News
March 18–22 saw representatives from 550 organisations from more than 75 countries gather in Cambodia’s Phnom Penh for the Clean Cooking Forum 2013. Their aim was to “further a market-based approach to the global adoption of clean cooking solutions”. It was, explained Radha Muthiah (Global Alliance for Clean Cookstoves, New York, USA), “an excellent opportunity to highlight the importance and scale of the issue”. And the importance and scale of the issue certainly warrants highlighting. 3 billion people worldwide live in households in which solid fuels—wood, animal dung, crop residue, or coal— are burned for cooking. Only rarely is there adequate ventilation, and only rarely does their cookstove work with efficiency. Instead, the residence fills with pollutants: benzene, carbon monoxide, sulphur, formaldehyde, naphthalene, nitrogen oxides, and polyaromatic hydrocarbons are all associated with combustion. Small particulates can reach concentrations far in excess of recommended international limits. The most recent Global Burden of Disease study estimated the number of deaths attributable to indoor air pollution to be 3·5 million per year. Such pollution has been definitively linked to pneumonia, lung cancer, and COPD. Liverpool University’s Nigel Bruce points out that smoking cigarettes and inhaling combusted biomass fuels amounts to much the same thing in terms of the mix of pollutants (although the “dose” generally sits between passive and active smoking). This finding is particularly worrying given that small children often attach themselves to their mothers as meals are prepared, inhaling vast quantities of smoke; in Africa, childhood pneumonia caused by indoor air pollution kills 500 000 children under 5 years annually. The Global Alliance for Clean Cookstoves, a public-private partnership launched by the UN Foundation www.thelancet.com/respiratory Vol 1 April 2013
in September, 2010, hosted the Cambodian forum. The week-long event was part of its drive towards its medium-term goal: the worldwide take-up of clean cookstoves by 100 million households by 2020 (this would cover 20% of the affected population). It brought together an array of partners, and potential partners, charged with implementing an endeavour which cuts across specialties such as climate change, female empowerment and education, technology, international development, and sustainable energy. But it is all underpinned by a concern for public health. And while entrepreneurs work on creating inexpensive and efficient cookstoves, and policymakers craft innovative financing mechanisms, epidemiologists strive to fill the gaps in what is a largely under-researched field. It seems increasingly likely that indoor smoke is also risk factor for tuberculosis, for example—“the evidence doesn’t quite reach the levels of consistency that would have allowed it to be included in the Global Burden of Disease, but we are starting to build up a more convincing picture”, affirms Bruce. Then there is the overarching question of how clean the new cookstoves need to be. “We need to know exactly how much disease the existing levels of pollution are causing”, explains Bruce. Work on calculating an exposure-response relation for diseases linked to solid fuel combustion is ongoing. When complete, it will permit an assessment of those cookstoves which develop intermediate levels of exposure (and are therefore cheaper and easier to produce). The RESPIRE trial was one of the first published studies in this area: it concluded that halving levels of indoor air pollution by installing a chimney stove did not have a significant effect on normal childhood pneumonia, but caused a sizeable reduction in severe pneumonia. “It needs replicating but these are very exciting and important results”.
Perhaps the trickiest question concerns how an intervention would realistically work. “The stoves are showing promising results in the laboratory but we still need to do field testing”, stressed Maria Neira (WHO, Geneva, Switzerland). One long-term study found that improved cookstoves made no difference to the health of households in Orissa, India. Rather, householders neglected to maintain the stoves or did not use them properly. Often, households continue using old cookstoves in tandem with, or perhaps instead of, new, cleaner models. This calls for concerted public awareness campaigns; the Global Alliance is well-placed to spearhead these, since its inception it has attracted high-profile support from, among others, Hillary Clinton, Julia Roberts, and Kofi Annan. “We need to have tools for monitoring and evaluating the health impacts of cleaner household energy interventions”, adds Neira. New air quality guidelines from WHO on household fuel combustion are expected later this year. “The standards can be used to certify clean cookstoves”, says Muthiah. It will be very difficult to enforce regulations on household air quality, but Muthiah believes that adherence could be ensured by including national standards bodies from the beginning of the process. The Global Alliance for Clean Cookstoves talks of a “perfect storm”, with technology, business, and the political establishment all working together to achieve the same thing. “The international community is making a big effort in terms of mobilising resources and doing advocacy”, agrees Neira. She notes that universal adoption of clean cookstoves and fuels would have across-the-board benefits, including cutting outdoor air pollution. “There is no doubt that it is the basis for public health”.
