Breakthroughs in tackling Indoor Air Pollution (IAP)-the toxic smoke from half the world's population cooking on wood, dung and coal fires-have the potential to significantly reduce the incidence of COPD in the developing world.
Worldwide, approximately 2 million people in developing countries die every year from IAP. Of those 2 million deaths, 54 percent are from COPD, according to a 2009 study from the World Health Organization (WHO) and United Nations Development Programme (UNDP).
IAP includes fumes, smoke and contaminants created from indoor cook stoves.
William Martin, Associate Director at the National Institute for Environmental Health Making it Better to Breathe Worldwide Sciences, says that it is the poorest people in the world who cook their food using biomass fuels—including wood, charcoal, crop residues, animal dung, and coal. The use of these fuels in primitive and inefficient stoves results in indoor smoke that can lead to the development of COPD, especially in women.
“Almost half of the world’s people fit into the category of being extremely poor,” Martin says. “Under these circumstances no matter where you go in the world, the people rely on biomass or solid fuels to cook their food and heat their home.”
The WHO/UNDP study shows that three billion people—almost half of humanity—rely on traditional biomass, as the available modern energy services fail to meet their needs.
Martin says that the exposure to smoke of people living in these conditions approaches levels they would experience if they were cigarette smokers.
“It’s an involuntary exposure that half the planet has, and the only reason they have it is because they’re poor,” he says. “They don’t do this by choice. You can tell someone [in this situation], ‘You as a woman are at risk for developing COPD’ but it doesn’t change [his or her] behavior. They have very limited access to cleaner fuels and stoves.”
Women over 30 exposed to IAP are 3.2 times more likely to develop COPD, according to the WHO/UNDP report. For men over 30, it is 1.8 times more likely.
The reasons for their mindset are part financial, part traditional.
“Sometimes they rather spend their money on other things,” Martin says. “Or they might say that their mother or grandmother cooked like this. It is very challenging to change how the world cooks. You must consider many cultural and social factors.”
Martin estimates that 600-800 million households worldwide use biomass and solid fuels to cook and heat their homes. The main problems with this method lie in improper stoves and ventilation.
There is a range of methods for tackling IAP—chimneys, open windows, keeping children away from fire—but the internationally recognized most effective solution is Improved Cook Stoves (ICS), according to Simon Bishop, head of Policy and Communications at the Shell Foundation.
“ICS still burns biomass but they significantly reduce fuel use and emissions. If these can be provided at scale then a significant reduction in IAP-related deaths [including likely COPD cases] could be achieved,” Bishop says.
The Shell Foundation, the corporate foundation of the energy company and Envirofit International, a US non-profit, began a partnership in 2007 designed to create a global ICS business distributing millions of ICS to developing countries in an effort to reduce IAP. Their goal is to see 10 million stoves sold in 5 countries over the next 5 years.
In the 1980s and late 1990’s, the government in India gave away 20 million new stoves to help combat the problem, Bishop says. However, the initiative was largely unsuccessful because people did not value stoves given to them for free and/or when the stoves broke down there was no reliable local repair-service to fix them, leading people to return to their traditional, polluting stoves.
Bishop says there are a couple reasons why new attempts to provide ICS at scale are more likely to succeed this time around.
“First, the growing link between indoor air pollution and climate change helps because it’s getting a lot more people—and therefore resources—directed to the sector,” he says.
“Secondly, several major commercial players have come into the ICS market. Historically, it was the domain of NGOs [non-governmental organizations] and governments who gave away stoves that focused on reducing deforestation and not the health impacts of indoor air pollution,” he says. “These new players have the potential to provide health-benefiting ICS at scale. Together, these elements suggest a paradigm shift is beginning to take place in the sector.”
So far, Envirofit has sold more than 100,000 ICS in southern India. Another player, First Energy (a company formerly owned by energy giant BP) has sold 450,000, while Philips, the consumer electronics giant has begun to sell ICS in India too. Bishop says Envirofit has also started exploring other markets, such as Africa and Brazil.
He points out that the ICS offer more efficient combustion methods. “With all these stoves, they smoke a little bit when you light them, but once you get them going, they’re almost smokeless. Compare that to traditional stoves when the whole room is full of smoke.”
While common sense suggests a reduction in indoor air pollution through ICS will lead to a reduction in health impacts, including COPD, Bishop says there is one major challenge.
“If you’ve got indoor air pollution, and you put an improved cook stove in a home, it will reduce pollution by anything between 40 and 90 percent. But is that enough to reduce COPD cases by 40-90 percent as well? At this stage there is not enough medical evidence to prove this link. We urgently need to plug this gap in medical research.”
Martin says there also needs to be policy changes based on what is known in terms of health risks, since most people in these developing countries have no access to health care.
“It’s a huge challenge because we live in a world of disparity,” he says. “We want governments, businesses, foundations helping to find solutions that are culturally sensitive and involve the community, and at the end of the day have more efficient stoves that protect the lives of women and children.”
Bishop says it will take time to both prove the impact putting an ICS in someone’s home has on the incidence of COPD—and to see ICS sold at scale but says it is worth putting the effort in to achieve this.
“Indoor air pollution affects half the world’s population and kills more people per year than malaria, yet few people are aware of its impact. We need to change that. In doing so, we could make a huge difference in the incidence of COPD in developing countries.”