[Stoves] Health protective environment and solid fuel burning devices

[Nikhil Desai]

Tom: (I got Crispin's reply as I finished this but haven't read it yet.)

Thank you. You have clarified things considerably, just that I will
rephrase some items of agreement.

I do not like general terms "health metrics" and "health benefits". I would
say that the choice of fuels, stoves, and operating practices has various
influences on the well-being of the cooks in and outside homes, but that
such influences cannot be quantified, considering the diversity (of fuels,
stoves, operating practices, immediate and extended environments, so on).

I like tighter definitions and precise propositions, though I fail at those
myself.

1. You must distinguish between DALYs and aDALYs. DALYs are for the cohorts
dead, aDALYs are for those alive and coming. DALYs are assigned different
"risk factors" by consensus -- causes of death and causes of disability are
illnesses with multiple risk factors - say, whether my hypertension is due
to caffeine or air pollution and in turn cigarette smoking in the past or
bad traffic or dust control. The future cohorts have very different
lifestyle, nutrition and health care services, education, food choices,
etc. It takes heroic assumptions to compute aDALYs; I don't care for such
assumptions.

2. The moment you dispense with DALYs and aDALYs, out go the WHO Guidelines
for Household Solid Fuel Use and precise emission rate targets, tiers, etc.
For economic, political, and scientific reasons this is the core of my
attack on the tomfoolery in the name of "health protection". One simply
cannot link, with any level of precision, hourly PM2.5 emission rates as
computed in labs (possibly with dubious test protocols) to a specific
exposure and disease profile all around the world. Context matters. Hence
the "international" standards exercise is not necessarily going to results
people expect of it. (It does have some ancillary benefits - e.g., debate
on standards and measurements.)

3. I have heard of a couple of stove development programs where some
computations of aDALYs have been generated. I was irritated, though I
believe Ajay Pilarisetti and Kirk Smith both were cautious enough to
qualify their results and their interpretations.I will have to go back and
read those reports, but GENERALLY, I don't think the BAMG aDALYs have a
place in serious discussions about usability and contextual design and
promotion of modern biomass stoves.

More below between ***




On Sun, Jun 4, 2017 at 3:41 AM, Tom Miles <tmiles at trmiles.com> wrote:

> Nikhil,
>
>
>
> The first question is really about what policy impact health metrics have
> on cook stoves development and dissemination. We agree that improving cook
> stoves for solid fuels has health benefits. You disagree specifically with
> the use of DALYS as a measure. How would removing DALYS affect change how
> cook stoves are developed or disseminated?
>

*** For one, the Goldman Sachs and C-Quest Capital fantasies of issuing
aDALY certificates for individual stoves and putting them in the market as
tradable products - with $/aDALY tag -- will be dead on arrival. It reminds
me of Enron engagement with "carbon offsets" and tradable allowances back
in the mid-1990s. What a fraud. ***


> Does it matter? Would it change how 160 or more programs around the world
> are funded? Most stove program benefits are probably not recorded in deaths
> but in incidence of respiratory and related disease.
>

*** I don't think there are too many such records, though what Crispin
reports on heating stoves is a remarkable exception. For household
cookstoves, too many confounding factors enter to be able to make a clear
epidemiological link between stove, fuel and operating practices on the one
hand, and disease incidence on the other. Please note that I take "fuel,
stove, and operating practices" as a package. Many stove programs do not
fix the biomass fuel quality and they cannot fix operating practices. So
they keep on generating worthless "studies" like the MIT-Harvard (e)cons
back five years ago (Remy, Duflo,Greenstone). I cannot categorically
dismiss all such measurements and studies, but to me they are academic
distractions. Emission rate is one of many considerations in switching
fuel, stove and operating practice, and benefits of such a switch are also
many. (For example, convenience, flexibility,versatility, none of which the
physicist crowd can say anything about. And all this while keeping
nutritional levels and health care service adequate, which doesn't often
happen. ***


> International working groups on household health and indoor air quality
> examine a long list of diseases and conditions associated with smoke, not
> just mortality. Respiratory diseases alone should be enough to drive policy
> without being overly concerned with numbers generated from estimates of
> mortality.
>

*** Agree. I also don't think these "international working groups on
household health and indoor air quality" have much data in terms of direct
measurements of indoor concentrations, composition of pollution, exposures,
disease incidence, or dose-response functions. Hence the recourse to
assumption of "equitoxicity" and the use of Integrated Exposure Response.
Stretching data and scientific method way, way beyond logically and morally
allowable. ***

>
>
> Are you saying that we shouldn’t spend money on measuring and modeling
> disease from cooking?
>

*** Money and minds can be put to better uses, considering Kirk Smith's
1999 warning about vast difference between outdoor air pollution in the
rich countries in the 1950s and the indoor air pollution -- poorly measured
in the first place -- in the poor countries in recent decades and going
forward. ***


