Cover story
Household air pollution and health
Key facts
? Around 3 billion people cook and heat their homes using open fires and simple stoves burning biomass (wood, animal dung and crop waste) and coal.
? Over 4 million people die prematurely from illness attributable to the household air pollution from cooking with solid fuels.
? More than 50% of premature deaths among children under 5 are due to pneumonia caused by particulate matter (soot) inhaled from household air pollution.
? 3.8 million premature deaths annually from noncommunicable diseases including stroke, ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer are attributed to exposure to household air pollution.
Indoor air pollution and household energy: the forgotten 3 billion
Around 3 billion people still cook and heat their homes using solid fuels (i.e. wood, crop wastes, charcoal, coal and dung) in open fires and leaky stoves. Most are poor, and live in low- and middle-income countries.
Such inefficient cooking fuels and technologies produce high levels of household air pollution with a range of health-damaging pollutants, including small soot particles that penetrate deep into the lungs. In poorly ventilated dwellings, indoor smoke can be 100 times higher than acceptable levels for small particles. Exposure is particularly high among women and young children, who spend the most time near the domestic hearth.
Impacts on health
4.3 million people a year die prematurely from illness attributable to the household air pollution caused by the inefficient use of solid fuels (2012 data). Among these deaths:
12% are due to pneumonia
34% from stroke
26% from ischaemic heart disease
22% from chronic obstructive pulmonary disease (COPD), and
6% from lung cancer.
Pneumonia
Exposure to household air pollution almost doubles the risk for childhood pneumonia. Over half of deaths among children less than 5 years old from acute lower respiratory infections (ALRI) are due to particulate matter inhaled from indoor air pollution from household solid fuels (WHO, 2014).
Stroke
Nearly one quarter of all premature deaths due to stroke (i.e. about 1.4 million deaths of which half are in women) can be attributed to the chronic exposure to household air pollution caused by cooking with solid fuels.
Ischaemic heart disease
Approximately 15% of all deaths due to ischaemic heart disease, accounting for over a million premature deaths annually, can be attributed to exposure to household air pollution.
Chronic obstructive pulmonary disease
Over one third of premature deaths from chronic obstructive pulmonary disease (COPD) in adults in low- and middle-income countries are due to exposure to household air pollution. Women exposed to high levels of indoor smoke are 2.3 times as likely to suffer from COPD than women who use cleaner fuels. Among men (who already have a heightened risk of COPD due to their higher rates of smoking), exposure to indoor smoke nearly doubles (i.e. 1.9) that risk.
Lung cancer
Approximately 17% of annual premature lung cancer deaths in adults are attributable to exposure to carcinogens from household air pollution caused by cooking with solid fuels like wood, charcoal or coal. The risk for women is higher, due to their role in food preparation.
Other health impacts and risks
More generally, small particulate matter and other pollutants in indoor smoke inflame the airways and lungs, impairing immune response and reducing the oxygen-carrying capacity of the blood.
There is also evidence of links between household air pollution and low birth weight, tuberculosis, cataract, nasopharyngeal and laryngeal cancers.
Mortality from ischaemic heart disease and stroke are also affected by risk factors such as high blood pressure, unhealthy diet, lack of physical activity and smoking. Some other risks for childhood pneumonia include suboptimal breastfeeding, underweight and second-hand smoke. For lung cancer and chronic obstructive pulmonary disease, active smoking and second-hand tobacco smoke are also main risk factors.
Impacts on health equity, development and climate change
Without a substantial change in policy, the total number of people relying on solid fuels will remain largely unchanged by 2030 (World Bank, 2010). The use of polluting fuels also poses a major burden on sustainable development.
Fuel gathering consumes considerable time for women and children, limiting other productive activities (e.g. income generation) and taking children away from school. In less secure environments, women and children are at risk of injury and violence during fuel gathering.
Black carbon (sooty particles) and methane emitted by inefficient stove combustion are powerful climate change pollutants.
The lack of access to electricity for at least 1.2 billion people (many of whom then use kerosene lamps for lighting) creates other health risks, e.g. burns, injuries and poisonings from fuel ingestion, as well as constraining other opportunities for health and development, e.g. studying or engaging in small crafts and trades, which require adequate lighting.
