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Environmental Factor

November 2011

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NIEHS aids the global fight against indoor air pollution

By Ian Thomas
November 2011

John Balbus, M.D.

John Balbus (Photo courtesy of Steve McCaw)

Francis Collins, M.D., Ph.D.

Francis Collins (Photo courtesy of NIH)

William Martin, M.D.

William Martin (Photo courtesy of Steve McCaw)

Roger Glass, M.D., Ph.D.

Roger Glass (Photo courtesy of the Fogerty International Center)

In a new article in Science( Exit NIEHS, NIEHS Senior Advisor for Public Health, John Balbus, M.D.(, and three co-authors outlined the urgent need for government intervention in the fight against indoor air pollution (IAP). According to a report by the World Health Organization (WHO), IAP directly contributes to some 2 million fatalities each year, making it the leading cause of death worldwide, even greater than malaria.

“NIEHS is committed to understanding the major environmental causes of disease and disability around the world and IAP strikes at the heart of that commitment,” Balbus explained. “By funding research on the effects of household biomass burning and partnering with like-minded organizations, the Institute is helping to expand the knowledge base on this issue and improve the health of the world's poorest populations.”

Why is IAP such a problem?

IAP is a form of air pollution that is caused by the burning of coal or biomass fuels, such as wood, crop residue, charcoal, or dung, in the millions of indoor fires and primitive stoves used by much of the poverty-stricken world. Utilized for both cooking and heating, these stoves produce thick clouds of black smoke that not only blacken walls and ceilings, but also lead to serious pulmonary, cardiovascular, and other health problems.

"Many people in developed countries don't realize that smoke from indoor cooking fires is a terrible scourge upon the health of countless people," said Francis Collins, M.D., Ph.D.,( Exit NIEHS director of the NIH and another author on the paper. "International efforts to combat this scourge are only now getting underway. Therefore, the NIH's role is to support the research that will determine the most efficient, cost-effective means to do so while safeguarding human health."

Collins and Balbus also point out that no one is more affected by this problem than women and children.  Since many of their daily responsibilities require women to remain at home, they are at significantly increased risk for exposure, not to mention additional risk for gender-based violence when they do venture out in search of fuel to burn at home. Children under their care share those same exposures.

“Tragically, many of them are children under the age of five who die of pneumonia induced by this very heavy exposure to the soot that builds up in those homes over time,” Collins noted. “Woman are also particularly vulnerable because they spend so much time in the home, huddled over the fire, which places them at the same level of risk for cancer and chronic obstructive pulmonary disease as a long-term smoker.”

The road ahead

With awareness of IAP growing by the day, scientists note that the research base for this issue is far from complete. Moving forward, Balbus believes that the key to future IAP research will hinge on two key components - data collection and technology development.

“On the data front, we've got to focus on finding out more precisely what level of exposure reduction is necessary to reduce the risk of illnesses like pneumonia and COPD while also identifying the primary social and behavioral barriers to cookstove adoption in specific locations,” Balbus noted. “On the technology front, we need to develop monitoring equipment and biomarkers to chart both chronic exposure rates and their biological effects on inhabitants.”

A worthy cause

In the days ahead, finding solutions to this global problem promises to be a daunting task, particularly given the extreme state of poverty surrounding so many of the people who are affected by it. Still, the authors agree no cause is more just.

“They may be living in small huts or households that barely protect them from the elements and yet, like all of us, they must cook their food, heat their homes, and seek light when it is dark outside,” said William Martin, M.D., associate director for prevention research and health promotion at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the article's lead author. “That's why it's the leading environmental cause of death in the world today.”

Fogarty International Center (FIC) Director Roger Glass, M.D., Ph.D., was also a co-author of the paper. FIC is dedicated to advancing the mission of the National Institutes of Health by supporting and facilitating global health research conducted by U.S. and international investigators.

Citation: Martin WJ 2nd, Glass RI, Balbus JM, Collins FS( Exit NIEHS. 2011. Public health. A major environmental cause of death. Science 334(6053):180-181.

(Ian Thomas is a public affairs specialist with the NIEHS Office of Communications and Public Liaison.)

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