Children’s Health in Latin America: The Influence of Environmental Exposures. Environ Health Perspect, March 2015, DOI:10.1289/ehp.1408292
Authors: Amalia Laborde, Fernando Tomasina, et al.
Specific Environmental Health Threats to Children in Latin America
Indoor air pollution. Indoor air pollution is the leading environmental threat to health in the Americas, being responsible for nearly 5% of healthy years of life lost and 7% of premature deaths (WHO 2014c). WHO estimates that in 2012, 7,500 deaths were attributable to indoor air pollution in children < 5 years of age in low- and middle-income countries of the Americas (WHO 2014c). In 2010, indoor air pollution ranked eighth among risk factors for chronic disease in Latin America (Lim et al. 2012).
Solid and biomass fuels are the major source of indoor air pollution, especially in rural areas. WHO estimates that in 2010, 10% of the population of Latin America relied on solid and biomass fuels for cooking and heating, largely in open fires or unvented stoves (WHO 2014b). The rural/urban ratio in use of solid fuels is 2.3 in countries in the lowest and, 11.7 in the highest quartile of the Human Development Index (http://hdr.undp.org/en/content/human-development-index-hdi). The Living Standards Measurement Survey (World Bank 2012) conducted in Guatemala demonstrated the highest reliance on solid fuel—up to 95% in some regions—among indigenous populations in rural areas.
Ten-fold disparities in death rates attributable to indoor air pollution are seen across Latin American countries and range from a high of 14 in the least developed countries, down to 0.3 for high-income countries (WHO 2014b). Thus in 2012, ≥ 50% of the populations of Guatemala, Haiti, Honduras, and Nicaragua used solid fuels as their main energy source (WHO 2014b). Even in urban areas of the less-developed countries of the Americas, a high percentage of the population relies on solid fuels (Soares da Silva et al. 2013; WHO 2014b).
Since 1990 the region has experienced a steady decline in the percentage of the population using solid fuels and the size of the population exposed (Bonjour et al. 2013). Some countries can make the transition to cleaner fuels, but others will likely continue to use solid fuels because of lack of infrastructure and the high costs associated with transition to gas and electricity.
Interventions are underway, especially in areas of the Americas, to introduce new cookstoves that use solid fuels more efficiently and are less polluting. A major study of this intervention in Guatemala found that using clean stoves was associated with a 30% reduction in severe pneumonia among children < 18 months of age (Smith et al. 2011). A study in Peru found that using the new cookstoves significantly reduced sleep and respiratory symptoms in children 2–14 years of age, but only in households that used the less-polluting stoves exclusively and with adequate maintenance (Accinelli et al. 2014).
