The Environmental Health Pathway

Household Air Pollution Risks in India

Kirk R. Smith, MPH, PhDProfessor of Global Environmental Health

University of California, Berkeley

Fulbright-Nehru Distinguished ChairIIT-Delhi

1.8 million years ago, the cooking becamea regular feature in human society

Catching Fire: How Cooking Made Us Human, R WranghamBasic Books, 2009

The three major solid fuels

Leading cause of disease burden in 2010 by countryPopulation Cooking with Solid Fuels in 2010 (%)

1990:85%: 700 million people using solid fuels

2010: 60%: 700 million people

~1980700 millionpeople in entire country

700 million people in the Chulha Trap

Or, since wood is mainly just carbon, hydrogen, and oxygen,doesn’t it just change to CO2 and H2O when it is combined with oxygen (burned)?

Reason: the combustion efficiency is far less than 100%

Woodsmoke is natural – how can it hurt you?

Energy flows in a well-operating traditional wood-fired cookstove

In to P o t2 .8 M J

1 8%

In P IC1 .2 M J

8 %

W a s te H e a t1 1 .3 M J

7 4%

W o o d: 1 kg1 5 .3 M J

T rad it ion a l S tove

PIC = products of incomplete combustion = CO, HC, C, etc.

15% moisture

Source:Smith,et al.,2000

A Toxic Waste Factory!!

Typical biomass cookstoves convert 6-20% of the fuel carbon to toxic substances

Toxic Pollutants in Biomass Fuel Smokefrom Simple (poor) Combustion

• Small particles, CO, NO2

• Hydrocarbons– 25+ saturated hydrocarbons such as n-hexane– 40+ unsaturated hydrocarbons such as 1,3 butadiene– 28+ mono-aromatics such as benzene & styrene– 20+ polycyclic aromatics such as benzo()pyrene

• Oxygenated organics– 20+ aldehydes including formaldehyde & acrolein– 25+ alcohols and acids such as methanol– 33+ phenols such as catechol & cresol– Many quinones such as hydroquinone – Semi-quinone-type and other radicals

• Chlorinated organics such as methylene chloride and dioxin Source: Naeher et al,J Inhal Tox, 2007

Typical chullah releases400 cigarettes per hour

worth of smoke

Health-Damaging Air Pollutants From Typical Wood-fired Cookstove.

1 0 m g/m 3

C a rbo n M o n ox id e :1 5 0 m g/m 3

0 .1 m g/m 3

P a rtic les3 .3 m g/m 3

0 .00 2 m g/m 3

B en ze ne0 .8 m g/m 3

0 .00 03 m g/m 3

1 ,3 -B u ta d ie ne0 .15 m g/m 3

0 .1 m g/m 3

F o rm a ld eh yde0 .7 m g/m 3

W oo d : 1 .0 kgP e r H o ur

in 1 5 A C H4 0 m 3 k itch en

Typical Health-based Standards Typical Indoor

Concentrations

Best single indicator IARC Group 1 Carcinogens

First person in human history to have her exposure measureddoing the oldest task in human history

Kheda District,Gujarat, 1981

Emissions andconcentrations,yes, but what aboutexposures?~5000 ug/m3

during cooking>500 ug/m3 24-hour

How much PM2.5 is unhealthy?

• WHO Air Quality Guidelines– 10 ug/m3 annual average– No public microenvironment, indoor or

outdoor, should be more than 35 ug/m3

• National standards – annual outdoors– USA: 12 ug/m3– China: 35 ug/m3– India: 40 ug/m3

CRA published along with the other GBD papers on Dec 14, 2012

in The Lancet

Annual Review of Public Health,vol 35, 2014, out this month

Comparative Risk Assessment Method

Exposure Levels:Past actual and past

counterfactual

Exposure-responseRelationships (risk)

Disease Burden by age, sex, and region

Attributable Burden by age, sex, and region

State-wiseestimates of 24-h kitchenconcentrationsof PM2.5 in India

Solid-fuel usinghouseholds

Balakrishnan et al.2013 (SRU group)

Study design N* OR 95% CI

Intervention 2 1.28 1.06, 1.54

Cohort 7 2.12 1.06, 4.25

Case-control 15 1.97 1.47, 2.64

Cross-sectional

3 1.49 1.21, 1.85

All 26 1.78 1.45, 2.18

Dherani et al Bull WHO (2008)

Diseases for which we haveepidemiological studies

ALRI/Pneumonia

COPD

Lung cancer(coal)

Cataracts

Lung cancer(biomass)

These diseases are included in the2010 Comparative Risk Assessment (released in 2012)

