HAP: the Growing Burden of Disease | 15 July 2015 1 |

Health Impacts of Household Energy Use Heather Adair-Rohani

Photo courtesy of: Ajay Pillarisetti

Health Impacts of household energy use 2 |

Overview of presentation

Who are the most exposed to household air pollution?

What are the health impacts from the inefficient use of energy in the home?

Where does the household air pollution go?

Why are there differing numbers/figures for household air pollution exposure and disease burden?

How is WHO addressing the household air pollution?

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Household Air Pollution (HAP) Household air pollution arises from the

incomplete combustion of fuels used in or around the home for cooking, heating, lighting and other household energy end-uses.

It is not the fuel itself that leads to household air pollution, but rather it is the efficiency and characteristics (e.g. chimney) of the energy technology in combination with the fuel that impacts the level of household air pollution.

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WHO ARE THE MOST EXPOSED TO HOUSEHOLD AIR POLLUTION?

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Who are the most exposed and at risk for ill health from household air pollution?

Populations living in low and middle-income countries

Women and children are the most exposed to household air pollution

Both rural and urban populations

Health relative risks are higher for women

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Household Air Pollution (HAP) Exposure, 2012

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Regional HAP Exposure, 2012

2.9 billion people exposed or…

42% of the global population

Over time the % exposed has decreased, but the absolute # of people exposed has remained the same

78%

15%

34%

12%

63%

45%

0%

0% 20% 40% 60% 80% 100%

Afr

Amr

Emr

Eur

Sear

Wpr

HIC

Population Primarily Cooking with Solid Fuels

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WHAT ARE THE HEALTH IMPACTS FROM THE INEFFICIENT USE OF ENERGY IN THE HOME?

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Health Impacts: Particulate Matter (PM)

Outdoor Air Pollution

PM is a complex mixture of chemical components that have diverse chemical & physical characteristics that can impact health such as size, particle core chemistry, metals, biogenic origin etc. The harmful effects of PM arise from the particle’s presence on biological tissues, to the actions of chemical constituents, including absorded components or a combination of these factors.

These toxic effects include: • bronchial irritaion • inflammation, • genotoxic events (i.e. carcinogenic) • reduced macrophage response

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HOUSEHOLD AIR POLLUTION

1. Outdoor Air Pollution

Medgadget .com

PM2.5

CO PAH

CH4

CH2O NOx

SOx

NMVOCs

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PM Across Combustion Sources

Outdoor air pollution (green)

Household air pollution (red)

Second-hand smoking (blue)

*Burnett et al EHP 2014

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What diseases are associated with household air pollution exposure?

Disease outcomes: Acute Lower Respiratory Infections (ALRI); Chronic Obstructive Pulmonary Disease (COPD); Lung Cancer (Biomass + Coal); Ischaemic Heart Disease (IHD) Stroke Cataract

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What diseases are associated with household air pollution exposure?

Disease outcomes: Acute Lower Respiratory Infections (ALRI); Chronic Obstructive Pulmonary Disease (COPD); Lung Cancer (Biomass + Coal); Ischaemic Heart Disease (IHD) Stroke Cataract Adverse pregnancy outcomes Tuberculosis Cognitive development Other cancers (cervical, upper aero-digestive)

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•Health risks extend beyond diseases outcomes •Women & children are at more risk for burns & scalding, as well as vulnerable to attack and injury during fuel collection •Kerosene consumption is one of the leading causes globally of childhood poisonings •Additional health impacts from the climate change caused by inefficient energy use like changes in precipitation, drought, temperatures, etc.

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Household Air Pollution & Global Impacts on Health

In 2012, 2.9 billion people primarily used solid fuels for cooking

4.3 million deaths a year from household air pollution—the largest environmental risk factor for disease

Accounts for over half of childhood pneumonia deaths (the largest cause of death in children under 5 years)

A major cause on NCDs (e.g. COPD, heart disease, stroke, lung cancer)

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Deaths per capita attributable to HAP in 2012, by region

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Deaths attributable to HAP in 2012, by disease

• 88% of HAP attributable burden is to non-communicable diseases

• Over 50% of all ALRI deaths in children under five years of age are attributable to HAP

547,904 13%

273,391 6%

927,844 22%

1,463,024 34%

1,096,249 25%

ALRILung cancerCOPDStrokeIHD

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WHERE DOES THE HOUSEHOLD AIR POLLUTION GO?

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Joint Effects: Disease Burden from Household AP + Ambient AP (AAP), 2012 In some areas, a significant fraction of ambient air pollution

(AAP) is caused by household fuel combustion

Around 400,000 of the ambient air pollution deaths are caused by household air pollution “leaking” outdoors.

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WHY ARE THERE DIFFERING NUMBERS/FIGURES FOR HOUSEHOLD AIR POLLUTION EXPOSURE AND DISEASE BURDEN?