> Who is spending the money?
>

*** US Government and Gates Foundation, to begin with. I quoted some
figures from State Department some time back; I think Hillary Clinton, when
announcing support to GACC, was clear that GACC did not receive much (if
any) US Government money which instead went to EPA, on the one hand, and
HHS entities (NIH, CDC) on the other, to the tune of some $100-125 million
each so far. I haven\t checked Gates Foundation data but you discovered the
news item about some $120 m of Gates Foundation money to NIH on to Emory,
et al. Gates Foundation has also supported IHME with some $150-250 m grant.
Then there are other sources of money in UK - DfID, Medical Council. There
are also other NIH or NSF grants to US universities. UNDP, SE4All, World
Bank may also have spent tiny amounts of money (for instance, the
Mozambique piece recently published). though I don't think any of it is for
primary epidemiological research. All told, I am guessing some $500 m has
been committed in the last seven years to cooking and health research that
I see has no value on the real policy issues on the ground -- support for
fuels, stoves, and actual health care. Stoves are not pills. ***


> I understand that European and other countries, not the US, are the major
> donor to stoves development programs. Do they care about estimates based on
> DALYs or on some other combination of measures?
>

*** I don't know of all, but DfID certainly went gaga over DALYs, climate,
blah blah. I reckon it has spent about $40 m on different grants; I have no
idea if any evaluations are made public. (Disclosure: I myself wrote a
draft discussion note advocating support for LPG and pressure cookers on
the grounds of health and climate co-benefits. I still stand by my lies. I
also wrote another short note for "energy vouchers" that could be used for
LPG, solar battery products, or "advanced" biomass stoves. I am still
interested in finding effective solutions that justify public
expenditures.) I think one or two World Bank projects -- from the health
sector, not energy sector -- used aDALY approach; I don't remember the
results. I generally don't think much of health sector trial balloons in
the energy sector. ***

>
>
> I agree that premature or even mature mortality from smoke would be
> difficult to determine. How good are general statistics?
>

*** Depends. Mortality data are "better" than disability and disease data;
quality varies by country, province, neighborhoods (as also in the US).
There is no "premature" or "mature" mortality except as our biases dictate.
A baby dying of faulty heart valve - happened to a cousin of mine - is not
a "premature" death. Another baby who nearly died of a different kind of
such malformation but survived (me) has been a candidate for "post-mature"
death all these years. Anyway, the quality of death statistics has improved
over time, and IHME recognizes that. IHME folks get death records, then
"fix" those records by dumping "garbage codes" (their discretion) and
assigning a single cause to every death (again, their algorithms). I have
some familiarity with health system statistics, having muddied my hands
once. Just remember WHO DG Margaret Chan's lament at the time of GBD 2012
-- something like "Now that we have better estimates, let's try to get
better data." :-) ***


> We may never have good statistics on actual deaths caused by smoke related
> diseases. Many smoke related conditions are probably not recorded. For
> example, a death certificate, if there is one, is more likely to list a
> very specific organism or condition that may have directly resulted in
> death rather than listing cancer as a cause, even though the cancer may
> have removed the resistance to the organism. I once had a skin tumor that
> my dermatologist diagnosed as likely to have been caused by a combination
> of smoke and ultraviolent rays from the sun while living in a tropical
> environment. At the time, I was exposed to cigarette smoke, household dust
> and cooking smoke. Smoke as a probable cause was not recorded on my health
> record when the tumor was removed.
>

*** Precisely. Smoke was a risk factor for the infection or melanoma; the
causal relationship with tobacco smoke is still being debated, leave aside
PM2.5 of all composition. But EPA has a vested interest in tightening NAAQS
- which it did a few years ago -- and then claiming more ground in
regulatory powers in the name of saving lives. I think its defense of the
residential wood heater NSPS was that it would avoid one premature death
per week. Out of some 60,000. ***

>
>
> In the US, regulations for heating appliances and large boilers are based
> on ambient air quality standards but they are implemented in different
> ways. The industrial boiler regs are not relevant here. The way the heating
> appliance testing standards evolved is relevant. Emissions and efficiency
> standards were developed for devices of different types and fuels. The
> standards basically say that you have to have a design that meets good
> combustion practices when used according to the accepted test conditions.
> Pass the test and you can put the product on the shelf for sale. If your
> appliance is cleaner or more efficient than the standard it is up to the
> consumer to pick your product to derive the benefit.
>

*** Yes, but the justification for these standards came from establishing
that certain areas in the US were out of compliance for certain periods
during the year -- namely, northeastern states and some parts of Appalachia
during winter nights. EPA couldn't just have begun regulatory research
without such a finding. (I remember; I was in Boston and sometimes stayed
in a Concorde home with a wooden stove and a chimney.) Air quality
standards gave EPA the authority. However, even as the manufacturers of
more efficient, low-emission wood heating stoves, and the masons, reached
consensus with EPA on the NSPS, implementation is still voluntary on the
part of the states. Let me think -- EPA probably spent $30 m before it
promulgated the Final Rule last year or the year before that, and these
regulations apply only to NEW stoves. If wood is free and the old stoves
are not used all that much, or don't bother the users (or their villages
and towns) very much, we might wait 40 years before the complete switch-out
occurs. ***