WHOs response
WHO is leading efforts to evaluate which new household cooking technologies and fuels produce the least emissions and thus are most optimal for health. WHO is also providing technical support to countries in their own evaluations and scale-up of health-promoting stove technologies.
Other WHO activities include the following:
New indoor air quality guidelines for household fuel combustion
To ensure healthy air in and around the home, WHOs new indoor air quality guidelines for household fuel combustion provide health-based recommendations about the performance of fuels, and stoves as well as strategies for the effective dissemination of such home energy technologies to protect health. These build upon existing WHO outdoor air quality guidelines and recently published WHO guidance on levels of specific indoor pollutants.
Household energy database
The WHO Household Energy Database is used to monitor global progress in the transition to cleaner fuels and improved stoves as well as contribute to assessments of disease burden from household energy and the energy access situation in developing countries.
Research and programme evaluation
WHO is working with countries, researchers and other partners to harmonize methods of evaluation across settings so that health impacts are assessed consistently and rigorously and also incorporate economic assessment of health benefits.
Leadership and advocacy in the health, energy and climate community
Health sector
WHO is working to integrate guidance and resources for supporting clean household energy
into global child health initiatives and decision-support tools, such as the Global Action Plan for Pneumonia and Diarrheal Disease (GAPPD), as well as into other aspects of WHOs own health policy guidance. WHO advocates about the compelling health arguments for cleaner household energy in a range of global forums addressing maternal and child health issues related to pneumonia as well as forums concerned with noncommunicable diseases in adults. This can help awareness of the importance of providing and scaling up of cleaner household energy as a core preventive public health measure.
Health and climate change
WHO is a partner of the Climate and Clean Air Coalition to Reduce Short-Lived Climate Pollutants (CCAC).
As a member of the CCACs health task force, WHO is providing technical support for harnessing health benefits from actions to reduce short-lived climate pollutants, and working to scale up health sector engagement to address such pollutants and improve air quality.
Health, energy and sustainable development
WHO has proposed using reductions in air pollution-related disease burden (both for household and outdoor) as an indicator of an energy post-2015 sustainable development goal.
WHO also has contributed to the development of the tracking framework to measure progress toward the UN Secretary-Generals Sustainable Energy for All initiative of universal access to clean energy.
WHO is a partner in the Global Alliance for Clean Cookstoves, led by the United Nations Foundation, and involving a range of UN agencies, donors, NGOs, civil society and country partners. The Alliance is promoting improved biomass cookstove designs that can
substantially reduce indoor air
pollution.
Supporting the Millennium Development Goals
Tackling indoor air pollution will help achieve the Millennium Development Goals (MDGs), in particular MDG 4 (reduce child mortality) and MDG 5 (improve maternal health).
It will also contribute to gender equality (MDG 3) as well as freeing womens time for income
generation that helps eradicate extreme poverty and hunger
(MDG 1).
Finally, clean household energy can help ensure environmental sustainability (MDG 7). WHO reports annually on the proportion of the population using solid fuels for cooking as a key indicator for assessing progress in health and development.
Source: WHO
Health in environmental management for sustainable development
Since the Earth Summit, numerous initiatives have been launched at local, national and global levels to highlight the need for health and environment action. Health and environment have a mutual nexus. The environment is an assemblage of physical, chemical, biological, social, cultural and economic conditions and all of these have implications for health.
Environmental threats to human health are numerous. According to the World Bank (2001), traditional hazards which are related to poverty and insufficient development include lack of access to safe drinking water, inadequate basic sanitation in the household and community, indoor air pollution from cooking and heating using coal or biomass fuel, and inadequate solid waste disposal. On the other hand, modern hazards are related to development that lack health and environmental safeguards, and to unsustainable consumption of natural resources. They include water pollution from populated areas, industry and intensive agriculture; urban air pollution from vehicle, coal and industry; climate change and trans-boundary pollution.
The environment in which people live (from the household to the global level) significantly affect their health. Environmental factors are, no doubt, a significant determinant of health and illness, especially in third world countries. One can look at environmental health problems from the viewpoint of the burden of death, disease and disability, and analyze the relative importance of the different environmental factors. The burden of disease on a per capita basis is about 100 times higher in the least developed countries than in the developed countries (WHO, 1995), due mainly to contribution of environmental factors of poor housing and living conditions, poor sanitation, lack of access to clean water and safe food.
