[Stoves] Air pollution kills

Tue May 8 14:37:47 CDT 2018

Hello Crispin,

So you say IAP wouldn’t change much if stoves were electrical.

What about Outdoor Air Pollution (OAP)? Isn’t most of it in Ulan Bator from
stoves and cars?

I googled about the issue. I have to admit I was skeptical at first about
the absence of farm animals being correlated to the frequency of asthma
cases, or the importance of smoking indoor.

But actually, I couldn’t find a lot of studies pointing very clearly at the
relationship between OAP and respiratory infections.

Well, you probably know all the studies about Mongolia already.

« Children in Ulaanbaatar, are taken bronchitis in 1.4-2.7 times and
bronchitis asthma in 5.5-7.9 times more than children who are living in
rural areas of less air pollution. » says Social Health institute.

http://www.unoosa.org/documents/pdf/psa/activities/2006/graz/presentations/0
1-02.pdf 

p 12.

So, is it because of the OAP of the city, or the fact they live in the city
and far from farm animals, and so built weaker immune systems? Or because of
the cold (colder in Ulan Bator ?!), or dust (dustier ?).

Litterature seemed indeed to point that children build asthma defenses when
they live close to farm animals (in rural regions). While when living in
cities, there are more admissions in hospitals due to asthma.

https://www.ncbi.nlm.nih.gov/pubmed/17298344 

This one attributes a bit quickly:

« Importantly the lung function of the children on the steppe was
significantly better than those living in Ulaanbaatar. So we concluded that
the level of urban air pollution in the capital city is clearly having an
adverse impact on the pulmonary health of urban Mongolian children. »

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043223/ 

It also says:

« Similar patterns of adverse health risk such as asthma, obesity and autism
in proximity to freeways and major roads have previously been well
documented by us and our colleagues in Los Angeles, CA. »

The study seems to show that depending on the world region, different
factors are involved in allergies:

https://pdfs.semanticscholar.org/7dca/35da8463d9c600f3651e1bb77ab3af259fc7.p
df 

For bronchitis, this study points to indoor smoking from parents as the main
source of children’s bronchitis cases:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835771/  -> but it is in a
rural area. It doesn’t explain why there are more cases in Ulan Bator. Seems
unlikely that people smoke more in urban areas?

It does not exclude the influence of IAP from stoves, and refers to a study
saying that stoves contributes a lot to IAP.

This one, in Ulan Bator, points to both indoor smoking and air pollution:

https://www.sciencedirect.com/science/article/pii/S1323893015001586 

This one puts again indoor parental smoking and IAP from stoves as probable
causes, and maybe outdoor air pollution: 

https://journals.lww.com/epidem/fulltext/2011/01001/Indoor_Air_Pollution_in_
Different_Mongolian.96.aspx

UNICEF says: « Outdoor air pollution is the most significant environmental
risk faced by children in Ulaanbaatar. »

https://www.unicef.org/mongolia/Mongolia_air_pollution_crisis_ENG.pdf

There seem to be a long list of medical studies (page 86) saying that air
pollution has an effect on children’s health, and even that OAP does:

https://www.unicef.org/publications/files/UNICEF_Clear_the_Air_for_Children_
30_Oct_2016.pdf 

There are studies correlating OAP and respiratory diseases in other parts of
the world:

https://www.ncbi.nlm.nih.gov/pubmed/22871325 

https://www.jacionline.org/article/S0091-6749(17)32516-2/fulltext 

I didn’t see anywhere that respiratory diseases were due to the cold in
Mongolia.

Regarding dust: there are more diseases in Ulan Bator than in rural areas,
yet the latter are more dusty (are they?). And Ulan Bator is far from the
Gobi desert, correct?

https://www.ncbi.nlm.nih.gov/pubmed/21488467 

This study looks at all the sources of air pollution, among which dust and
ash ponds. It still concludes:

« With 50 % of the ambient PM pollution (and more in the winter months)
originating from household stoves for cooking and heating, this sector tops
the list of the most opportunistic of the interventions for better air
quality. »

http://www.urbanemissions.info/wp-content/uploads/docs/2013-09-AQAH-Ulaanbaa
tar-PM-Pollution.pdf 

You’re quoted a bit below Crispin BTW.

Are there meta-analysis of medical studies on the correlation between OAP
and respiratory diseases? It seems to me we don’t know for sure to what
extent each factor contributes to diseases and mortality. But we have good
hints that the main factors may be:

·         OAP and IAP from stoves

·         indoor smoking

To me there seems to be only a handful of factors. That means that solutions
are relatively straight-forward.

So, if « 7 million deaths » from WHO may be far fetched, it seems reasonable
to me to call for cleaner stoves.

And, in the case of Ulan Bator, to sensitize people against indoor smoking:
is it actually being done?