>
>
> The tier system for cooking stoves appears to be different. There does not
> seem to be an “acceptable” threshold for different types of stoves (solid
> fuel, pellet, coal, lpg, biogas, etc.).
>

*** Why should there be, if the intent is to set the Tier 4 PM2.5 Emission
Rate Target so high as to drive all solid fuels out of consideration? Why
do you think I have been railing against this WHO overreach of
jurisdiction, beyond their technical or legal competence, in the ISO TC 285
business? I will have to recheck, but I think I once posted that the hourly
emission rate target for Tier 4 cookstoves -- which are used for shorter
durations - as proposed by WHO is LOWER than the EPA hourly emission rate
target for US residential wood heaters -- which are used for much longer
periods, sometimes for months at a time. I don't know what kind of one-room
air circulation model is used for the former and a three-room air
circulation model is used for the latter; the main point is, emission rates
have no bearing on exposures except via such mindless modeling. Michael
Johnson readily agrees that this requires enormous simplification. I say it
requires acquiescing in experts' stupid excursions for the sake of
publishing papers.

Ranting aside, it is erroneous to think of an "acceptable" threshold unless
you "fix the fuel", as Frank Shields argues, and also "fix the meal|"
(proxy for operating practices), as Paul or Todd effectively argue (I am
using different phraseology). With LPG or even coal, the fuel is fixed, and
people adjust their meals and beverages accordingly. So there are
"standards" for LPG stoves; don't know about coal. Solid biomass is so
diverse, fixing a standard for some standard stove using standard
ventilation and standard pot and standard cook, standard meal simply
doesn't make sense. Variation in emission according to power levels is the
main reason to avoid such simplistic linking of emissions rates to
'acceptable' thresholds. ***


> It seems to reward only higher performing stoves. People feel they are at
> a disadvantage if their stove is not in the highest tier. How real is that?
>

*** I don't know about "higher performing stoves". What is "higher
performing"? High efficiency for boiling water? Blah! On the other hand,
stoves that might be better attuned to users' requirements of power levels
may not score on this metric of "efficiency in boiling water", with the
result that "better" stoves are rated low by such metrics. (And protocols
make the deception worse. Hence my criticism of ARC paper that reveled in
rating stoves independent of fuel qualities and other realistic factors.
***


> Is that the money issue?
>

*** I don't know enough about the contexts for all such stoves, but you are
correct, this is precisely the problem with the Tier system (independent of
alleged health arguments). The performance metrics have nothing to do with
the reality of cooking. They are fuel-free, fact-free, cook-free. They
please the cognoscenti at SE4All and EPA, but that's that. There's money
for such pretentious theorizing and no money for pushing the envelope on
stove design and field testing. That's what should make blood boil. ***


> What is it worth to a stover? Selecting stoves according to tiers is a
> policy decision.
>

*** Only where donor-funded stove programs come in. For all the efforts and
roughly $1-2 billion (peanuts, sure) of expense on "biomass (excl.
charcoal) stove promotion" over the last 40 years, such "stove programs"
have contributed to probably 5% of new stoves purchased or installed over
these decades. (Does anybody have a better number? The stove must have been
used for the period expected.) So the "tier" system is an excuse to hide
ignorance, to justify a shot in the dark by getting the blessings of Kirk
Smith for "truly health protective" hourly emission rate? Have policymakers
gone bonkers? This is the Achilles heel of stove programs -- finance
ministers let the donor-funded circus continue on grant money, because they
are by now cynical enough to realize that nothing more is to come from
stovers. GACC goes pretending it can give policy advice and design
comprehensive national clean cooking programs from Haiti to Myanmar; sure,
so long as US or Canadian ambassadors - or Gina McCarthy in Ghana and
Nigeria - keep on pressing political buttons and throwing a few million
dollars here and there. All it does is keep the middlemen and middlewomen
employed, and expand the distance between the stover and the user. ***


> Would changing the testing conditions change the results for the stove
> producer?
>

*** I don't think of the stove producer as such, because I am not concerned
yet with donor-funded stove programs. Rather, IF the stove producer has
created a contextually relevant design that has been found usable with
specific fuels and operating practices, then one must ask if the testing
conditions frustrate such a realistic stove designer and favor some
thermodynamics loony who obtains high efficiency rating for boiling water
for a stove that would rust, collect dust, or end up in junk. I suppose
changing the testing conditions will change the results for the stove
producer -- one argument for dumping WBT -- but my objection is with the
performance metrics themselves. I think it was Todd who ***

