Estimated 4,000,000 Deaths from Household Cooking Smoke - A Note from Dr. Kirk Smith

This was sent to the cook stoves email list server on December 21st, 2012

Dear Colleagues,

The recently released "Global Burden of Disease 2010," a new systematic analysis of all major global health risks, has concluded that household air pollution from cooking with solid fuels kills 4 million people annually worldwide. This figure is double the previous estimate, and includes 3.5 million deaths associated with indoor exposures and another 500,000 deaths from cookstoves' contribution to outdoor air pollution. Additionally, millions more are sickened from lung cancer and disease, lower respiratory infections, cardiovascular disease, and cataracts associated with household air pollution. The study was funded by the Bill and Melinda Gates Foundation and represents the work of 486 co-authors from 50 countries.

The Global Burden of Disease Study 2010 (GBD 2010), published On December 13, 2012, in the journal Lancet, is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. GBD 2010 consists of seven articles, each containing data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups).

The last of the seven articles reports the comparative risk assessment among about 60 risk factors, including household air pollution. It can be cited as:

A Comparative Risk Assessment of Burden of Disease and Injury Attributable to 67 Risk Factors and Risk Factor Clusters in 21 regions, 1990-2010: A Systematic Analysis for the Global Burden of Disease Study 2010. Lancet, 380: 2224-60, 2012. S Lim, et al. (Link) (Download is free, but registration is required)

Below are selected excerpts from a summary of the article by Kirk Smith of the University of California-Berkeley. A video of Dr. Smith's presentation about the GBD study is also available. To learn more about this study and efforts underway to address this serious global health challenge, visit the Global Alliance for Clean Cookstoves at www.cleancookstoves.org.

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As chair of the skilled and dedicated expert group on Household Air Pollution (HAP), I here summarize four aspects of the assessment related to HAP:

First the numbers. The scale of HAP's health impact is quite large.

• 3.5 million direct premature deaths annually in 2010 – compared to 3.3 million for outdoor air pollution (particles and ozone) and 6.3 million for active and passive smoking.
• 0.5 million more from the outdoor air pollution due to household fuels — what one might call "secondhand cookfire smoke."
• This makes ~4 million total attributable to HAP from cooking fuel.
• 0.5 million of the total are child pneumonia deaths.
• The rest are adult deaths (men and women) from lung cancer, cardiovascular disease (CVD), and COPD. Cataracts are also included, but they cause very few deaths.
• In terms of absolute impacts, men are more affected than women. This counterintuitive result is because men have so much higher background rates of the major diseases. Thus, although women have higher exposures and higher elevations in risk for these diseases, men end up with the larger burden. In relative terms, as indicated below, however, women are more affected by HAP.
• In terms of DALYs (lost healthy life years), HAP is the 2nd most important risk factor for women and girls globally among those examined and 5th for men and boys. It is 1st for both sexes in South Asia and for women and girls in most of sub-Saharan Africa. HAP is 6th for both sexes in East Asia.
• HAP is the most important single environmental risk factor globally and in poor regions. Behind outdoor air pollution (OAP) in richer countries, of course, and in China, where OAP ranks fourth among all risk factors examined.
• 2.8 billion people rely on solid fuels for their main cooking fuel in 2010, a number that seems to have been roughly stable globally for the last decade or so. This are now more people than anytime in human history relying on solid fuels for cooking.

Second, the bottom lines:

• Most of the impact is now understood to occur in adults.
• But still, Acute Lower Respiratory Infections (ALRI) (pneumonia)) deaths in children are significant — 500k globally — even with much lower background ALRI death rate globally.
• Household cooking fuel emissions contribute substantially to outdoor air pollution in many countries — 25-30% in India, for example — "secondhand cookfire smoke."
• The new integrated exposure-response (IER) analyses provide excellent new cross-risk-factor validation of the effects we find for a range of diseases — lung cancer, COPD, ALRI (IERs link epidemiological evidence across the four particle categories - outdoor air pollution, secondhand tobacco smoke, HAP, and active smoking).
• HAP plays a large role in non-communicable diseases (NCDs) which are now understood to be so important in India and other low and mid-income countries.
• It is important to remember that interventions that do not reduce all the way to the clean levels used for comparison (see next section) will not produce the full health benefits. Based on studies across combustion particle sources in the GBD, it is now believed that the impacts are highly non-linear at the levels commonly experienced in households cooking with solid fuels. Thus, for example, a reduction of a factor of two in smoke exposures at these high levels will produce far less than a reduction of 50% in health impacts. Need to reduce exposures down to levels in the range of the WHO Air Quality Guidelines to do so.

Third, many will wonder why the results show so much larger effects for HAP compared to what was found in the previous CRA for 2000 published in 2004 (1.6 million premature deaths).

There were actually factors that tended to decrease the attributable burden in the new estimates:

• ~40% of the world use solid fuels for cooking in 2010, down from the ~50% estimated for 2000. This is based on much more robust estimate of global household solid fuel use for cooking informed by ~600 nationally representative household fuel use surveys compared to ~50 last time.
• We were able to be more careful in separating out cooking fuel only. There is much less confusion with heating fuels than before.
• The risks for COPD were less than before, based on the new systematic reviews and meta-analyses.