Adam Hart-Davis/Science Photo Library
Not just hot air
For more on the Global Burden of Disease study see http:// www.thelancet.com/themed/ global-burden-of-disease For the RESPIRE trial see Articles Lancet 2011; 378: 1717–26 For more on the long-term study of improved cookstoves see http://papers.ssrn.com/sol3/ papers.cfm?abstract_ id=2039004
Talha Khan Burki 107
March 18–22 saw representatives from 550 organisations from more than 75 countries gather in Cambodia’s Phnom Penh for the Clean Cooking Forum 2013. Their aim was to “further a market-based approach to the global adoption of clean cooking solutions”. It was, explained Radha Muthiah (Global Alliance for Clean Cookstoves, New York, USA), “an excellent opportunity to highlight the importance and scale of the issue”. And the importance and scale of the issue certainly warrants highlighting. 3 billion people worldwide live in households in which solid fuels—wood, animal dung, crop residue, or coal— are burned for cooking. Only rarely is there adequate ventilation, and only rarely does their cookstove work with efficiency. Instead, the residence fills with pollutants: benzene, carbon monoxide, sulphur, formaldehyde, naphthalene, nitrogen oxides, and polyaromatic hydrocarbons are all associated with combustion. Small particulates can reach concentrations far in excess of recommended international limits. The most recent Global Burden of Disease study estimated the number of deaths attributable to indoor air pollution to be 3·5 million per year. Such pollution has been definitively linked to pneumonia, lung cancer, and COPD. Liverpool University’s Nigel Bruce points out that smoking cigarettes and inhaling combusted biomass fuels amounts to much the same thing in terms of the mix of pollutants (although the “dose” generally sits between passive and active smoking). This finding is particularly worrying given that small children often attach themselves to their mothers as meals are prepared, inhaling vast quantities of smoke; in Africa, childhood pneumonia caused by indoor air pollution kills 500 000 children under 5 years annually. The Global Alliance for Clean Cookstoves, a public-private partnership launched by the UN Foundation www.thelancet.com/respiratory Vol 1 April 2013
in September, 2010, hosted the Cambodian forum. The week-long event was part of its drive towards its medium-term goal: the worldwide take-up of clean cookstoves by 100 million households by 2020 (this would cover 20% of the affected population). It brought together an array of partners, and potential partners, charged with implementing an endeavour which cuts across specialties such as climate change, female empowerment and education, technology, international development, and sustainable energy. But it is all underpinned by a concern for public health. And while entrepreneurs work on creating inexpensive and efficient cookstoves, and policymakers craft innovative financing mechanisms, epidemiologists strive to fill the gaps in what is a largely under-researched field. It seems increasingly likely that indoor smoke is also risk factor for tuberculosis, for example—“the evidence doesn’t quite reach the levels of consistency that would have allowed it to be included in the Global Burden of Disease, but we are starting to build up a more convincing picture”, affirms Bruce. Then there is the overarching question of how clean the new cookstoves need to be. “We need to know exactly how much disease the existing levels of pollution are causing”, explains Bruce. Work on calculating an exposure-response relation for diseases linked to solid fuel combustion is ongoing. When complete, it will permit an assessment of those cookstoves which develop intermediate levels of exposure (and are therefore cheaper and easier to produce). The RESPIRE trial was one of the first published studies in this area: it concluded that halving levels of indoor air pollution by installing a chimney stove did not have a significant effect on normal childhood pneumonia, but caused a sizeable reduction in severe pneumonia. “It needs replicating but these are very exciting and important results”.
Perhaps the trickiest question concerns how an intervention would realistically work. “The stoves are showing promising results in the laboratory but we still need to do field testing”, stressed Maria Neira (WHO, Geneva, Switzerland). One long-term study found that improved cookstoves made no difference to the health of households in Orissa, India. Rather, householders neglected to maintain the stoves or did not use them properly. Often, households continue using old cookstoves in tandem with, or perhaps instead of, new, cleaner models. This calls for concerted public awareness campaigns; the Global Alliance is well-placed to spearhead these, since its inception it has attracted high-profile support from, among others, Hillary Clinton, Julia Roberts, and Kofi Annan. “We need to have tools for monitoring and evaluating the health impacts of cleaner household energy interventions”, adds Neira. New air quality guidelines from WHO on household fuel combustion are expected later this year. “The standards can be used to certify clean cookstoves”, says Muthiah. It will be very difficult to enforce regulations on household air quality, but Muthiah believes that adherence could be ensured by including national standards bodies from the beginning of the process. The Global Alliance for Clean Cookstoves talks of a “perfect storm”, with technology, business, and the political establishment all working together to achieve the same thing. “The international community is making a big effort in terms of mobilising resources and doing advocacy”, agrees Neira. She notes that universal adoption of clean cookstoves and fuels would have across-the-board benefits, including cutting outdoor air pollution. “There is no doubt that it is the basis for public health”.
Adam Hart-Davis/Science Photo Library
Not just hot air
For more on the Global Burden of Disease study see http:// www.thelancet.com/themed/ global-burden-of-disease For the RESPIRE trial see Articles Lancet 2011; 378: 1717–26 For more on the long-term study of improved cookstoves see http://papers.ssrn.com/sol3/ papers.cfm?abstract_ id=2039004
Talha Khan Burki 107