>
>
> There is also an assumption in many arguments on this list that stove
> performance is the only criteria for selecting which stoves to support.
> When I speak with donors I get the impression that is not the case and that
> they take a more comprehensive approach when selecting stove programs to
> support.
>

*** I do not know enough about how all donors operate, but I am pleased to
note that "performance" is not limited to efficiency ratings. To me,
efficiency of free fuel is a contradiction in terms and even if fuel
savings mattered, the cook optimizes many factors (some only she knows, not
the physicist bean-counter) all the time. There is as yet no way to model
cooks' behavior. (I am thinking of revising an old English book on being a
good cook, hostess and wife, but separating the three roles for the modern
woman. One chapter will be on stoves; seeking cooperation from British
women of a certain age who know such books from the late 1800s. Other
ex-imperial women also welcome.)

I would urge Cecil - and some old friends of mine - to examine the new
sociology of "stove programs". I am not against donor-funded programs as
such, but would like to see stoves and fuels together, for all fuels and
all users. That is not what this GACCian paradigm of "clean cookstoves"
implies, though. ***

>
>
> Is the tier system over-kill?
>

*** Don't know yet. My problem is not with ordinal ratings -- like the star
system for air-conditioners - or even mpt (meals per ton) ratings (under
ideal conditions) - but the specific targets chosen. Again, let me remind
you that the bandwagon has now moved to "implementation science" for Tier 4
- LPG and electricity - stoves. What hubris. What presumptuousness. What
waste of money and minds. But that's GACC for you. ***


> Consumers in low and middle-income countries now have more choices of
> stove models. They don’t seem to select models just based on tier ranking.
> A self-supporting stove producer in Central America recently announced that
> they had now produced 30,000 stoves, which suggests that consumers select
> the stoves because they are functional and they like them. The stoves are
> basic designs that employ good combustion practices and are tailored to
> local foods and habits. What is wrong with “good enough.”
>

*** Amen. I have been talking up strangers I have met in this part of India
to understand the types of wood and charcoal stoves, and their relation to
the dwelling designs. I have roughly concluded that in this relatively
better-off part of India, the relatively better-off communities and
families had multi-story dwellings from about 150 years ago and started
using multiple stoves'fuels/pots in multiple (at least two) locations as
new options became available. When I post things like some wood and
charcoal stove designs are familiar from childhood, I am aware that I am
speaking of a *"middle class"* of the last Century, and fuel supply chains
even older than that. Just that one can't obsess with the firebox, ignore
fuel qualities and reliability of supply, immediate environment, use
patterns, and try to invent a new firebox that passes tests for irrelevant
or dubious "performance metrics" under dubious testing protocols. This is
where I argue we need to go back to the basics and ask, what are we doing?
Why? What have we done for the last 40 years, and what can we get done in
the next ten years? From all I can tell, GACC cannot claim much about
progress toward its 2020 target by anything it did -- nobody needed GACC to
advocate LPG, and the charcoal stoves it has sought to expand the sales of
in Sub-Saharan Africa could have been better promoted by anybody else,
minus the hoopla of imperial hotel dinners - but what about the next ten
years? Doesn't GACC need to be reformed? Don't we all need some honest
discussion? ***


> What is “good enough” and how do you measure it?
>

*** ASK COOKS. (Oh, Cecil Cook to begin with? :-))


> Shouldn’t we be concentrating on making solid fuel stoves that are  ”good
> enough” to substantially improve health rather than meeting an arbitrary
> standard?
>

*** Yes, just that academic ambulance-chasers --- I mean, those obsessed
with "results", without a theory of change -- will press for "evidence".
>From tCO2e avoided -- you know how such calculations are manipulated -- to
DALY avoided, they have latched on to demanding "results". They forget that
some 5 billion people transitioned from "dirty combustion" to "clean human
environments" over the past Century -- in their households, their office
and commercial buildings, in their trains and ships, in their power plants
and industrial facilities -- with nary a thought about quantifiable health
improvements, leave alone the DALY nonsense.

The poor of the earth are trapped in the trappings of academic and
bureaucratic theorists whose interests lie in making things more
complicated than need be. ***

>
>
>
>
> Tom
>
>
>
>
>
***  In sum, I believe we agree on a few things:

1. The phraseology and methodology of "cooking and health" needs to be
monitored carefully. There is more to cooking than stoves, fuels and pots;
principally adequate and well-cooked food at the times and in the manner
desired. The intake of the latter, not emissions from the former, is
probably a more significant determinant of health outcomes.
2. The methods of DALY and aDALY computations are questionable and
unhelpful -- in general and in particular for TC 285 ERTs for different
Tiers.
3. Fuel, stove, operating practices should be seen together, and in the
respective context of cooks and their immediate environments. There is no
standard fuel, there are no standard inter-fuel choices, and no standard
performance metrics and test protocols that help decide what would please
the cook and what options must be banned. (Exceptions:Multi-storey
dwellings are not appropriate for wood, dung, straw and perhaps even
charcoal stoves for cooking.)
4. The question of what is "good enough" is not yet answerable, at least
not while sitting atop high mountains of the
academic-bureaucratic-consultant-donor
(ABCD) complex. Context matters.
5. Air quality management strategies require consideration of all
components and all sources - natural and anthropogenic - with a view to
minimize the incidents of extreme exposures and to combine source
regulation with timely health care services until air quality levels
improve to nationally enforceable standards.

