'Fuel for life': household energy and health.

INDOOR AIR POLLUTION FROM COOKING AND HEATING with solid fuels, including wood, dung and coal on open fires or traditional stoves, is responsible for at least 1.5 million deaths every year worldwide. Such pollution causes acute lower respiratory infections in children under five years of age and chronic obstructive pulmonary disease in adults.

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"It is a travesty that 1.5 million lives a year-many are children whose lives have not even started-are snuffed out every year because of needless exposure to indoor smoke. We have simple affordable solutions; let us ensure that they reach the people who can benefit from, and live by, using them", said Dr. Maria Neira, World Health Organization (WHO) Director for Public Health and Environment. Exposure levels are particularly high among women and children, who spend the most time indoors by the fireside, and were responsible for nearly 800,000 deaths among children and more than 500,000 among women in 2002. In developing countries, indoor air pollution is the most lethal killer after malnutrition, unsafe sex and lack of safe water and adequate sanitation. Sub-Saharan Africa and South East Asia are particularly affected, with 396,000 and 483,000 annual deaths, respectively.

The use of inefficient, polluting fuels places a major burden on the health of poor families in developing countries, as they do not have the resources to obtain cleaner and more efficient fuels and appliances. This holds back economic development, thereby continuing a vicious cycle of poverty. A new report from WHO, "Fuel for Life: Household Energy and Health", which was launched to coincide with the 14th meeting of the United Nations Commission on Sustainable Development, demonstrates that investing in cleaner household fuels can yield a sevenfold economic benefit in health and productivity gains. It gives an overview of the health impacts of indoor air pollution from solid fuel use and describes solutions to promote health and development in the context of the household energy challenge. It asserts that innovative policy approaches and a rigorous acceleration of investments are needed to save lives and enable development, and that progress in access to modern cooking fuels since 1990 has been negligible.

In order to halve by the year 2015 the number of people relying on solid fuels, 485,000 people will need to gain access to cleaner fuels every day for the next ten years. The report states that investing $13 billion per year to halve by 2015 worldwide the number of people cooking with solid fuels by giving them access to liquefied petroleum gas shows a payback of $91 billion per year, which will overcome a major barrier to achieving the Millennium Development Goals. Improved household energy practices promote education, empower women, save lives--mostly of children and mothers--and benefit the forests and climate. In addition, evaluating the impacts of household energy projects and programmes will shed light on how technical solutions could be fine-tuned to maximize health, social and environmental benefits, and by learning from experience will provide a model for putting into action large-scale programmes that will be successful.

Liquefied petroleum gas, biogas and other cleaner fuels represent the healthiest alternative, the report states. Switching from a traditional to an improved stove substantially reduces indoor smoke. On average, 100 million more homes using these modern fuels for cooking would lead to 473 million fewer people being exposed to harmful indoor air pollution and 282,000 fewer deaths from respiratory diseases per year. For as little as $6, families can install better ventilated, fuel-efficient stoves; making them available to half of those still using traditional stoves would save $34 billion in fuel expenditure a year and generate a $105-billion economic return every year over a ten-year period.

WHO has developed a comprehensive programme on indoor air pollution, which focuses on research and evaluation, capacity-building and evidence for policymakers, by documenting the health burden of indoor air pollution and household energy, evaluating the effectiveness of technical solutions and their implementation, acting as a global advocate for health as a central component of international and national energy policies, and monitoring changes in household energy habits. WHO works closely with key partners, including the Partnership for Clean Indoor Air, the United Nations Environment Programme (UNEP), the United Nations Development Programme (UNDP) and the World Bank, as well as many research institutions and non-governmental agencies. It is also actively taking part in projects in Kenya, the Lao People's Democratic Republic, Mongolia, Nepal and Sudan, aimed at introducing improved stoves and other technical solutions to reduce indoor air pollution. It is a partner in the most sophisticated scientific study to date, which is being undertaken in Guatemala, to assess how an improved stove enhances children's and women's health.

RELATED ARTICLE: Indoor Air Pollution, Household Energy and the MDGs

WHO has been assigned to monitoring progress of indoor air pollution from cooking and heating with solid fuels, one of the key environmental risk factors to health, by regularly checking the percentage of house-holds using solid fuels at the country level to reflect the progress in development and poverty-reduction and serve as an indicator for progress in population health.

Improvements in access to cleaner energy and cleaner energy practices can contribute toward achieving the Millennium Development Goals (MDGs). Monitoring household energy and tackling indoor air pollution are inextricably linked to achieving these Goals, in particular in reducing child mortality, promoting gender equality and empowering women, opening up opportunities for income generation and eradicating extrerne poverty, and ensuring environmental sustainability. WHO is directly responsible for reporting the proportion of the population relying or using solid fuels for cooking, which constitutes as an indicator to MDG 7--ensure environmental sustainability--and is used to assess progress towards the integration of the principles of sustainable development into country policies and programmes, and to reverse the loss of environmental natural resources.

1. ERADICATE EXTREME POVERTY AND HUNGER. The security of household livelihoods depends on the health of its members. Being ill or having to care for sick children reduces earning potential and leads to additional health-care and medication expenses. Improved house-hold energy practices provide opportunities for income generation and the development of small enterprises. Improved stoves that use less fuel facilitate more efficient food preparation, and access to electricity ensures a source of light for economic activities in the evening.

2. ACHIEVE UNIVERSAL PRIMARY EDUCATION. With less time spent on fuel collection and very little lost time due to ill health, children will have more available time for school and homework. Better lighting allows them to study at night without straining their eyesight.

3. PROMOTE GENDER EQUALITY AND EMPOWER WOMEN. Alleviating the burden of collecting fuels and cooking by using more efficient devices will free women's time for adult education and childcare. Involving women in household energy decisions will contribute to their empowerment and promote gender equality. Also owning a less-polluting stove raises indirectly a person's prestige through a soot-free kitchen environment.

4. REDUCE CHILD MORTALITY. Reducing exposure to indoor air pollution will make a significant contribution to decreasing child morbidity and mortality, responsible for nearly 1 million deaths in children under five years old.

5. IMPROVE MATERNAL HEALTH. Women are most at risk for chronic respiratory and pulmonary diseases as they are usually in charge of cooking. Cutting down indoor air pollution will contribute to better respiratory health among mothers who spend time by the fireside after having given birth.

6. COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES. Exposure to indoor air pollution increases the risk of tuberculosis--one of the leading causes of death globally--with approximately 1.6 million deaths every year.

7. ENSURE ENVIRONMENTAL SUSTAINABILITY. The reliarce on fuelwood can put considerable pressure on forests, particularly where biomass is scarce and the demand for wood outweighs natural regrowth. Depending on the environmental context, deforestation is a driving force for land degradation and desertification. Traditional stoves have low efficiency. As a result, a large percentage of fuel energy is lost as products of incomplete combustion, as in gas methane that has a greenhouse effect many times greater than carbon dioxide. Environmentally-sound technologies, such as energy-efficient devices based on renewable sources, can substantially reduce harmful impacts on the environment and human health.

8. DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT. Development agendas and partnerships must recognize the fundamental role that clean household energy practices play in economic and social development.