Findings of the World Health Organization (WHO) confirm that, ‘Air pollution is now the world’s largest single environmental risk’. Globally, 7 million people die each year because of exposure to air pollution, which means that 1 in 8 deaths occurring worldwide are due to breathing dirty air. While outdoor air pollution is responsible for 3.7 million of these deaths, surprisingly more deaths — 4.3 million — are linked to indoor air pollution chiefly caused by use of solid fuels for cooking and heating. Add to this smoking tobacco and e-cigarettes, and you have a veritable inferno of deadly air circulating within closed doors.
Among these 4.3 million deaths attributed to indoor air pollution, 12% are from pneumonia; 34% from stroke; 26% from ischaemic heart disease; 22% from chronic obstructive pulmonary disease (COPD), and 6% from lung cancer. Indoor air pollution is also the 2nd leading cause of death in women worldwide through respiratory infection and COPD after ischaemic heart disease.
Solid fuels: As per the current WHO estimates, around 3 billion (or 52%) of the world's population relies on solid fuels, including biomass (wood, animal dung and crop waste) fuels and coal for cooking and heating. According to the 2011 Census, an estimated 142 million, or almost 85% of total rural households in India are dependent on traditional biomass fuel for cooking.
Dr Kirk Smith, Professor of global environmental health at the University of California, avers that, "Having an open fire in your kitchen is like burning 400 cigarettes an hour." Carlos Dora, coordinator for the WHO Interventions for Healthy Environments unit, puts it more scientifically--"The home with a dirty cook stove using coal can reach 2,000 or 3,000 micrograms per cubic metres of particles that is 200 to 300 times the WHO's average daily standard for maximum concentration of the fine particles of air pollution that can settle deeply in the lungs.”
Exposure to household air pollution almost doubles the risk for childhood pneumonia. WHO estimates that pneumonia caused by inhaling particulate matter (soot) in the home accounts for more than 50% of premature deaths among children under 5 years old. 1.4 million or nearly 25% of all premature deaths due to stroke (of which half are in women) and more than 1 million or nearly 15% of all premature deaths due to ischaemic heart disease can be attributed to exposure to household air pollution. Over 33% of premature deaths from COPD in adults in low and middle income countries, and nearly 17% of annual premature lung cancer deaths in adults are also due to air pollution caused by cooking with solid fuels as well as from active smoking and/or second hand tobacco smoke.
The adverse health impacts of using traditional biomass and animal dung based fuel warrant a transition to cleaner and sustainable forms of energy. We need a substantial change in government policy to achieve the UN Secretary General’s goal of Sustainable Energy for All (SE4All) by 2030.
Even households that use safe energy sources need to safeguard the quality of indoor air they breathe. Many common household products like shower curtains, sheets, cushions, furnishings, and carpets, might be produced from chemical-laden synthetic materials and emit toxic volatile organic compounds that are released into the room air. Lack of proper cross ventilation is also a problem in many modern houses.
Second-hand smoke (SHS) is another major source that adversely impacts indoor air quality and hence our health. SHS exposure kills around 600,000 non-smokers each year. Tobacco smoke contains more than 50 carcinogenic chemicals and increases the risk of heart disease by 25%-30%. Children exposed to SHS have a 50%–100% higher risk of acute respiratory illness including asthma and pneumonia.
Smoking flavored tobacco through water pipes/hookahs makes indoor air polluted, what with hookah lounges proliferating in many urban cities, (including those in India). According to Patrick Breysse, from the Institute for Global Tobacco Control at the Johns Hopkins University's Bloomberg School of Public Health and the lead author of a new study, " There is a mistaken notion that because the tobacco smoke is drawn through the water, it is somehow cleaner. Our study found that water pipe smoking creates higher levels of indoor air pollution than cigarette smoking, putting people at increased health risk from SHS exposure".
Recently, the WHO published a report explaining that regulations are required to address health concerns associated with e-cigarettes. It recommends taking steps to end indoor use of e-cigarettes in public and work places. Evidence suggests that exhaled e-cigarette aerosol increases the background air level of some toxicants, nicotine and particles. Hence, just like SHS, e-cigarettes can also increase the exposure of non-smokers to nicotine and other toxicants.
Community voices from an urban slum
(i) I use a wood cook stove. My husband is a smoker and does not keep good health. All 7 members of my family live in one room where I cook food also. There is too much smoke inside. I know that this is harmful for my kids and me but I cannot help it, as we cannot afford anything better. I wish I could use a gas stove.
(ii) I cook on wood stove. The smoke gets into my eyes and has affected my eyesight. It is affecting the health of my 4 children as well. On top of this my husband smokes bidis. All of us live in one room that doubles up as a kitchen also. I cannot afford a gas stove.
iii) I have 2 daughters and one son. None of them go to school. My husband is a daily wage earner. I use a wood cook stove. The smoke gets into my eyes and is affecting my children’s health. But there is no way out.
(iv) I use a wood cook stove. My 4 kids run out of the room when I cook food as the smoke gets into their eyes. But I cannot run away. The smoke is affecting my eyesight and I am having breathing problems also. It feels as if the smoke enters my body and burns it from inside. But much as I want to, I cannot afford a gas stove.
(v) My husband is suffering from cancer. He had been a smoker. I am also ill. I have 3 kids. I use wood to cook food, as I cannot afford anything better.
Expert speak-- Dr Quan Gan of the International Union Against Tuberculosis and Lung Disease (the Union) says that, “There are two main sources of indoor air pollution--secondhand smoke and particulates from use of biomass fuels. To prevent exposure to secondhand smoke, smokers should not smoke inside or in front of non-smokers including children. Particulate exposure from biomass fuels can be avoided through upgrading to more efficient fuels such as natural gas. Ventilation in the house should also be good.”
Dr. Flavia Bustreo, WHO Assistant Director-General Family, Women and Children’s Health has rightly said that, “Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves.”
Shobha Shukla, Citizen News Service (CNS)
2 September 2014
(The author is the Managing Editor of Citizen News Service - CNS. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email: shobha@citizen-news.org, website: www.citizen-news.org)