What you will probably not agree to is my objection to the equitoxicity
assumption for all PM2.5 from fuels, foods, other sources. Air quality
monitors do a horrendous job in developing countries by failing to pick up
the highly toxic particulates and organic pathogens that are extremely rare
in rich countries. This is a subject to be taken to AWMA - Air and Water
Management Association - and not to BAMG or IHME***


Nikhil

>
>
>
>
>
>
>
>
> *From:* pienergy2008 at gmail.com [mailto:pienergy2008 at gmail.com] *On Behalf
> Of *Nikhil Desai
> *Sent:* Saturday, June 03, 2017 12:18 PM
> *To:* Tom Miles <tmiles at trmiles.com>
> *Cc:* Discussion of biomass cooking stoves <stoves at lists.bioenergylists.o
> rg>; Crispin Pemberton-Pigott <crispinpigott at outlook.com>
>
> *Subject:* Re: [Stoves] Health protective environment and solid fuel
> burning devices
>
>
>
> Tom:
>
> Thank you for your comment and question what health metric I would propose
> for cookstoves in developing countries. (Short answer: None. An emission
> rate metric is not a health metric.) I have three other incomplete
> responses to your questions and prodding, but let me get to this first.
>
>
> Please suggest what new literature I ought to be reading for determination
> of DALYs for the Global Burden of Disease.
>
> You are correct; the Guatemala and Kenya papers are old. The Nepal and
> Malawi papers are not. In any case, my argument is not with little one-time
> studies with small samples here and there. I have no doubt smoke leads to
> ill health; I think our ancestors in caves had figured that out, without
> multi-million dollar research expeditions with results of no predictive
> value.
>
> Let's take the 2015 GBD. Some 55 million people died; they had lived some
> 30 trillion hours and consumed some 5 trillion meals and beverages, say 3
> trillion of which were cooked on solid fuels (consider that all premature
> deaths are people who died before age 86, so those who died at ages 70-86
> surely had more of their early meals cooked on solid fuels).
>
> What data do IHME have on the emissions, concentrations, exposures,
> disease incidence, or causes of death for the 55 million individuals'
> health damage from 3 trillion meals?
>
> NONE. ZERO. IHME is not about evidence. It is about creating model
> estimates (wilfullly?) based on modeled assumptions based on model
> estimates based on modeled estimates based on ... well, you know the game.
>
> I think I rubbished the GoBbleDygook in one paragraph. Please read Kirk
> Smith ("Millions Dead" 2014) if you have any doubts. With a disclaimer he
> does not make - for the assumption of equitoxicity. After decades of work
> measuring all kinds of organic toxins in some fuel smoke - but not food
> smoke, as if he was intent on demonizing fuels - that he still calls
> equivalent of 400 cigarettes, he has given into the assumption of
> equitoxicity. That essentially makes his judgements fuel-free and
> stove-free, because emissions depend on both fuel and stove, both of which
> vary considerably around the world. Let's wait on that discussion another
> time.
>
> Or please ask WHO to provide the data for last 86 years, even 8.6 years,
> on all these parameters. Direct measurements, not modeled estimates.
>
> And also ask WHO to name 4,000 individuals of the 4 million in that 2015
> cohort that allegedly died prematurely as a result of exposure to Household
> Air Pollution.
>
> How about 400 names? Also 400 from those who died post-maturely but still
> had been exposed to HAP (as nearly everybody over age 86 would have been)?
>
> WHO has no premature mortality data, and can't have any. Premature
> mortality is a population attribute assumed by experts. Even though far
> fewer people in the developing world died after age 86. Nearly all deaths
> in the developing countries are thus premature deaths, and because
> infectious diseases kill fewer and fewer people, all these premature deaths
> have to be blamed on something.
>
> Even Kirk Smith has taken to reporting GBD estimates as DATA.
>
> No, sir. Model output may well be garbage depending on what you feed the
> model; a model is not Mother Cow producing milk from feed.
>
> Estimates are estimates. Absolutely challengeable on grounds of data,
> assumptions, and theory.
>
> Now to your charge - "You haven’t described what health metrics you would
> propose to use in developing countries."
>
> I assume you mean health metrics for cookstoves.
>
> The answer is simple - NONE. Stoves are for cooking, not saving lives, no
> matter how much jumping and screaming is done that chulhas are death
> traps.(Yes, in India, stoves are used as death traps to kill women or for
> them to commit suicide. I don't think Hillary Clinton cared to save those
> women.)
>
> What health metric do you have in the US for cookstoves? What authorizes
> EPA bandits to go around preaching the world something it doesn't have in
> the US? I doubt EPA has the legal authority yet to even incorporate the ISO
> TC 285 stove standards and testing methods or to designate ARC as an
> ISO-compliant testing facility for cookstoves.
>
> (The sheer idea that some 500 million household cookstoves in the
