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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?
Health Impacts of household energy use 3 |
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.
Health Impacts of household energy use 4 |
WHO ARE THE MOST EXPOSED TO HOUSEHOLD AIR POLLUTION?
Health Impacts of household energy use 5 |
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
Health Impacts of household energy use 6 |
Household Air Pollution (HAP) Exposure, 2012
Health Impacts of household energy use 7 |
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
Health Impacts of household energy use 8 |
WHAT ARE THE HEALTH IMPACTS FROM THE INEFFICIENT USE OF ENERGY IN THE HOME?
Health Impacts of household energy use 9 |
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
Health Impacts of household energy use 11 |
PM Across Combustion Sources
Outdoor air pollution (green)
Household air pollution (red)
Second-hand smoking (blue)
*Burnett et al EHP 2014
Health Impacts of household energy use 12 |
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
Health Impacts of household energy use 13 |
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)
Health Impacts of household energy use 14 |
•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.
Health Impacts of household energy use 15 |
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)
Health Impacts of household energy use 16 |
Health Impacts of household energy use 17 |
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
Health Impacts of household energy use 19 |
WHERE DOES THE HOUSEHOLD AIR POLLUTION GO?
Health Impacts of household energy use 20 |
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.
Health Impacts of household energy use 21 |
WHY ARE THERE DIFFERING NUMBERS/FIGURES FOR HOUSEHOLD AIR POLLUTION EXPOSURE AND DISEASE BURDEN?
Health Impacts of household energy use 22 |
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)
Health Impacts of household energy use 23 |
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?
Health Impacts of household energy use 26 |
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
Health Impacts of household energy use 27 |
WHO Guidelines for Air
Quality
Health Impacts of household energy use 28 |
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
Health Impacts of household energy use 29 |
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
Health Impacts of household energy use 30 |
IER function for PM2.5 and child ALRI risk (linear scale)
WHO IT-1 (35 µg/m3 PM2.5)
Health Impacts of household energy use 31 |
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%
Public health and environment 32 |
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.
Public health and environment 35 |
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’
Health Impacts of household energy use 36 |
Synergies: Harmonizing Efforts Across Initiatives
WHO IAQG
ISO/IWA Standards
SE4All Multi-tier tracking
framework
GACC Clean cooking catalogue
Post-2015 SDGs
HARMONIZATION
Health Impacts of household energy use 37 |
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)
Health Impacts of household energy use 38 |
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
Health Impacts of household energy use 39 |
THANK YOU & ANY QUESTIONS