Ischemic heart disease

Stroke

New Category of Evidence for CVDNew Category of Evidence for CVD

• No direct studies of CVD and HAP, yet– But studies showing effects on blood pressure

and ST-segment, important disease signs

• Epidemiologic evidence shows clear, consistent evidence of increasing risk across exposures to combustion particles– at higher exposures – Active smoking– and lower exposures – Outdoor air pollution

and secondhand tobacco smoke

Heart Disease and Combustion Particle Doses

HAPZone

From “Mind the Gap,” Smith/Peel, 2010 and Popeet al., 2009

Integrated Exposure-Response: Outdoor Air, SHS, and Smokingand Heart Disease

HAPZone

CRA,2011

Outdoor Air

Pollution

SecondhandTobacco Smoke

Smokers

EHP, 2007

EHP, 2011

EHP, 2011

Integrated Exposure-Response: Outdoor Air, SHS, and HAP

Solid Fuel

Zone

Pneumonia from combustion particlesAnnual average PM2.5 in ug/m3

0

10

20

30

40

50

60

4 30 60 90 120 150 180 210 240 270 300

An

nu

al In

cid

ence

HAP

Zone

CRA,2010

Outdoor Air

Pollution

SecondhandTobacco Smoke

Stroke

Ischemic Heart Disease

ALRI

ug/m3 annual average PM2.5

COPDLung Cancer

Metrics• Mortality – important, but can be misleading as

it does not take age into account or years of illness/injury– Death at 88 years counts same as at 18, which is not

appropriate

• Disability-adjusted Life Years (DALYs) lost do account for age and illness.

• GBD 2010 compares deaths against best life expectancy in world – 86 years

Global DALYs 2010: Top 20 Risk Factors

Premature DeathsHBP -9.3 millionAlcohol – 7.7Tobacco – 5.7 SHS-T – 0.6House AP – 3.5 SHS-C – 0.5High BMI – 3.4Phys Inactive – 3.2Outdoor AP – 3.3High Sodium – 3.1

Global Burden of Environmental Risks

Top 15 causes of ill-health in India (GBD/CRA 2010)HAP Total: ~1,000,000 premature deaths annually

Women and Girls Men and Boys:

Framing• Not called “indoor” because stove smoke

enters atmosphere to become part of general outdoor air pollution (OAP)

• HAP contributes about 12% to OAP globally, but much more in some countries

• ~25% in India• Thus, part of the burden of disease due to OAP

is attributable to cooking fuels in households

%PM2.5 from “Residential” Emissions from INTEX_B

36Source: Asian Emission Inventory for NASA INTEX_B 2006 (accessed 2010) Chafe, 2010

25-30% of primary particle

pollution in India is from

household fuels

Satellite-based ambient PM2.5

van Donkelaar et al, EHP 201037

Delhi Jan 14, 2013 24h mean PM2.5: 316.5 µg/m3

Rural India24h mean PM2.5: 194.7 µg/m3

HAP mortality in India in 2010 ~10 lakh annualpremature deaths

-About one-quarter of global total-Secondhand cooksmoke

~1,5 lakh more-About 10% of national mortality

-About the same as tobacco-About 50% more than outdoor air pollution,

which is about 600k

n.b. these estimtes can be compared but not added as there are overlaps

Summary• One of the top risk factors in the world for ill-health. • Biggest impact in adults --3 million premature deaths (two-thirds

the DALYs)• Still important for children ~500,000 deaths (one-third the

DALYs)• One million total premature deaths in India• Biggest single risk factor of any kind for Indian women and girls • Important source of outdoor air pollution • Impact going down slowly because background health

conditions improving• Actual number of people affected is not going down

What can be done?

Increasing Prosperity and Development

Dec

reas

ing

Hou

seho

ld A

ir Po

llutio

n

Very Low Income

200 million

Low Income400 million

Middle Income400 million

High Income200 million

Crop WasteDung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels

Liquefied Petroleum Gas

Biogas

Wood

Conceptual Indian Energy Ladder

The Energy Ladder: Relative Pollutant Emissions Per Meal

0.1

1.0

10.0

100.0

CO Hydrocarbons PM

CO 0.1 1.0 3 19 22 60 64

Hydrocarbons 0.3 1.0 4.2 17 18 32 115

PM 2.5 1.0 1.3 26 30 124 63

Biogas LPG Kerosene Wood RootsCrop

ResiduesDung

Smith, et al., 2005

“Clean” “Dirty”


Dec

reas

ing

Hou

seho

ld A

ir Po

llutio

n

Very Low Income

200 million




Crop WasteDung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels


Biogas

Wood


??

Public health and environment 46 |

Integrated Exposure-response relationshipIntegrated Exposure-response relationship

Risk

PM2.5 Exposure

O/Fire‘ChimneyRocketLPG

3

1

125 200 300 µg/m325

Fan

2

WHO air quality annual

guideline:10µg/m3

IT1 : 35 µg/m3

Child pneumonia

Leaves ~80% of burden

untouched

Can we get here?