> developing world can be regulated like fans and lightbulbs seems rather
> queer to me. But who knows, poor people will take to them like CFLs.)
>
> No stove produces health or illness, just as PM2.5 pollution is not an
> inherent property of fuels. (There are PM2.5 emissions from foods being
> cooked; after all, they are also biomass with gaseous output at high
> temperatures. Find me studies that separate fuel emissions from food
> emissions, or report disease incidence from smoke on people who go hungry
> half a day every day.)
>
> This whole WHO business of associating hourly emission rates of PM2.5 with
> DALYs is a charade. A fraud. With all its limitations, GBD is an estimate
> of DALYs - for the cohort dead, no matter what the data - attributable to
> different risk factors.
>
> As Kirk Smith cautions, attributable is not necessarily avoidable. Most
> illnesses are attributable to multiple risk factors, whose quantified
> influence is estimated at the population level, not individual level.
> Controlling one risk factor has indeterminate consequences for disease
> incidence, when other risk factors become more important.
>
> Please tell me what you find objectionable in this.
>
> Now to your mention of stoves and boilers air emissions regulations in the
> US. I studied the history of power plant and industrial boiler New Source
> Performance Standards, fuel bans, location controls, and "bubble" from
> around 1966 to 1996. Here is where I think you are wrong in comparing that
> history to cookstoves in developing countries:
>
> 1. You say "until minimum acceptable levels were determined for different
> types of appliances"
>
> Not true as far as large boilers go. First came the NAAQS. Then the
> identification of non-compliance areas. Then fuel bans or new plant siting
> decisions. Then the NSPS.
>
> The NSPS only applied to NEW boilers. Old ones continued operations, even
> in non-compliant areas. Only when Gina McCarthy approved a State
> Implementation Plan revision for New Mexico coal use did the state come
> into compliance. (This was in 2010, and became the basis for Obama's Clean
> Power Plan.)
>
> Similar story about vehicles and stoves. EPA took 30 years to develop NSPS
> for residential wood heaters and may still be blocked from enforcing it.
>
> If you want to wait 50 years for developing countries to enforce Ambient
> Air Quality Standards, then Indoor Air Quality Standards, then stove NSPS
> that would take another 10-20 years as the old stock is replaced, be my
> guest.
>
> 2. For WHO to meddle into cookstoves, it has to develop an overall
> strategy for making indoor air compliant with its air pollution guidelines.
> You cannot control emissions from new sources of a particular type and
> expect to achieve any definite predictable change in PM 2.5 exposures from
> all sources (dust, landfills, excreta, tobacco, pollen, what not).
>
> WHO Guidelines for Household Solid Fuel Use is one of the nuttiest effort
> at environmental management I ever saw in my life.
>
> It was that - and the underlying facade of science of GBD and BAMG - that
> made my blood boil this time around.
>
> Mark my words -- this is a drive to push solid fuel cookstoves out of the
> reach of the poor.
>
> But it will not succeed. You must push not for some "health metrics" -
> can't be any - but "clean enough" modern cooking options. A cook will buy a
> stove that s/he can optimize the use of with respect to his/her
> preferences, safety from many points of view, time spent on specific task,
> perceived "clean"-ness, finances for stoves and fuels (assume "stacking"),
> and how they "fit" in her "rhythm of life" (daily, weekly, seasonally, when
> she is pregnant vs. has three teenage boys to cook for.)
>
> All of this is context-dependent. To pick some hourly PM2.5 emission rate
> and call it "truly health protective" demeans the meaning of health and
> hence also demeans 3 billion people. It's a nutty conspiracy.
>
>
>
> Nikhil
>
>
>
>
>
> ------------------------
>
> Nikhil Desai
>
> (India +91)909 995 2080 <+91%2090999%2052080>
> *Skype: nikhildesai888*
>
>
>
> On Sat, Jun 3, 2017 at 10:12 PM, Tom Miles <tmiles at trmiles.com> wrote:
>
> Nikhil,
>
>
>
> You are citing some old literature. What recent review articles on cook
> stoves and health reflect the biases that you are claiming? What is the
> actual impact of health risk assessments on funding and dissemination of
> improved cookstoves?
>
>
>
> Emissions from heating appliances (stoves, boilers) were actively explored
> for several years in North America until minimum acceptable levels were
> determined for different types of appliances. New appliances are tested for
> compliance but research organizations, like CANMET and EPA, are not
> searching for maximum achievable emissions. In some areas, where weather
> inhibits ventilation, wood burning in fireplaces and stoves is banned
> entirely to meet ambient air quality standards. Ambient standards are based
> partly on health risk modelling. You haven’t described what health metrics
> you would propose to use in developing countries.
>
>
>
> Tom
>
>
>
> *From:* Stoves [mailto:stoves-bounces at lists.bioenergylists.org] *On
