Editor, Washington Post, April 18, 2012
Have you heard the story about the economist who was asked what he would do if washed ashore on a desert island? — “I would pick up a rock and assume it was a radio”
The so-called “improved” stove in the Indian study reported on by Brian Palmer (“Too many cookstoves spoil the effort to cut indoor air pollution” April 17) was not clean in any important way and so of course did not improve health. It was a simple local stove that did not change combustion to reduce smoke. Unfortunately, many NGOs and other well-intentioned groups involved in stove dissemination are convinced by their own rhetoric and at most a few lab tests that their stove is truly improved and will be adopted even though they do no systematic field testing to show it works well in practice or will be used by people over time.
The lesson learned long ago is that “you don’t get what you expect, but what you inspect” Just calling something “improved” (or a radio) does not make it so.
The word “improved” is a marketing trick with a long history. Half the products on shop shelves all over the world are called “improved.” Maybe the box or color is changed, but the word works by tricking us into buying things with the assumption that it is improved in a way that is meaningful to us without the seller having to actually show that it does. Adding “improved” to the label of products gives you a bump in sales every time – which is why it is done. But it does not make them into radios.
In contrast, before our RESPIRE study mentioned in the article we spent eight years in Guatemala, actually measuring stove performance and use. We proved that our stove lowered indoor pollution by a factor of ten in households over years, well before we started the trial to understand the health benefits. Currently, we have electronic monitoring devices in place that measure stove usage –a decade after introduction the households are still using their stoves 90% of the time. We have described this in detail in over 40 articles in the peer-reviewed biomedical literature, in which we showed that infants whose smoke exposures were reduced by 90% had 50% less pneumonia, the chief cause of child death in the world.
The article claims that the Indian “improved” stove was cheaper than the one we used. The data show otherwise. A $10 stove that few use, gives few benefits, and lasts a few months is extremely expensive – not cheap. A $100 one that lowers pollution exposure, people like and use, and lasts for a decade is much cheaper.
We also learned that the particular stove we used is not perfect by any means, even though locally accepted. Global understanding of how clean stoves have to be to obtain serious health benefits has changed significantly as a result of our work. Cleaner stoves are needed than nearly all those now being promoted, although some provide partial benefits. Thus the name of the new Global Alliance for Clean Cookstoves – not “improved” ones.
Please do not compare our study with one that started by assuming a rock was a radio. And do not think that by doing so that it has shown anything at all about what a real radio can do. Or a truly clean cookstove that people like and use.
Kirk R. Smith, Professor of Global Environmental Health, UC Berkeley
Principal Investigator, RESPIRE project
krksmith@berkeley.edu