News are always alarmist. We see « 7 million deaths because of air
pollution!!! » because we work in stoves, but in the news, there are also:

« 6 million deaths because of smoking!!! »

https://www.popsci.com/smoking-is-still-bad-for-you 

« Poor diet is a factor in one in five deaths !!! »

https://www.theguardian.com/society/2017/sep/14/poor-diet-is-a-factor-in-one
-in-five-deaths-global-disease-study-reveals 

That’s true, news tend to make us think that the main cause of mortality in
Mongolia is air pollution. But if we go through a few articles, we see they
actaully also talk about other causes:

https://www.mcc.gov/our-impact/story/story-preventing-mongolias-leading-kill
ers 

https://www.theguardian.com/global-development/2017/nov/07/mongolia-liver-ca
ncer-crisis-no-other-country-has-a-problem-like-this 

https://www.theguardian.com/world/2013/oct/20/ulan-bator-killer-winter-stove
s 

News also talk more about respiratory diseases, because many children suffer
from it.

http://time.com/longform/ulan-bator-mongolia-most-polluted-capital/ 

It is understandable that even if these diseases are not the major killer at
the population level, they are still given a higher priority by public
deciders, than, say, heart diseases which strike mostly adults.

So human lives are shortened by a number of diseases. There is a number of
causes for these diseases. And we are working on one of these causes:
stoves.

So I agree, there is no need to be alarmist, and to exagerate or
misrepresent a truth which is, actually, already quite alarming. But the
fact that the situation is a bit more complex than the one presented the WHO
reports or the newspapers doesn’t mean air pollution isn’t a serious issue.
And that we shouldn’t be working on that issue with the highest possible
energy.

Best,

Xavier

De : Stoves [mailto:stoves-bounces at lists.bioenergylists.org] De la part de
Crispin Pemberton-Pigott
Envoyé : lundi 7 mai 2018 03:05
À : Discussion of biomass cooking stoves
Objet : Re: [Stoves] Air pollution kills

Dear Xavier

Let’s take Ulan Bator. There are 1.5 million inhabitants.

If all of them were using electrical heating and cooking, and driving
bicycles instead of cars:

*	would we likely see less indoor and outdoor air pollution?
*	would we likely see less cases of respiratory infections like
bronchitis, pneumonias, etc.?
*	would the respiratory infections cases likely be less acute?
*	would there likely be less cases of deaths due to a respiratory
infection?
*	would the life expectancy of the population likely be higher?

1.	There isn’t much air pollution now indoors so it would probably not
be reduced. In a home where no one smokes and they have a typical Stove
Programme stove, the majority of IAP is caused by smoking and cooking. In
the case of IAP in gers (yurts) the indoor air is generally better than the
ambient air outside.
2.	Respiratory infections are greatly influenced by the temperature in
the home and seasonal flu. Assuming people would not be heating their homes
any higher than they are now (which means ‘chronically cold all the time’)
the rate would probably not change much. This was demonstrated in Kyrgyzstan
when it was shown that increasing the average temperature 5 degrees and
heating for more than 16 hrs per day instead of 2-6 there was a huge medical
health benefit – nothing to do with smoke. Being chronically cold in a
stove-smoke-free environment would help reduce eye irritation and asthma
attacks, I think. 
3.	I can’t see the acuteness of the infections being much affected with
an annual average PM2.5 of 160 microgrammes, if nothing is done to address
the chronic underheating issue. Mostly children get sick, and they get sick
because they are cold so much of the time, or are subjected to large changes
in temperature all day from traditional stoves going from zero to 40 kW then
back to zero. Electric heating would moderate that, presumable, but you
described changing the energy source, not the temperature profile. 
4.	About the deaths, this is the same as Q3 about acute problems.
Remember that changing the energy sources for a few things doesn’t change
all the other sources of air pollution : ash ponds, the Gobi Desert, and
vehicles. Using electric vehicles would remove about 50% of the PM2.5
downtown, but not the considerable fugitive dust created by those vehicles
on dirt roads. Dust storms are 50 times worse than air pollution from
people.  Construction dust is considerable. Stove smoke is only about 45% of
the total. It used to be 88% in some areas.
5.	The life expectancy is affected negatively by a lot of things other
than air pollution : alcohol is a big problem, the diet consists largely of
meat and fat is appreciated, the average income is very low, there is a
great reliance on traditional medicine. There are a great many car accidents
and falls from horses.  Here are the top 25 causes of death in Mongolia (I
don’t have it for UB alone) :

cid:image001.jpg at 01D3E65F.551C5C80

Which of those are related to diet and what is the first on the list that
might be contributed to by air pollution? A lot of people smoke and smoke
indoors. Breathing the city air is on average like smoking a 1/28th of a
cigarette per day – the same as Calcutta.

So how do Mongolian causes of death rank in the world?

cid:image002.jpg at 01D3E65F.551C5C80

Number 1 for liver cancer, stomach cancer and number three for suicide and
stroke. Do you see any diet-related diseases there cause by consuming a
large amount of meat and alcohol?

They have a very low global ranking for breast and prostate cancer and
diabetes (all >170). 

All things considered, it would be much better if there were no air
pollution in the city, but is it a major killer, or the major killer?
Doesn’t look like it.

Bright side :

Improving the domestic combustion devices greatly reduces indoor and outdoor
air pollution, saves money, increase the comfort level, being warm greatly
reduces the incidence of bronchitis, and makes people a lot happier. Those
are reasons enough to support stove programmes. Given the context, it is not
going to make much difference to the premature death rate from ambient air
pollution. Moving people from gers to heated apartments increases their IAQ
problems because so many people smoke and the apartments have a low air
change rate.  It is never simple and context is everything.

Never assume anything.

Crispin

---
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