Environmentalists seek to set research agenda on indoor air pollution
Source – BMJ 2011; 342:d3062
Nearly half the world’s people use open fires and traditional biomass cooking stoves that expose them to indoor air pollution and cause an estimated 1.9 million premature deaths a year. Women and children are particularly affected.
The Global Alliance for Clean Cookstoves seeks to reduce this exposure through a switch to cleaner, more efficient alternatives. It is promoting the ambitious goal of converting 100 million homes by the year 2020.
A three day meeting of health advocates and biomedical researchers has proved to be the catalyst for setting a research agenda on indoor air pollution in developing countries. The US National Institutes of Health organised the conference, held near Washington, DC, on 9-11 May.
Themes reported by the conference’s working groups included the need to create a common database to eliminate duplication of research and standardisation of terms and measures to enable comparisons and aggregation of research findings.
The researchers seek to build on lessons and methods developed in tobacco research, identifying similarities and differences between tobacco toxins and the various components of indoor air pollution. It will be crucial to establish valid dose-response curves to exposure and to understand the epigenetics of exposure during each stage of human development.
Kirk Smith, an environmental scientist at the University of California at Berkeley, said that the RESPIRE study in India is documenting the effect on low birth weight babies of substituting cleaner cook stoves. “If we can show even half the observational [effect], the economic value of reduced neonatal care would justify the cost of the [cook stove] programme.”
Another priority is to strengthen the foundation of biological plausibility of interactions of indoor air pollution with cancers and infectious diseases, particularly diseases affecting the lung. As the Global Alliance for Clean Cookstoves’ Sumi Mehta said, even a small increase in susceptibility to or the severity of tuberculosis would have a great effect in terms of public health because of the huge burden of that disease.
The conference’s co-chairman, John Balbus, called the conference “a watershed moment” in bringing together implementers of this initiative and the scientific community to discuss the issues. He said, “We know that there is a huge burden, but we don’t have the iron-clad science to say we know how to do the interventions to maximally reduce this burden.”
Dr Balbus, who is the senior administrator at the National Institutes of Health’s National Institute of Environmental Health and Safety, told the BMJ that he was pleased that the conference “has broadened the engagement of the biomedical scientific community at NIH on these issues and gotten them to think about studies to conduct.”
“We now have a road map for a research agenda that can dovetail with what the Global Alliance will do on implementation,” added his co-chairman, William Martin II, of the NIH’s National Institute of Child Health and Human Development.
The Columbia University toxicologist Joseph Graziano expressed a note of caution. He wondered whether perhaps “the advocacy has gotten ahead of the science.” He was one of three reviewers not working on indoor air pollution who had been brought in to offer an outsider’s expert opinion.
He pointed to the example of Bangladesh, where contaminated surface water had resulted in extensive childhood diarrhoea. Unicef led an effort to drill wells to provide safe drinking water “without seriously evaluating that intervention” for other potential risks.
Only years later did public health officials come to understand that the groundwater contained significant levels of arsenic, which brought other health risks. “To this day there is precious little direct evidence that the well drilling programme achieved its stated goal of reducing infant mortality,” Dr Graziano said.
