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Health and household energy - the need for better links between research and development
[top] [end]IntroductionAround two-thirds of all households in the developing countries still rely primarily on unprocessed biomass fuels (wood, dung, crop residues) for their daily cooking and heating needs (WRI 1998). In many of these households, the fuel is burned indoors on open fires or poorly functioning stoves, often with no chimney. The World Health Organisation (WHO) has recently argued that by far the greatest global burden of air pollution exposure occurs, not outdoors in the cities of the developed world, but indoors in poor rural communities (WHO 1997).[top] [end]Health problemsThe health problems associated with household energy can usefully be thought about under the following three headings:[top] [end]Fuel production and the environment
[top] [end]Fuel collection and supply
[top] [end]Fuel Use
The goal so far as smoke pollution is concerned must be to reduce exposure sufficiently to have a useful impact on key health outcomes. For many poor rural and urban communities this may present a considerable challenge. [top] [end]Practical issues in reducing exposure to bio-fuel smoke[top] [end]The drive for fuel conservationOver the last 20-30 years, the major goal of projects aimed at improving the household environment has been to substitute traditional open fires with more fuel-efficient stoves. An example of this type of activity is the ITDG Upesi stove project in Kenya (Figure 1), which aimed to achieve widespread introduction of an improved ceramic wood stove.
When compared with open fires, these stoves have been shown to use about 40% less firewood, and reduce carbon monoxide levels in the kitchens by nearly 30% (which is indicative of a reduction in other components of air pollution, including particulates). A key element of the success of the project has been the training of the producers, sellers and promoters of the stoves (most of whom are local women), in effective dissemination techniques. Many of the households with these improved stoves have reported that:
However, with no flue and few other ways of venting smoke from the home, any reduction in exposure is due mainly to improvements in efficiency and the consequent reduction in cooking times. [top] [end]Reducing exposure while meeting household needsExperience from stove development work has shown that substantially reducing exposure levels, while at the same time preserving or improving fuel efficiency, is a technically demanding task. Many so-called improved stoves may yield one benefit, but this is often achieved at the expense of other aspects.Identifying improved stoves that perform well across all relevant criteria is therefore important. Work carried out by WHO in the western highlands of Guatemala has included some detailed studies of a locally produced chimney stove known as the plancha (Figure 2). Two studies comparing the plancha with the traditional open fire and with LPG have been completed (Naeher 95, Boy, in press), and have shown:
[top] [end]Reducing exposure in more demanding environmentsSubstantial numbers of households in Asia, Africa and the Americas live in cold environments (some extremely cold), and the demands on the devices used to provide household energy are that much greater. An example of this situation is to be found in Ladakh in Northern India. Open fires are used, and around the capital Leh, many households have stoves with metal flues. Winters are extremely cold, and women and young children spend many hours each day indoors. The condition of the stoves and flues, which typically leak good deal, means that homes are very polluted. Ventilation is reduced to a minimum, and embers are raked out on a hearth to assist with space heating.In settings such as these, the open fire or stove must provide the means to cook, to heat the home, provide light, as well as being a social focus for members of the household who may need to spend long periods indoors. It will not be easy to bring about substantial reductions in exposure in circumstances such as these where fuel is scarce and efficiency vital, alternatives to bio-mass are limited, and where poverty is widespread. [top] [end]Key points
[top] [end]Interventions to reduce smoke exposureThe following list illustrates the broad range of interventions that can contribute to reducing indoor air pollution exposure. In any given setting it is likely that a combination could be considered, but local circumstances should determine what is appropriate.[top] [end]Technical interventions
[top] [end]Behavioural interventions
[top] [end]Policy level interventions
[top] [end]What factors can help bring about change in policy?[top] [end]Greater awareness of risk to healthThe health risks associated with household energy, especially the exposure of women and young children to indoor air pollution, should be seen as a priority issue on the policy agenda. It is important to emphasise the potential health gains that can be achieved by reducing exposure, for the majority of households in the developing world, in both rural and urban settings.[top] [end]What information is needed?Research has an important part to play in providing the kinds of information needed to advocate for a stronger policy response, to develop and test more effective interventions and monitor progress. These research needs are summarised below:[top] [end]By how much does exposure need to be reduced?This apparently simple question has important consequences for research and policy, for example with the primary prevention of childhood pneumonia.Pneumonia, the most common type of acute lower respiratory infection (ALRI), remains the single most important cause of death world-wide among children under 5 years of age. The risk of dying from ALRI is highest in the first year of life, and especially in the first six months. However, if instead of asking whether smoke causes pneumonia, we turn the question round and ask, 'how much will feasible reductions in smoke exposure benefit children's health?', then for many of the world's poorest populations we are faced with considerable uncertainty. We have very little idea whether, say, halving pollution levels (as may be achieved by substituting an open fire with a fairly typical 'improved' stove) would reduce any of the major health problems associated with smoke exposure. It may well be that much more substantial reductions are required to achieve worthwhile improvements in health. The importance of this question is emphasised by the fact that, in practice, it has been very difficult to achieve large reductions in pollution levels - particularly in poor rural communities. The best way to answer this issue is to study directly the health benefits that result from measured reductions in exposure of children. Although studies of this type will be complex and expensive because of the need to measure health outcomes (such as the incidence of pneumonia) the findings would be very valuable and provide momentum for development work in the household energy field and support efforts to bring about really substantial improvements in the living conditions of the poorest people.
[top] [end]Opportunities for linking research and development activitiesResearch and development work should not be seen as separate, unrelated activities. Better links can help promote a two-way exchange - ensuring the relevance of research to development needs and priorities, as well as helping to ensure that new knowledge derived from research is put into practice. Table 1 lists, for three broad types of study, examples of the kinds of objectives which can be addressed if a more integrated approach is taken to research and development.[top] [end]A proposal for action through co-ordinated demonstration projectsThere is a pressing need for those working in the field of health and household energy to raise the profile of this serious environmental health problem, and to encourage practical approaches to achieving effective change. This could be achieved by developing a co-ordinated programme of research and development, to strengthen the available scientific evidence on health effects, to promote the development and evaluation of cost-effective, sustainable interventions, and to monitor progress.Better integration of this research and development work should be a theme which runs throughout these activities. One practical way to move this forward would be through establishing a co-ordinated set of demonstration projects in a range of settings, developing and evaluating locally appropriate interventions with well - standardised methods, and ensuring wide dissemination of the experience gained. Proposals for this are under development, and anyone interested in taking part is encouraged to contact the author. [top] [end]Bibliography
Another useful contact for information on the health impacts of smoke is the USAID-Environmental Health Programme: contact Dan Campbell at CampbellDB@... [top] [end]Contents: Boiling Point 44: Linking household energy with other development objectives
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17 July 2007; Last edited:
24 September 2008; Version: 1 | |||||||||||||||||||||
Pagename: HealthAndHouseholdEnergy-TheNeedForBetterLinksBetweenResearchAndDevelopment @HEDON: QVFA | |||||||||||||||||||||