Fourth, there were other differences, however, that led to higher estimates:

• Evidence now allows us to add estimates for two new categories of disease: cardiovascular disease (CVD) and cataracts.
• As CVD is the chief cause of mortality in nearly all countries, the additional burden is substantial.
• Evidence of effects in men now for all adult endpoints except cataracts.
• We now using a low counterfactual (~7 ug/m3 annual PM2.5 — same as the OAP group used) — equivalent to cooking with gas.
• This allows the HAP results to reflect the full benefit that could be expected from moving the 40% of households with solid fuel to the low pollution experienced by 60% of world population using gas or electricity for cooking.

The net result was a major increase in the estimated burden.

Kirk R. Smith, MPH, PhD
2012 Tyler Laureate
Professor of Global Environmental Health
Director of the Global Health and Environment Program
School of Public Health
747 University Hall
University of California

Shipping Industry Going Green (Singapore)

Read more on CNN

 

More than 700,000 Premature Deaths due to Air Pollution in South Asia

An explosion of car use has made fast-growing Asian cities the epicentre of global air pollution and become, along with obesity, the world's fastest growing cause of death according to a major study of global diseases.
Article from the Guardian, December 17th, 2012

In 2010, more than 2.1m people in Asia died prematurely from air pollution, mostly from the minute particles of diesel soot and gasses emitted from cars and lorries. Other causes of air pollution include construction and industry. Of these deaths, says the study published in The Lancet, 1.2 million were in east Asia and China, and 712,000 in south Asia, including India.

Worldwide, a record 3.2m people a year died from air pollution in 2010, compared with 800,000 in 2000. It now ranks for the first time in the world's top 10 list of killer diseases, says the Global Burden of Disease (GBD) study.

The unexpected figure has shocked scientists and public health groups. David Pettit, director of the southern California air programme with the Natural Resources Defence Council (NRDC), said:

"That's a terribly high number – and much more people than previously thought. Earlier studies were limited to data that was available at the time on coarse particles in urban areas only."

Anumita Roychowdhury, head of air pollution at the Centre for Science and Environment (CSE), a New Delhi-based environmental group, said: "There is hard evidence now to act urgently to reduce the public health risks to all, particularly children, elderly and the poor. No-one can escape toxic air."
The full effects of air pollution on health in Asian cities may not be seen for years, she said. "Toxic effects like cancer surface after a long latency period. Therefore, exposure to air pollution will have to be reduced today to reduce the burden of disease," she said.

According to the report, by a consortium of universities working in conjunction with the UN, 65% of all air pollution deaths are now in Asia, which lost 52m years of healthy life from fine particle air pollution in 2010. Air pollution also contributes to higher rates of cognitive decline, strokes and heart attacks.

If the figures for outdoor air pollution are combined with those of indoor air pollution, caused largely by people cooking indoors with wood, dirty air would now rank as the second highest killer in the world, behind only blood pressure.

Household air pollution from burning solid fuels such as coal or wood for cooking fell noticeably, but not having clean cooking and heating fuels remains the leading risk in south Asia.

Fine particle air pollution in India is far above the legal limits of 100 microgramme per cubic metre. This can rise to nearly 1,000 microgrammes during festivals like Diwali.

Improvements in car and fuel technology have been made since 2000 but these are nullified by the sheer increase in car numbers. Nearly 18m are expected to be sold this year alone. In Delhi, there are now around 200 cars per 1,000 people compared with 70-100 per 1,000 population in Hong Kong and Singapore.

Rajendra Pachauri, head of the Intergovernmental Panel on Climate Change and director-general of the Energy and Resources Institute in New Delhi, this week suggested the need to "demand restraint measures" in Delhi, to put a check on the growing number of cars so that there was a check on pollution.

Air Pollution Responsible for 2200 Premature Deaths per Year in Tehran, Iran

Considering short-term effects, PM10 had the highest health impact on the 8,700,000 inhabitants of Tehran city, causing an excess of total mortality of 2194 out of 47284 in a year. Sulfur dioxide, nitrogen dioxide and ozone caused about, respectively, 1458, 1050 and 819 excess cases of total mortality.

Download the paper published in Iranian Journal of Environmental Health Science and Engineering
 www.ijehse.com/content/pdf/1735-2746-9-28.pdf

Nearly 400,000 Bangkok Commuters are Suffering from Respiratory Diseases Due to Air Pollution

According to the BMA's medical division, the number of people suffering from respiratory diseases such as asthma and allergies has risen drastically over the past seven years, with about 20,000 to 30,000 Bangkokians developing symptoms every year.


Traffic in Bangkok is getting worse thanks to the government's first-car tax-rebate policy. As of October 31, car registrations in Bangkok had revved up to 7,384,934, of which 296,553 were for new cars bought under the first-car policy.

Though the number of cars registered has risen this year, the Pollution Control Department's director general Wichian Jungrungreung said the quality of air in the capital was still "good" and that the number of particles smaller than 10 micrometres had reduced over the past two years.

