[Stoves] Health protective environment and solid fuel burning devices

[Nikhil Desai]

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
*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.
> org>
> *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
>
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