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Environmental Factor, November 2012

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Workshop addresses the millions who die yearly from household air pollution

By Cindy Loose

NIH Director Francis Collins, M.D., Ph.D.

Collins’ presentation was a tangible expression of the interest NIH has in reducing indoor air pollution worldwide. (Photo courtesy of NIH)

Linda Birnbaum, Ph.D.

Birnbaum observed that the NIEHS commitment to global health is an important component of the Institute’s 2012-2017 Strategic Plan, specifically theme 4 — health disparities and global environmental health. (Photo courtesy of Steve McCaw)

Cooking meals can be a deadly activity for the poorest three billion people in the world who burn wood, dung, and other biomass in their homes. Women and children, who usually spend the most time indoors breathing air polluted by cooking fires, are the most frequent victims. The pollutants are also a major contributor to global warming.

“Nearly two million women and children around the world die every year, and many more are made sick or disabled, as a result of exposure to smoke from biofuels,” said NIEHS/NTP Director Linda Birnbaum, Ph.D., in her keynote address at the Household Air Pollution Research Training Institute Meeting Oct. 9-12 at the Fogarty International Center on the National Institutes of Health Bethesda, Md., campus.

A critical problem

The extent of the problem was described to participants from multiple federal agencies and institutions around the world by NIEHS grantee Kirk Smith, Ph.D., a professor of global environmental health at the University of California, Berkeley. He noted that World Health Organization guidelines recommend particulate matter exposure at no more than 10-35 milligrams per cubic meter per year. “In India, the particulate matter exposure is 330 and that is every day,” said Smith. Exposures in homes in Guatemala have been measured at 8,670 milligrams per cubic meter, added speaker Jacob Moss, director of the U.S. Cookstoves Initiatives at the U.S. Department of State.

Studies have shown clear evidence that household air pollution causes lung cancer and other respiratory diseases, chronic obstructive pulmonary disease, cataracts, and low birth weight. Further study is needed to confirm that it is implicated in a number of other diseases. Smith, who leads a project in Guatemala, said research shows that as exposures rise, childhood pneumonia soars. Birnbaum noted that pneumonia is the leading cause of death of children worldwide.

“We must have reduction in exposures and a little bit isn’t enough — it has to be a significant reduction,” said NIH Director Francis Collins, M.D., Ph.D., during the opening session the evening of Oct. 9, as he lauded the fact that numerous federal agencies participated, including three NIH institutes — NIEHS; the National Heart, Lung, and Blood Institute; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development — that partnered with the U.S. Agency for International Development to organize the workshop.

Solutions from science

Scientists and technicians have a twofold research mission — to quantify the health problems and identify interventions, including alternative cookstoves. Birnbaum noted that NIEHS is working on both fronts and providing $3 million in cookstove research this year. Additionally, NIEHS, the Fogarty International Center, and the National Institute for Occupational Safety and Health jointly funded 16 applications for studies in five regions of the world.

The three-day workshop exemplifies the training aspect of the effort. Numerous prototypes and alternative cookstoves were demonstrated and tested in workshops attended by both young and established researchers from the U.S., China, India, and a number of countries in Africa and South America. Other workshops discussed research designs for measuring exposures and health outcomes, and how to set standards so that cooking alternatives are sufficient to make a difference in public health.

Collins and others urged that alternatives be designed to consider cost, sustainability, ease of operation, and cultural differences. They noted that a stove perfect for cooking tortillas in Guatemala might not be good for cooking injera, a yeast-risen flatbread that is a staple in Ethiopia.

(Cindy Loose is a contract writer with the NIEHS office in Bethesda, Md.)

John Balbus, M.D.

NIEHS Senior Advisor for Public Health John Balbus, M.D. , serves as the Institute’s lead on the cookstove initiative. (Photo courtesy of Steve McCaw)

Kirk Smith, Ph.D.

Along with many other honors, Smith received the Heinz Prize in the Environment and the Tyler Prize for Environmental Achievement, in recognition of his cookstove and household air pollution research. (Photo courtesy of University of California, Berkeley)

Simple solutions for a major public health problem

Richard Grinnell, vice president and chief operating officer of HELPS International in Guatemala, demonstrated an inventive cookstove he brought, and said his organization first became alarmed about open cook fires because so many children came to the health clinic with severely burned hands, or with fingers fused or even missing. Later, his group realized the enormous risk of respiratory and other diseases.

U.S. Environmental Protection Agency Assistant Administrator for the Office of Air and Radiation Gina McCarthy said that solving the problem could resolve many existing issues — overall public health; women and children’s rights; safety in war zones where women and children risk their lives to collect fuel; environmental justice; and lack of education, because children who spend the day looking for fuel can’t go to school. Moss noted the potential benefit of cookstove alternatives on climate change, saying that 20 percent of black carbon — one of the most harmful climate changers — comes from burning biomass for cooking.

“Most times when it comes to environmental issues, the fat lady never sings because the problem is never over,” said McCarthy. “This is something we can get our arms around and solve. Every minute we put into this, we’ll be saving lives.”

Collins emphasized the point, while strumming his guitar and leading the group in a song with the refrain “If not now, if not now, tell me when.”

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