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Previous WHO estimates

• In 2002, WHO estimated that 2.7 billion people were exposed to household air pollution (vs. 2.9 billion in 2012)

• In 2002, approximately 2 million deaths- ~900,000 to COPD, ~1 million to ALRI, and 100k to lung cancer from coal use (vs. 4.3 million deaths in 2012)

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What accounts for the big increase?

• Underlying population & mortality estimates

• Disease outcomes accounted for

• Risk estimates – methods & values

• Methods assessing exposure

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Lots of numbers but same MESSAGE

BIG EXPOSURE +

BIG DISEASE BURDEN =

MAJOR PUBLIC HEALTH ISSUE

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HOW IS WHO ADDRESSING HOUSEHOLD AIR POLLUTION?

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WHO RESOLUTION: Health and the Environment: Addressing the health impact of air pollution

(WHA68/A/CONF./2 Rev.1) Highlights the key roles that national and local health authorities

need to play in raising the awareness about the health impacts of air pollution

Call for multi-sectoral action to address air pollution

Urges MS to develop and enhance air quality and health monitoring systems

Promote clean fuels and technologies, in addition to sharing of international expertise, technologies and scientific data

http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_ACONF2Rev1-en.pdf

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WHO Guidelines for Air

Quality

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Previous Air Quality Guidelines – how they relate to new Indoor Air Quality Guidelines

Pollutant Guideline or target

Exposure period

Level (µg/m3)

PM2.5 (2005)

Guideline Annual average

10 IT-3 15 IT-2 25 IT-1 35

Pollutant Guideline or target

Exposure period

Level (mg/m3)

Carbon monoxide (2010)

Guideline 8-hour 10 Guideline 24-hour 7

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WHO Guidelines for Indoor Air Quality: Household Fuel Combustion

What do they tell us… • How clean is clean enough • What fuels shouldn’t be used • All end-uses (e.g. cooking,

heating, lighting) need to be clean

• Transition to clean will take time & vary across settings

• Climate co-benefits

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IER function for PM2.5 and child ALRI risk (linear scale)

WHO IT-1 (35 µg/m3 PM2.5)

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WHO IAQG: Household fuel combustion Recommendation 1(a) Emission rate targets

emission ,2.5of homes to meet the WHO AQGs for PM %90For rates should not exceed the emission rate targets (ERTs) set out below.

Emissions rate targets (ERT)

Emission rate (mg/min)

Percentage of kitchens meeting AQG (10 µg/m3)

Percentage of kitchens meeting AQG IT-1 (35 µg/m3)

Unvented Intermediate 1.75 9% 60% Final 0.23 90% 100% Vented Intermediate 7.15 4% 60% Final 0.80 90% 100%

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Rec 2: Household energy transition

Urban and peri-urban

2015 2020 2025 2030

Rural better-off

Rural poor

Clean fuel

Traditional biomass

Low emission biomass

To ensure ‘best possible’ • Testing • Standards • Certification

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WHO IAQG: Household fuel combustion

Recommendation 3: Unprocessed coal should not be used as a household fuel

Recommendation 4: Household combustion of kerosene is discouraged while further research into its health impacts is conducted

Public health and environment 34 |

Good Practice Rec: Securing health and climate co-benefits

Recommendation: Considering the opportunities for synergies between climate policies and health, including financing– governments and agencies who develop & implement policy on climate change mitigation should consider action on household energy and carry out relevant assessments to maximize health and climate gains.

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Supporting implementation in countries

COUNTRY

Survey and AQ measurement tools

HAPIT tool

Emissions model

Adoption tool

Needs assessment and mapping

M&E strategy, capacity and

resources

Intervention options

assessment

Policy (finance, market, &c.) for adoption and sustained use

Standards, testing and certification

ACTION PLAN Multisectoral ‘task

group’

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Synergies: Harmonizing Efforts Across Initiatives

WHO IAQG

ISO/IWA Standards

SE4All Multi-tier tracking

framework

GACC Clean cooking catalogue

Post-2015 SDGs

HARMONIZATION

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How WHO is working on domestic energy needs? Clean Home Energy Solutions

Raising awareness and supporting the tracking, monitoring & evaluation of health impacts from home energy

– Global databases on household air pollution measurements & solid fuel use in the home

– Field research on the health impacts of various interventions (e.g. LPG, “improved” stoves)

– Tracking the health effects of other domestic energy needs (e.g. lighting, heating)

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How WHO is working on domestic energy needs? Clean Home Energy Solutions

Connecting WHO’s AP work to other global work on home energy, sustainable development & climate

– Global Alliance for Clean Cookstoves (GACC) – UN Secretary General’s Sustainable Energy for All

initiative (SE4All) – Climate & Clean Air Coalition on Short-Lived Pollutants

(CCAC) – WHO’s Global Platform for Air Quality & Health

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THANK YOU & ANY QUESTIONS