Read More at the Nation, December 15th, 2012

Rapid Rail Transit for the National Capital Region of Delhi

If the NCR Planning Board achieves its target of getting the three rapid rail transit systems operational by 2016, people living in the National Capital Region can hope to save Rs 1 lakh crore annually.

The board's member-secretary, Naini Jayaseelan, however, believes that the approved expenditure of around Rs 72,000 crore on the three rapid rail transit systems is only a trickle, compared with what an enterprise of this magnitude calls for.

The estimated value of the economic benefits accruing to the NCR after the Delhi-Alwar, Delhi-Meerut and Delhi-Panipat rapid rail alignments are completed will be around Rs 3.5 lakh crore, according the NCRPB.

Read more on Daily Mail

National Capital Region Planning Board

Global Burden of Disease Study 2010 (The Lancet)

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middle-aged adults are dying and suffering from disease and injury, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness.

GBD 2010 consists of seven Articles, each containing a wealth of data on different aspects of the study (including data for different countries and world regions, men and women, and different age groups), while accompanying Comments include reactions to the study's publication from WHO Director-General Margaret Chan and World Bank President Jim Yong Kim. The study is described by Lancet Editor-in-Chief Dr Richard Horton as "a critical contribution to our understanding of present and future health priorities for countries and the global community."

Read more in the Lancet, December 13th, 2012

An article in the Times of India focusing on Asia and India.

A press release from Health Effects Institute.

London Assembly Reports 4000 deaths per year due to Air Pollution

Up to nine per cent of deaths in the capital’s most polluted areas are attributable to air pollution, a new paper from the London Assembly reveals.

The percentage of deaths attributable to man-made airborne particles was highest in the City of London (9 per cent), Westminster (8.3 per cent), Kensington and Chelsea (8.3 per cent) and Tower Hamlets (8.1 per cent).  Bromley and Havering (both 6.3 per cent) had the lowest proportion in London, though are still above the England average of 5.6 percent.


The Assembly’s Health and Environment Committee's paper highlights the long-term health impact of toxic pollutants, which have been linked to life-shortening lung and heart conditions, breast cancer and diabetes.  It is estimated there are over 4,000 extra deaths each year in London from particulates and health costs are estimated at up to £20 billion a year – twice the cost of obesity.

Read More

TRASHED (The Documentary) by Jeremy Irons

A review in The Guardian

Less Meat is Good for You and the Environment !!

Hairy Nose from Clean Air Asia (BAQ 2012)

The Hairy Nose campaign was launched at the three-day Better Air Quality (BAQ) 2012 conference, organized by Clean Air Asia, the Hong Kong SAR Environmental Protection Department and The Hong Kong Polytechnic University, which will kick off on December 5, 2012 in Hong Kong. The campaign which consists of a online video, a micro website where people can check pollution levels in their city and select their own nose hair styles will be rolled out after BAQ 2012 to a number of Asian countries where Clean Air Asia has regional offices and networks including China, India, Pakistan, Sri-Lanka and Vietnam

The Hairy Nose video can be seen at:www.cleanairasia.org/hairynose
The Hairy Nose Micro site can be found at:
www.cleanairasia.org/hairynose/home

Top 100 cities with the worst air quality in the World (WHO, 2011).  

Varieties of Carbon - Black to Green

from article published in Pacific Standard

Brown carbon: Brown carbon is a light-absorbing particle in the Earth’s atmosphere that has the unique characteristics of both cooling the planet’s surface and warming its atmosphere. It was originally distinguished from black carbon in a 2006 report by M.O. Andreae, who has a doctorate in oceanography, and A. GelencsÄr, a chemist. Research published in 2008 by Arizona State University professor Peter Crozier suggests that this nanoscale atmospheric aerosol species is abundant in the atmosphere over East Asian countries and should be explicitly included in models of radiative forcing (the gap between energy radiation reaching the Earth and that leaving through the upper atmosphere).

Green carbon: Green carbon is the carbon that is stored in terrestrial ecosystems such as forests, pastures and soils. This carbon can be released into the atmosphere through deforestation and fire. The U.N. Framework Convention on Climate Change noted in a 2008 report that increasing green carbon stores through reforestation and preservation efforts has great potential to combat global warming.

Blue carbon: Blue carbon is carbon that lives in the world’s oceans. An estimated 55 percent of carbon in living organisms is stored in mangroves, marshes, seagrasses, coral reefs and macro-algae. This carbon is cached for millennia, unlike green carbon, which may be stored for decades or centuries. A new report from UNEP, The Food and Agriculture Organization, and UNESCO’s Intergovernmental Oceanographic Commission highlights the alarming fact that blue carbon ecosystems are being degraded five to 10 times faster than rainforests. Coastal ecosystem services are valued at $25 billion per year — they provide vital nutrition for close to 3 billion people.

Black carbon: Last but not least, black carbon is the carbon formed through incomplete combustion of fuels — essentially soot. It is the most widely discussed form of carbon, and some scientists suspect it is second only to carbon dioxide as a contributor to global warming. Black carbon can be reduced through the adoption of clean-burning technologies.