[Stoves] Air pollution kills

Fri May 11 20:07:15 CDT 2018

Xavier:

I see my name was mentioned.

I will try to make the briefest possible responses to your questions. I
might comment in greater detail to Crispin's posts; he causes me heartburns
sometimes.

"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?"

1. I don't think Crispin has any basis to claim IAP wouldn't change much if
stoves were electrical. Perhaps with the lowest-emission coal stoves, but
not compared to traditional stoves, fuels, operating practices, and ger
design (or for HOBs in UB and Aimac centers).

2. It is meaningless to distinguish OAP and IAP. What matters is exposures,
according to age/sex/medical condition/duration according to concentration
and composition. I hold that the PM2.5 concentration is a weak proxy for
exposures, and the assumptions of equitoxicity, no threshold are simply
untenable. Then you add the rigmarole of Integrated Exposure Response to
compute Relative Risk, using data for one type of PM2.5 for one type of
cohort and then apply it to anybody everywhere. This is not just nonsense,
it is becoming an intellectual nuisance.

3. Using chimneys, or burning coal in a central power plant equipped with
PM and SO2 controls to deliver electricity to home use, changes the
composition and location, residence times of pollutants. "Outdoors" - which
is a contextual term - some pollutants react in presence of sunlight to
produce a different composition of pollutants. One may do source
apportionment studies of varying quality, assumptions, and data sources.
For UB, the contribution of stoves, cars, power plants, industry, building
boilers, dust storms, etc. would vary by time of day and season.

A lot of public health dogma rides on faith. But we need dogma to focus
people's attention.

If God gives us dogma, the Devil is in the details.

You imagine "solutions are relatively straight-forward".  Not so. Localized
air-quality management plans take an enormous amount of systematic work.
Changing or banning fuels or devices - or for that matter, people (what
would it take to dislocate all the poor and throw them miles away?) - is an
easy answer for people who don't bother with economics, politics, totality
of population health over long periods.

Nikhil

------------------------------------------------------------------------
Nikhil Desai
(US +1) 202 568 5831
*Skype: nikhildesai888*

On Tue, May 8, 2018 at 3:37 PM, Xavier Brandao <xvr.brandao at gmail.com>
wrote:

> 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/01-02.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/35da8463d9c600f3651e1bb77ab3af
> 259fc7.pdf
>
>
>
> 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-Ulaanbaatar-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-killers
>
> https://www.theguardian.com/global-development/2017/nov/
> 07/mongolia-liver-cancer-crisis-no-other-country-has-a-problem-like-this
>
> https://www.theguardian.com/world/2013/oct/20/ulan-bator-
> killer-winter-stoves
>
>
>
> 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) :
>
> [image: 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?
>
>
>
> [image: 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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