scale, health benefits could include a dramatic reduction in rural mortality attributable to air pollution, with even greater health benefits associated with non-fatal endpoints.

Urban projects manual

Air pollution is an important public health concern in China, with high levels of exposure to both ambient and household air pollution. To inform action at provincial levels in China, we estimated the exposure to air pollution and its effect on deaths, disease burden, and loss of life expectancy across all provinces in China from 1990 to 2017.In all 33 provinces, autonomous regions, municipalities, and special administrative regions in China, we estimated exposure to air pollution, including ambient particulate matter pollution (defined as the annual gridded concentration of PM2·5), household air pollution (defined as the percentage of households using solid cooking fuels and the corresponding exposure to PM2·5), and ozone pollution (defined as average gridded ozone concentrations). We used the methods of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to estimate deaths and disability-adjusted life-years (DALYs) attributable to air pollution, and what the life expectancy would have been if air pollution levels had been less than the minimum level causing health loss.The average annual population-weighted PM2·5 exposure in China was 52·7 μg/m3 (95% uncertainty interval [UI] 41·0–62·8) in 2017, which is 9% lower than in 1990 (57·8 μg/m3, 45·0–67·0). We estimated that 1·24 million (95% UI 1·08–1·40) deaths in China were attributable to air pollution in 2017, including 851 660 (712 002–990 271) from ambient PM2·5 pollution, 271 089 (209 882–346 561) from household air pollution from solid fuels, and 178 187 (67 650–286 229) from ambient ozone pollution. The age-standardised DALY rate attributable to air pollution was 1513·1 per 100 000 in China in 2017, and was higher in males (1839·8 per 100 000) than in females (1198·3 per 100 000). The age-standardised death rate attributable to air pollution decreased by 60·6% (55·7–63·7) for China overall between 1990 and 2017, driven by an 85·4% (83·2–87·3) decline in household air pollution and a 12·0% (1·4–22·1) decline in ambient PM2·5 pollution. 40·0% of DALYs for COPD were attributable to air pollution, as were 35·6% of DALYs for lower respiratory infections, 26·1% for diabetes, 25·8% for lung cancer, 19·5% for ischaemic heart disease, and 12·8% for stroke. We estimated that if the air pollution level in China was below the minimum causing health loss, the average life expectancy would have been 1·25 years greater. The DALY rate per 100 000 attributable to air pollution varied across provinces, ranging from 482·3 (371·1–604·1) in Hong Kong to 1725·6 (720·4–2653·1) in Xinjiang for ambient pollution, and from 18·7 (9·1–34·0) in Shanghai to 1804·5 (1339·5–2270·1) in Tibet for household pollution. Although the overall mortality attributable to air pollution decreased in China between 1990 and 2017, 12 provinces showed an increasing trend during the past 27 years.Pollution from ambient PM2·5 and household burning of solid fuels decreased markedly in recent years in China, after extensive efforts to control emissions. However, PM2·5 concentrations still exceed the WHO Air Quality Guideline for the entire population of China, with 81% living in regions exceeding the WHO Interim Target 1, and air pollution remains an important risk factor. Sustainable development policies should be implemented and enforced to reduce the impact of air pollution on long-term economic development and population health.Bill & Melinda Gates Foundation; and China National Key Research and Development Program.