> Behalf Of *Nikhil Desai
> *Sent:* Saturday, June 03, 2017 3:33 AM
> *To:* Discussion of biomass cooking stoves <stoves at lists.bioenergylists.o
> rg>
> *Cc:* Crispin Pemberton-Pigott <crispinpigott at outlook.com>
> *Subject:* Re: [Stoves] Health protective environment and solid fuel
> burning devices
>
>
>
> Crispin:
>
> 1. Heating stoves come in wide ranges appropriate to the local weather
> conditions and housing structures. Your results are context-dependent.
>
> 2. At the same time, only context-dependent evidence of change in disease
> incidence -- don't call it general "health benefit", which is a meaningless
> term -- matters. "Health protective" is a vague, meaningless term. I have
> said here repeatedly that I disagree with Kirk Smith's claims about "truly
> health protective" -- I disagree with the term and I also disagree with the
> baseless association of "health protective" with hourly emission rates.
>
> I wonder why it has escaped notice that much of the empirical work on
> "cookstoves and health" has been done in areas where long-term,
> high-temperature heating is not required but short-term, low-temperature
> heating is required -- Kirk Smith's project in Guatemala highlands, Dan
> Kammen and others' work in Kenyan highlands, and the other reports we see
> from Nepal (some Johns Hopkins babble a couple of  years ago) or Malawi (we
> discussed this here a few months ago).
>
> Is it purely coincidental that health researchers go find the demonic
> smoke in relatively cold areas, where traditional housing may have less
> ventilation, at least part of the year, and people may have a higher
> prevalence of respiratory difficulties (altitude, climbing up steep) and
> lower prevalence of air pollution other than household smoke, as also lower
> prevalence of some infectious diseases?
>
> It is simply silly - if not deceitful - to ignore geography.
>
> As far as I am concerned, it is up to Kirk Smith and IHME to prove that
> solid fuel emission rates, irrespective of the variations in fuel, stoves,
> and cooking practices, have a quantifiable link to future lifetime
> disability, disease, and death (i.e., DALYs). If nothing else, there is no
> way to track individual exposures to all PM2.5 - from foods,
>
> Such computation of "health damage" cannot be done without regard to the
> demographic, geographic, nutritional characteristics of a cohort - leave
> aside individuals, just statistically. Kirk Smith said so in 1999, then got
> drawn in the "global burden" dogma of "equitoxicity of PM2.5" and
> "integrated exposure response", "no or very low threshold".
>
> Just because WHO has bought into this babble of killing people by
> assumptions does not mean stove designers have to get into a meaningless
> competition to produce quantifiable evidence of "lower disease incidence"
> from "low emission heating stoves".
>
> WHO has raised a red herring. To help get research grants so youngsters
> can be kept busy with mindless modeling.
>
> We have far more serious work to do -"clean enough" stoves that users find
> usable.
>
> Yes, we cannot ignore " the improvement of indoor air quality (or not) and
> ambient (meaning outdoor) air pollution. This is a very important argument
> being made presently in the* funding pool* and we should have a clear
> perspective on what works and doesn't, and what is *fundable* and what is
> not."
>
> We need to educate the funders that there is zero evidence that transition
> to gas and electric cooking over the past 100 years has reduced DALYs and
> that to compute aDALYs from "clean cooking solutions" is a meaningless
> exercise with very weak theoretical foundations.
>
> Poor people of the world being held hostage to opinions of BAMG modelers
> is immoral. We have enough deceit with boiling water. Emphasize how your
> results from heating stove interventions lowering pollutant concentrations
> - with some consistent research on exposures (all pollutants in real life,
> of which household fuel emissions may have been a large component) and
> disease incidence - are the appropriate methods to study cost-effective
> interventions, not this babbler about ISO TC 285 Tier 4 emission rate
> targets.
>
>
>
> Nikhil
>
> Boil blood, not water.
>
> ------------------------------------------------------------------------
> Nikhil Desai
>
> (India +91) 909 995 2080 <+91%2090999%2052080>
> *Skype: nikhildesai888*
>
>
>
> On Fri, Jun 2, 2017 at 7:47 PM, Crispin Pemberton-Pigott <
> crispinpigott at outlook.com> wrote:
>
> Dear Friends
>
> I will be posting, as I find it, information relating to the concept that
> there is a 'health protective' aspect to the lowering of stove emissions,
> the improvement of indoor air quality (or not) and ambient (meaning
> outdoor) air pollution. This is a very important argument being made
> presently in the funding pool and we should have a clear perspective on
> what works and doesn't, and what is fundable and what is not.
>
> Individual perceptions are necessarily partial so through consultation we
> should be able to draw a larger picture.
>
> Because everything cannot be put into a single message I hope readers will