Starting hereGoing

here

How close to clean enough?• New WHO Indoor Air Quality Guidelines will

be about 0.9 mg/min PM2.5 to protect ~80% of households at AQG-IT1, 35 ug/m3

• Cleanest biomass blower stove tested by the USEPA is about 8 times more polluting in lab.

• But does not achieve this over time in the field• Need to push harder to find ways to make

biomass burn cleanly in inexpensive devices

Public health and environment 48 |

Secretary Vivek Rae• Doubled number of distributors for next year --20 million new

people• Brought together heads of marketing for the 3 major oil

companies to hear the lecture• Had his staff do the homework in advance• By adjusting requirements for distributors and a massive push• They are developing a plan to double LPG access in rural India in

next five years• ~250 million people

•


Dec

reas

ing

Hou

seho

ld A

ir Po

llutio

n

Very Low Income

200 million




Crop WasteDung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels


Biogas

Wood


?

Story of Two States

Gujarat: 1981-2013

Kerala: 2005-2013

In the 1980s, the first link to air pollution science

First person in human history to have her exposure measureddoing the oldest task in human history

Kheda District,Gujarat, 1981

Field Team, Gujarat, 1981

Diwaliben, October 2013

Gujarati Villages since 1981• Reliable electricity• Piped water• Cell phones• Satellite TV• Pucca schools• More pucca houses and roads• In spite of 3-5 “improved” biomass stove programs

since the 1970s – none now in existence• Chulhas in every house

Smith, et al., 1983

Assessment of “Improved Stoves”

Neighborhood Pollution in anIndian Village

Smith, et al., 1983

Measurement of Neighborhood Pollution

Kerala story

• Like most of India, Kerala has had an electric peak in early evenings

• Starting after mid decade, however, Kerala started experiencing a fast-growing morning peak as well

• Reason: massive sales of induction cookstoves (ICs) were shifting demand

• Experience is that once a woman is used to an IC, she does not want to go back.

Kerala Energy Management Centre, 2011

What is an induction cookstove?• Electric, yes, but• Entirely different technology from traditional electric

stoves – high frequency magnetic field induces heat in pot alone

• More efficient ~90% instead of ~60%• Faster cooking >1.5x• Finer and more responsive control of heat• Safer – surface is warm but does not burn or cause fires• Long-lived, easy to clean, sophisticated controls if desired

- - Bajaj Electrical Ltd.- Compton Greaves Ltd.- Eurolux

- Glen Appliances Pvt. Ltd.- Inalsa- Jaipan Industries Ltd.- Kenwood Ltd.- Khaitan Electrical Ltd- Morphy Richards- Panasonic Corp.

- Phillips- Preethi Kitchen Appliances, Ltd.-Sunflame-TTK Prestige Ltd.-Usha International Ltd.

-Westinghouse

Induction Cooktop Market in India 2012-2016

Published: March 2013Infiniti Research Limited

35.4% per year growth predicted: 2012-2016

Factor of nearly five increase!

Biggest shareof Indian market

Dozens of models

Commercial sectorgrowing rapidlyalso

Not yet aimed torural areas

Flying off the shelves in China

Considerations• Power reliable in major cities and 2-3 full states and on

the march nationally.• Cooking would add serious additional demand, but at

great benefit, and not large compared to need in general– E.g., for 100M households, 20 GWe more during addition of

needed 200+ in next decades

• PV microgrids are proliferating in India to supply villages without power– Technically doable to provide sufficient power for induction

cooking, but economics uncertain


Dec

reas

ing

Hou

seho

ld A

ir Po

llutio

n

Very Low Income

200 million




Crop WasteDung

Natural Gas

Electricity

Non-solid fuels

Solid Fuels


Biogas

Wood


?

Questions for consideration

• What are the full benefits of reliable electricity?

• Is there a leapfrog cooking technology that would

– Be clean, efficient, and safe?

– Sufficiently transformational to “sell itself” and rapidly take over the market?

• How else to fill in the “empty quarter” of the energy ladder?

Key Word!


Dec

reas

ing

Hou

seho

ld A

ir Po

llutio

n

Very Low Income

200 million




Crop WasteDung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels


Biogas

Wood


How do we help people move into

this realm?

India: What If?Millions

9% instead of 5.5%/yrfor 20 years

A Chulha Trap or a

Clean Fuel Gap?

Bottom line: HAP

–In addition to continuing to try to

Make the available clean–Shouldn’t we also try harder to

Make the clean available?

Bottom Line: OAP

• Need to consider household combustion as one of the important sources

• Need to measure in rural areas where there are many sources and people

• Need to develop OAP management regions that are organized by air basin, not political boundaries such as cities

Many thanks

Publications and

presentations on website

– easiest to just

“google” Kirk R. Smith

The Environmental Health Pathway

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