Also, inequalities based on wealth and location, together with flawed policies mean that poor people pay the most and travel the furthest for environmental infrastructure (WHO, 2011). However, achieving even the basic minimum standard of access to, say, water (20 litres per person per day of safe water from an improved source, which can be maintained if the source is within 30 minutes roundtrip from the home) remains a huge challenge (WHO, 2011).
This means that the availability of good environmental infrastructure close to the home has numerous benefits, especially in terms of human health with subsequent linkages to all the other dimensions of livelihood. Such gains in human health have an intrinsic value in terms of quality of life as a developmental end, and as a means for higher economic productivity. The environment also plays a particularly important role in determining the distribution of vector-borne diseases. In addition to water and temperature, other factors such as humidity, vegetation, density, patterns of agriculture and housing may be critical to the survival of the different species of diseases carrying vectors. Such diseases, according to UNCED (1992), include acute respiratory infections, diarrhea diseases, infectious diseases, malaria and other tropical vector-borne diseases, injuries and poisonings, mental health conditions, cardiovascular diseases, cancer, chronic respiratory diseases, allergies, reproductive health problems, etc. All of these diseases are most serious in the poorest countries and those living in the most difficult and impoverished environmental conditions (WHO, 2007).
There is no gainsaying the fact that environmental quality is an important direct and indirect determinant of human health. Deteriorating environmental conditions are a major contributory factor to poor health and poor quality of life, and hindrance to sustainable development.
The problems facing the health sector today are increasingly complex and multidisciplinary in nature. The health sector cannot address these problems on its own. New and innovative approaches are needed to integrate and operationalize the concept of environmental sustainability which incorporates economic, social and political dimensions. Wide-ranging reforms are also needed to more adequately deal with assessment and management of environmental health risks within a framework of sustainable development. In the analysis of the approximate environmental contribution of health conditions, a long-term sustainable prevention rather than curative measures is advocated. For example, Africa and Asia, including China, are most affected by environmental health-related diseases, as 24 percent of the global disease burden and 23 percent of all deaths can be prevented through environmental interventions.
Effective and sustainable prevention or significant mitigation of environmental health risks requires first, environmental preventive action through environmental management. Reducing modern risks calls for sound environmental management through pollution control and abatement measures, which in turn require setting and enforcing environment standards, developing a culture of environmental compliance and creating effective incentives.
Many countries have instituted new policy and planning tools since the Earth Summit of 1992 to make environmental concern a part of the environmental planning process. Measures to incorporate health and environment initiatives into national programmes have varied from country to country, depending on planning mechanisms, the current status of sustainable development in the specific country and the way in which planning responsibilities are divided. Thus, different approaches are being used for promoting health sector involvement in addressing health and environment issues. WHO (1997) stresses that in some countries, health and environment plans are prepared for inclusion in national plans for sustainable development, while in others, sectoral plans are reviewed and modified to include health and environment concerns.
Environmental management provides a sustainable and supportive environment for health, which is free from major health hazards, satisfies the basic needs of healthy living, and facilitates equitable social interaction. Environmental management does not mean management of the environment, but is the intelligent management of activities within tolerable constraints imposed by the environment itself and with full consideration of ecological factors. It is a requirement of health where the global cycles and systems on which all life depends are sustained through environmental management.
According to WHO (2006), sound environmental management brings health benefits and is essential to a sustainable interaction between people and their environment, in a world where finite resources are being depleted and the capacity of natural cycles and systems to absorb wastes are being exceeded. Human health, therefore, depends on societys capacity to manage the interaction between human activities and the physical, social, psychological and biological environment in ways that safeguard and promote health but do not threaten the integrity of the natural systems on which the environment depends. This is the heart of environmental management and sustainable development.
