[Stoves] On healthier environments (was Tom Re: Ghana news ... HAP deaths "alarming")

Fri Oct 13 14:06:33 CDT 2017

Tom:

I am afraid you misunderstood. There can be no debate at all about "promote
healthier environments"; that's like mother's milk and apple pie in America
or chomchom in Kolkata.

There is NO "health indicator" to justify "improved stoves programs". I
don't bother with academic jugglery about false promises of "results"; the
professoriat can argue till all post-mature deaths. For me proposing an
alternative, I stopped chasing tail a long time ago.

I would warmly, heartily welcome suggestions about indicators to "promote
healthier environments". I don't have to go far - one can start with US
"criteria pollutants" for ambient air and WHO "guidelines" for such
pollutants for ambient as well as indoor air. Just that guidelines have
zero value until translated into standards and compliance goals.

I have argued - and people have chosen to ignore - that the proper
indicators are for indoor air quality, not hourly average PM2.5 emission
rates. There should be "indoor air quality improvement plans" like we in US
have "Ambient Air Quality Standards State Implementation Plans" (SIPs). I
would jump to head a SIPs strategy for cities, states or provinces within
South Asia and Sub-Saharan Africa that seek improvement of both indoor and
outdoor quality according to national standards.

We don't even have standards for indoor air quality, and the so-called WHO
indoor emissions "database" is a list of small, one-time studies with
varying measurement instruments and protocols.

Before seeking "healthier environments", it may be useful to know how dirty
they are. There are weak statistics and satellite measurements for ambient
air; for HAP, there is next to nothing, despite WHO and Kirk Smith to the
contrary. From the types of modeled estimates they have, they would've been
ignored but for the deceit of Integrated Exposure Response (IER) functions
and defining HAP "exposure" as "# of households reporting principal cooking
energy source is solid fuels". That's not first or zeroth approximation;
it's a bald lie.

I have no problem there is no convincing evidence that cookstoves kill or
that clean fuels save. I think that is a research junket of little value to
stove design. It is the illiterate claims about "kill" and "health
benefits" that I do find objectionable, because there is no there there.

I would like to hear from doctors - I mean medical practitioners, not
physics or engineering professors, nor non-practicing MDs. By all means do
"more physiological studies"; there might even be a pill for smoke.
Hundreds of millions of dollars spent on physiological research won't buy
charcoal, cookstoves, or meals for the poor.

The empires of "knowledge" are of no use to the poor.

++++

It is precisely the types of example you cite - my father died of cancer 27
years ago but his death certificate did not list cancer either - that make
the GBD statistics worthless for anything other than a statistical jumboree
for "summary population statistics". And precisely because the certified
causes of death are not considered "valid" by WHO and IHME that they go
through the rigmarole of dumping "garbage codes" and assigning, by
negotiations, a single cause of death from an agreed list. But that does
still mean that these are expert-generated shows of persuasion and
computing power, not useful for medical research.

I have been looking over WHO Global Health Estimates 2016 Summary Tables
(March 2017), "Estimated deaths ('000) by cause, sex and WHO Member State,
2015).

Country tables are in three colors - green, yellow, and pink (with shading
if the countries have high rates of  HIV/Aids prevalence.)

Many developing countries - including India, Pakistan, Bangladesh,
Afghanistan, practically all of Sub-Saharan Africa - are pink. (Sri Lanka,
South Africa, Brazil, China are yellow, Mexico is green).

Pink means: "Death registration data are unavailable or unusable due to
quality issues. Estimates of mortality by cause should be   interpreted
with caution.  Estimates may be used for priority setting, however, they
are *not likely to be informative for  policy evaluation or comparisons
among countries*. "

The pink code countries are also the ones with the highest numbers of
infant deaths and most of them are from communicable diseases. Listed
causes of death vary, and I would venture to compare across countries -
neonatal conditions, diarrhoeal disease, malaria dominate.

Those who want to fool others into thinking that stove smoke kills children
and that LPG would save children's lives are selling snake oil.

Disability data among developing countries are far worse quality. So DALYs
and aDALYs in most developing countries is a cooked up pork strips served
as a vegetarian salad.

I will post some support from a Kirk Smith, et al. paper but let me quote
something else from a WHO Europe (2014) report of an Expert Committee
<http://www.euro.who.int/__data/assets/pdf_file/0010/263629/WHO-Expert-Meeting-Methods-and-tools-for-assessing-the-health-risks-of-air-pollution-at-local,-national-and-international-level.pdf>
on
"Methods and tools for assessing the health risks of air pollution at
local, national and international level." A paper on Integrated Exposure
Response (IER) functions cooked up by Burnett et al. (2014) says:

"The IER model was based on the following assumptions:

 PM2.5 exposure from diverse sources is associated with increased RR of
mortality from IHD, stroke, COPD, and LC and with increased incidence of
ALRI;
 *The health effects of PM2.5 are only related with inhaled mass
(exposure), but not with PM2.5 composition and source*s;
 The relationship between PM2.5 exposure and excess mortality is not
necessarily restricted to be linear;
 The *RR of mortality from exposure to AAP, SHS, HAP, and AS does not
depend on the temporal nature of the PM2.5 exposure*;
 *No interaction exists among the various PM2.5 exposure types for any
cause of mortality*."

and

"A major limitation of the IER approach is that it depends on several
underlying assumptions mentioned above, about which expert opinion is not
in complete agreement."