> keep things in mind and add relevant perspectives. The first thing to
> establish is whether improvements in indoor air quality can be achieved
> with current technologies (this is first, a technology question). Here is
> an example of a 'desired result:
>
> [cid:image002.png at 01D2DAB4.468F98B0]
>
> In this region a lot of homes have inexpensive LPB (low pressure boilers,
> hydronic heaters, to Americans) and this is a set of measurements made by
> Fresh Air in comparable homes. The metric is intended to show IAQ (indoor
> air quality). In the control homes, the PM2.5 level was 165, 45 and 62 (24
> hr average, if I read correctly).
>
> In the homes with a higher performance and better constructed LPB (about
> the same price as the usual ones) there is a significant difference,
> 'significant' meaning a difference larger than the limit of determinability
> (LOD) by a factor of 3 (which is a sort of standard, accepted way of saying
> the difference is real which high confidence).
>
> In order to have some way of saying, "This product delivers significant
> health benefits" we have to be able to prove that either the overall result
> (24 average PM2.5) is 'acceptable' or we have to be able to prove that the
> contribution to the total has been reduced a great deal. What I mean by
> that is if the above values of 25 for each of the improved LPB homes is
> only made of cooking emissions (boiled fats etc), smoking indoors,
> shuffling of feet, clapping of hands, combing of hair, outdoor air ingress
> and so on, then the contribution by the LPB is zero. So changing fuels from
> chopped wood to wood pellets would make no difference unless it affected
> the contribution from the ambient air ingress.
>
> We should not casually mix these two reporting 'mechanisms'. There is the
> PM2.5 delivered into the home from the device, and there is the total. We
> cannot look at the total exposure (those are individual exposures, not
> indoor air averages - people wore personal measurement devices) and say
> that it was all from the appliance.  Those are two different things. If I
> put the LPB in a lab, pipe all the exhaust outside the lab, and measure the
> leakage from the appliance, I can quantify the total that comes out. If I
> place that in a home and measure the total in the room or the total to
> which someone is exposed, I do not get the same answer because now the
> leakage is mixed with all the other sourced materials. Are you with me?
> There is the contribution from the device and the total contribution.
>
> A lab test is a good at to isolate the stove's contributions. A field test
> is a good way to show the difference between a home with and without the
> device. Obviously the test conducted in the lab should have the same
> typical burning conditions and fuels as the field test so the difference
> has meaning. There is literally no use testing in the lab and getting an
> emissions number and then taking it to the field to check how that impacts
> the total exposure, say, but operating the stove differently with a
> different fuel. That is nearly useless as a method of producing the
> information needed to inform policy.
>
> To 'inform policy' one needs enough information to decide whether or not
> to support the dissemination of a particular device.
>
> Here is another way of making a comparison of 'performance':
>
> [cid:image008.jpg at 01D2DAB4.468F98B0]
> Baseline CO (48 hrs)
>
> [cid:image009.jpg at 01D2DAB4.468F98B0]
> Improved stove installed.
>
> This is a demonstration that the CO level can be reduced quite a lot just
> by changing the stove. There are very few other sources of CO other than
> the stove however one should not rule out that other cooking appliances may
> be in the home. My home has a dozen different 'appliances' from kettles to
> BBQ. A gas BBQ is a significant source of PM2.5 but not a big source of CO.
> In the second chart the average is a bit less than 10 ppm. Prior to
> changing the stove there were periods of several hours with a value above
> 50, sometimes 100 in other homes.
>
> Important to the discussion is that all these improvements were achieved
> without changing the fuel. It is all coal or dung or wood or (frequently in
> the baseline homes) combinations. Dung burns much better in a dreadful
> stove if it is mixed with crop waste like cotton stalks or wood.
>
> There is a toxin spreading through the stove community which is the claim
> that only gas and certain (but not all) liquid fuels can deliver the
> necessary 'health benefits'.  It is obviously false, based on the above,
> but it is easier to say it than to effectively counter a years-long
> campaign to demonise solid fuels in general using the invalid assumption
> that the above results are impossible to achieve.
>
> If we are going to talk about 'health benefits' we have to talk about the
> whole package and the discussion has to be grounded on first principles.
> Measuring PM2.5 for IAQ purposes has to be analysed correctly.
>
> End of rant
> Crispin
>
>
>
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://lists.bioenergylists.org/pipermail/stoves_lists.bioenergylists.org/attachments/20170604/956231b7/attachment.html>