The physical environment has a major influence on human health not only through temperature, precipitation and composition of air and water but also through its interaction with the type and distribution of the flora and fauna (the biological environment). The biological environment is a major influence on the food supply and on the reservoirs and transmission mechanism of many diseases. For instance, WHO (2011) asserts that more than one-third of diseases in children under the age of 5 years is caused by environmental exposure such as acute respiratory infections (from indoor air pollution), diarrheal diseases (from poor water, sanitation and hygiene), and malaria (from inadequate environmental management and vector control). Interventions such as draining marshlands within or close to settlements in malarial areas can greatly reduce the incidence of malaria by removing mosquitoes breeding sites. Other physical environmental remedial measures include improved water and sanitation, household energy, housing, vector disease control, and pollution management. For instance, Health in Housing (HIH), a World Health Organizations collaborating programme for research, is an approach based on helping families to learn how to improve their health while upgrading their housing and physical environment (WHO, 1996). The nexus between environmental factors and mental well-being is obvious. UNCED (1992) identifies positive forces and factors that can mediate mental disorders and social pathologies. They include policies, legislation, educational and preventive intervention programmes, environmental action programmes, community self-help programmes, urban renewal programmes, etc. To date, much of the efforts to make the environment healthier have focused on urban renewal programmes.
For instance, organized open spaces which is an important land-use category, is considered as a paradise, a family place for happiness and enjoyment and a haven for peace and for release from the pressures of the outside world (Laurie, 1983). Open spaces are part of our creative heritage and this exposure to nature enhances our psychological well-being. In healthy cities work, attention should be given to the principle that health can only be improved by modifying the environment. Nevertheless, various environmental development activities aimed at offering health opportunities and enhancing the health status of the population can cause health hazards if they lack health and environmental safeguards (WHO, 2006). This calls for the integration of environmental health assessment and analysis into environmental management tools for any developmental activity.
Establishment of supportive environment for health depends upon full participatory and contributory actions of the members of the society as well as the cooperative action between sectors. An inter-sectoral approach is the most effective means of formulating environmental health policy since it can help to ensure that priorities are coherent and not in conflict with the of individual sectors. Also, joint programmes involving ministries of health, environment and others would enable much more to be achieved in environment and health issues.
Finally, I am suggesting following a call for action to achieve sustainable development with health implications:
i. The systematic integration of Environmental Health Assessment (EHA) into various environmental management tools so as to address risks to health during project preparation, implementation, monitoring and evaluation.
ii. The application of appropriate environmental health management and technology, and effective management of manpower and material resources in diverse environmental settings. (Reprint)
iii. The improvement of the understanding of the linkages between health outcomes and development activities in infrastructure, energy and the urban and rural sectors, and
iv. A holistic and multi-sectoral approach in formulating environmental health policies.
(Reprint)
Some effects of global warming on health
Dr Wrishi Raphael
The cataclysmic effects of climate change on our health and well being cannot be ignored any more. This summer has already claimed the lives of more then 3000 people in India leaving thousands more ill or needing urgent treatment. Not only is hyperthermia (body temperature in excess of 41.1? C or 106? F) a cause for concern, other problems attributable to indoor and outdoor air pollution, water or soil pollution are rattling our medical infrastructure with shockwaves of respiratory, gastrointestinal, kidney and other systemic diseases. What makes hyperpyrexia and heat strokes formidable is that old people and children are the ones who are easily affected and the symptoms mimic those of acute infections, food, drug or chemical poisoning. Day labourers and farmers must always carry the brunt of this blistering heat as their work does not allow them the luxury of paid sick leaves or working in the comfort of air-conditioned rooms. Urgent instructions must be delivered by the government in public interest, to wear wide brimmed hats, light coloured cotton clothes, use umbrellas and drink plenty of fluid to combat the effects of this punishing summer.
Heat stroke becomes a risk factor in countries like India and Bangladesh where high temperatures, especially when combined with high relative humidity, persist for several days. Higher temperatures are also the most influenced by human behaviour: the fewer heat-trapping emissions we release into the atmosphere, the cooler we can keep our planet. Although progress is steady to reach international consensus about lowering factory emissions of green house gases, the light at the end of the tunnel is very bleak. If carbon emissions are not reduced significantly; by the year 2040 the chances of experiencing heat waves like the current ones will increase by 12 %. Not only will the inherent cooling mechanisms of our body fail to keep us safe and alive during such harsh summers, the impacts on food production and farming will be catastrophic.