So much for the credibility of the gullible.

I rest my case. There's nothing for us to debate - there is no there there.
WHO needs to be alerted -- its division of health statistics don't know
what its division of social and environmental determinants of health are
doing. I will draft an appeal for statistics and clarification, and look
forward to your cooperation.

Nikhil
-----------------

On Fri, Oct 13, 2017 at 11:52 AM, <tmiles at trmiles.com> wrote:

> Nikhil,
>
>
>
> You complain that there is no demonstrated causality between emissions
> metrics (HAPS, PM2.5) and mortality and argue that therefore a stoves
> program shouldn’t be based on models and estimates of mortality. For many
> years the doctors in this community have advocated for more physiological
> studies.  Direct causes are difficult to get from death records. For
> example, my father’s death certificate lists a cause that was the
> consequence of the treatment rather than the cancer that he suffered from
> so he might not show up in a cancer statistic. I do know that wherever I
> travel people in industry and in government are concerned about PM 2.5
> levels from any combustion source. Real or imaginary a relationship is
> assumed and PM 2.5 is regulated.
>
>
>
> The stove policies and programs are based on a strong statistical
> correlation between PM 2.5 and reported mortality due to respiratory or
> cardiovascular causes. That correlation has been validated for some
> developed and developing countries. (Every study I have seen cautions about
> the shortcomings of the statistics but the correlations are strong.) If I
> were a policymaker I would find enough justification in the statistical
> correlation to promote healthier environments through programs like
> improved cookstoves of all kinds. The estimates that you complain about are
> likely based on the global rather than local statistics.
>
>
>
> You have told us at least weekly for almost a year that you are unhappy
> with using health indicators to justify improved stoves programs but you
> have not offered any alternative. (Listening to your complaints has been
> like listening to a broken record.) What do you propose? And, what should
> the stoves community do about it?
>
>
>
> Tom
>
>
>
>
>
>
>
> *From:* Stoves [mailto:stoves-bounces at lists.bioenergylists.org] *On
> Behalf Of *Nikhil Desai
> *Sent:* Thursday, October 12, 2017 10:50 AM
> *To:* Discussion of biomass cooking stoves <stoves at lists.bioenergylists.o
> rg>
> *Subject:* [Stoves] Ghana news: Second Lady named GACC ambassador; HAP
> deaths "alarming"
>
>
>
> On the one hand, we have GBD (2016) saying deaths attributable to HAP from
> solid fuels declined from 3.3 m in 2006 to 2.6 m in 2016 and DALYs
> attributable to HAP over these ten years declined from 109 m to 77 m.
>
> And here we see a claim not about attribution but causality -
>
> "According to the World Health Organization, household air pollution from
> cooking kills over 4 million people every year and sickens millions more."
>
> I would like WHO to give us HAP deaths by level of exposure, cause of
> death, and age/sex deciles by country for every 10-year interval since
> 1980.
>
> Coming to Ghana, from WHO data I have, in 2008 some 37% of Ghana
> households reported using charcoal, 46% wood, and 11% LPG. WHO has no data
> on fuel use shares since.
>
> What about deaths? World Bank says Ghana population is some 28 million,
> and crude death rate 8 per 1,000 which means a total of some 1.76 million
> deaths per year. So the alleged 17,000 deaths attributable to HAP are less
> than 1%.
>
> Ghana Statistical Service reports
> <http://www.statsghana.gov.gh/docfiles/publications/CRVS%20Assessment%20Report%20Final_%2018.04.17.pdf>
> that its Civil Registration system is do deficient,
>
> "Each year, about one third of births go unregistered, adding to the
> growing number of its population who live and die without leaving a trace
> of their existence and/or their characteristics on any legal document or
> statistical record. Also, only one in five deaths each year gets recorded.
> "
>
> No worries. We have WHO to kill by assumptions and Ajay Pillarisetti to
> save by assumptions.
>
> Nikhil
> Samira Bawumia named ambassador of Global Alliance for Clean Cookstoves
> <https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Samira-Bawumia-named-ambassador-of-Global-Alliance-for-Clean-Cookstoves-589941> Ghanaweb
> 12 October 2017
>
>
>
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