Kirk Smith – Changing Paradigms in Clean Cooking

April 22, 2015 · 1 comment

Changing Paradigms in Clean Cooking. EcoHealth, April 2015.

Author: Kirk Smith

The latest Comparative Risk Assessment of the Global Burden of Disease (GBD) estimates that household air pollution (HAP) from solid cooking fuels imposes the largest environmental health burden in the world among all risk factors examined (Lim et al. 2012). With about 4 million premature deaths annually from both the household exposures and the exposures downwind from household contribution to outdoor air pollution (secondhand cooksmoke), HAP is ranked fourth in the world among all the risk factors, even though only about 40% of the world is directly exposed, those in poor countries cooking with biomass or coal (Smith et al. 2014).

There will be changes in these estimates going forward, due to better evidence on relative risks of the current diseases associated with HAP [acute lower respiratory infection (pneumonia) (ALRI), chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), stroke, lung cancer, and cataracts], more accurate exposure estimates, and addition of new diseases for which evidence is suggestive but not yet convincing (e.g., TB, birth outcomes, and cognitive effects), but it seems that HAP has crossed a historical threshold. Regardless whether it is 4, 2, or 6 million premature deaths, HAP is clearly responsible for much ill health among, almost by definition, the least advantaged people in the world. It has joined the gorillas in the room like outdoor air pollution, high BMI, sodium intake, child underweight, and physical inactivity, in the global burden, although somewhat smaller than the three elephants: high blood pressure, alcohol, and smoking. Like all these others, it is not going away easily either in our risk estimates or on the ground.

The health impacts of HAP have been suspected for decades, and a few isolated studies occurred more than a half century back (e.g., Padmavaty and Pathak 1959), but it has only been in the last period that the sufficient evidence has been marshaled to make a systematic case across a range of diseases. Extremely helpful in this task was the development in the recent GBD project of Integrated Exposure Response functions that link the risks of five diseases across four exposure categories of combustion pollution, in order of exposure levels: ambient air pollution, secondhand tobacco smoke, HAP, and active smoking. The same diseases are caused by each, albeit at risk levels commensurate with their quite different exposure levels (Burnett et al. 2014).

Although basic epidemiological and exposure research continues, given the that this threshold has been passed, there is a need now to examine carefully the paradigms behind efforts to ameliorate the situation as intervention research becomes more to the fore. Here I examine the traditional paradigms that have dominated thinking over the last half century and then propose five new ones to help in the future.

 

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Tegras Busobozi April 24, 2015 at 10:43 am

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