The human skin is capable of heat loss by sweating at remarkably high temperatures provided the humidity is not high. But if high temperature is accompanied by high humidity the bodys heat regulatory mechanisms begin to collapse causing heat strokes or hyperthermia. To calculate the limits in which it is safe for normal people to work in extreme heat, scientists use a special thermometer which takes into account the humidity and actual temperature of any particular time period. This is called the wet-bulb globe temperature. At wet bulb temperature higher then 35?C the body becomes incapable of cooling down on its own and a person will suffer collapse or shock. The US army suspends training if wet bulb temperature reading reaches 32?C. It is high time that we started adopting such technology and coming up with more pragmatic solutions to protect our poor and aged.
Hyperthermia is a critical condition which requires immediate resuscitation but its treatment is simple and requires promptness by part of caregivers. Heat strokes can occur at 104? F and is characterized by hot, dry, flushed skin with a rapid pulse. If the patient seems confused, disoriented or his mental state is altered; shock can become an inevitability. General Practitioners or Emergency Medicine Physicians cannot be complacent if blood pressure is normal or near normal as shock and hypotension (BP lower then 90/60 mm of Hg) can result in a very short time.
Although treatment with saline may not be necessary, cooling down is vital and requires diligent efforts by part of medical personnel if shock and hypotension is to be avoided.
Treatment of heat strokes is simple and the condition is completely reversible in most cases provided the care providers or medical teams help the patient quickly and effectively.
Immediate effective cooling water applied to skin
Icepacks at critical points (e.g. axillae, neck, head)
Ice water bath if possible
Aim should be to bring down temperature by 1C (every 10 minutes).
The writer can be reached at w.t.raphael@gmail.com
Health and environment friendly plants
Dr Miah Faiz Ahmed
The use of medicinal plant (Indigenous plants) species offers many benefits to landholders and the environment. Medicinal plants are the original flora, or plants that occur naturally, in a given location. Plants have medicinal potential adapted over thousands of years to the conditions of the locality. Medicinal plants offer many maintenance, environmental, and productivity advantages. Indigenous plants can provide many environmental benefits as well as fulfill farm purposes such as the provision of shelter, wind breaks, soil erosion control, salinity control and provide timber for fence posts and firewood.
Environmental benefits medicinal planting (indigenous) species provides a living environment that is part of the local natural system. Indigenous plants have evolved as part of the entire biological population of an area. A strong interdependence exists between indigenous plants, animals, insects, and micro organisms. Planting indigenous species can contribute to the maintenance of a balanced and diverse ecosystem.
The use of local species by landholders can enhance the health of surrounding stands of remnant vegetation. They can be used to create valuable links between stands of remnant vegetation that occur in reserves, along roadsides and waterways and on private properties. This will allow wildlife to move along these vegetation corridors.
Establishing an under storey of local plant species will create a plant community that is attractive and ecologically balanced. Under storey species such as herbs, grasses and wild flowers provide valuable food and shelter for a range of fauna species such as lizards and small birds. Local plant species will not become weeds, as do many introduced plants. Unlike non-indigenous plants, there is no risk of indigenous species escaping and invading areas of bush land.
Health facts on plants: Plants have a benevolent effect on people and the spaces in which they live and work.
Hospital patients recover faster when they are in a room with a view on a park. Plants reduce the accumulation of dust on the horizontal surfaces in your house or office, and at the same time they optimise the air humidity. Plants help to reduce stress. A group of experimental subjects recovered from health problems such as headaches, exhaustion, coughs and eye irritation after they had put a few house plants in their living room or work environment.
All plants absorb carbon dioxide and different kinds of harmful substances, and they release oxygen. Some household plants remove significant amounts of benzene, formaldehyde and trichloroethylene as well. There are micro-organisms in the soil that also contribute to the purification of the surrounding air.
Ecologically grown plants The agricultural sector is actually the most innovative with regards to the saving of energy. We are developing greenhouses that deliver a surplus of energy back to the energy net. These days environmental requirements are becoming more and more strict. It is nowadays hardly possible to grow plants in ways that are not ecological. Many weed killers that had been used throughout the decades have since long been prohibited.
(Reprint)
