[Stoves] Air pollution kills

[Nikhil Desai]

Xavier:

1. PM2.5 toxicity is a theological monument, built with steel girders of
assumptions, concrete of arrogance, and glass of pretense. Read today's
Washington Post opinion piece by Robert Hahn about USEPA's debating of
rules of scientific evidence; PM2.5 is central to this debate. (Hahn was
the White House anchor for the Acid Rain and other Clean Air Act Amendments
of 1990. I knew him briefly about a decade later. An economist of sense and
integrity, which is unfortunately rather rare.) Without the PM2.5 toxicity
assumptions -- for that is what they are, estimates based on assumptions
based on estimates based on assumptions - and their questionable (and
questioned) epidemiological basis, a lot of last 20 years of talk on "air
pollution kills" would be rendered as rubble of a monument.

2. Whatever the received dogma - the fatwas we are familiar with - my
Satanic Verses are simple:

Health is a property of an *individual* body-mind.
Lifetime disease incidence and death are influenced by *individual*
genetics, nutrition, exposures to disease vectors and risk factors (in
varying intensities, durations, locations) according to age and sex, timely
identification of disease and availability of medical care.

3. In simple terms, epidemiology is a tool for studying pathways taking
into account all such influences for different cohorts, so that
pharmacology and physician/nursing care can be geared to *individual*
attention.

Yes, mass propagation of medicines or technologies does transform the
patterns of disease incidence. Hence the search for marketable "better
cooking methods", tailored to specific contexts and cohorts.

Quantification of the change in predicted disease incidence and death is,
however, subject to serious pitfalls, and lumping random epidemiological
studies with "meta-analysis" pretense should be left to WHO (as it indeed
did, in order to come up with utterly fictitious Guidelines for Household
Fuel Combustion). Differences in cohorts, contexts, confounding factors
mean most epidemiological studies for HAP and disease have no reliable
quantification. (Hence the ultra-heroic assumptions behind HAPIT and which
is also why WHO had to cook up the HAP GBD with no data on use quantities
and qualities, emission rates and concentrations, and disease incidence or
their variance by time, duration or space.)

We need an anthropologist of this Environmental Health tribe, including
Lancet editor, who seems to have very little actual experience with
experiments. Curiouser and curiouser statements have been emerging from
this tribe.

Pick ANY context. Characterize health and air pollution (emission,
exposures) baseline. Make an action plan for air quality management in
toto. It's no use debating stoves cooking fuels alone, and criminal to do
so without a well-defined context.

I just looked up NY Times website for news items from 1851 to 1988 - with
phrases "air pollution" and "cooking". The search failed to show up
anything about air pollution and cooking.

I wonder why there are no studies of avoided premature deaths due to
transition from solid fuels to gaseous fuels and electricity in Western
households from 1920s to 1980s.

Nikhil


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


On Fri, May 11, 2018 at 5:31 PM, Xavier Brandao <xav.brandao at gmail.com>
wrote:

> Dear Crispin,
>
>
>
> OK, but maybe not all studies are like the Korean one.
>
> Then, for Ulan-Bator, for Mongolia, and as well for the world, there is a
> need of a serious meta-analysis, which also reviews and criticizes the
> methodology of the epidemiological studies on air pollution.
>
>
>
> Then only, we might have a better view on the current landscape of
> research, of the state-of-the-art on air pollution and health.
>
>
>
> « There is correlation between OAP and IAP and infections, but they are
> associations, not causal relationships.”
>
> Sure, I understand the difference. But from what I understand there are
> fields of research where this is the best you can get. That doesn’t mean it
> doesn’t have grounds.
>
> I wouldn’t throw epidemiology with the bath water. It seems to me that it
> is epidemiology which found the link between smoking and lung cancer:
>
> https://www.theguardian.com/society/2005/apr/24/smoking.medicineandhealth
>
>
>
> “The claim that 4.3m people ‘die from air pollution’ per annum is clearly
> false”
>
> Indeed, but they might say instead: “Based on our data and statistics and
> methodology, we have attributed the death of around 4.3 million people to
> air pollution. It might be less, or more. We might be wrong, but this is
> the best we have, sorry. The fact is that we highly suspect air pollution
> to be dangerous for human health, so beware.”
>
> That would be more correct. Would that change the outcome, which is to
> take public policy measures to try to mitigate air pollution?
>
>
>
> « Who simple is this statement? Did anyone measure IAP in the rural areas
> where they burn dung for heating and cooking? Many people in the rural
> areas are reasonably well fed and clothed. A lot of people in Ulaanbaatar
> were driven there by absolute poverty and live in desperate conditions,
> some depending on coal vouchers to obtain fuel. How did the temperature of
> the home affect the incidence, and what is the socioeconomic conditions of
> the families with high occurrence? Are there bronchitis epidemics in town
> that do not occur in rural areas because the possibility of transmission is
> so much lower? Yes the OAP is much lower in rural areas, but is their
> exposure to smoke, for example, lower or higher?”
>
> Sure, it raises a lot of questions. But let’s say we believe the data the
> doctors have. I’d say this is a fact:
>
> ”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”
>
> Mentioning this “less air pollution.” is already attributing a cause.
>
>
>
> “Prof Lodoysamba confirmed the ‘colder’ hypothesis this winter using a
> pretty sophisticated monitoring station at his home in Nalaikh with
> thermometers at different heights above the ground.”
>
> Maybe the cold is responsible of the bronchitis in Nalaikh, but not in
> Ulan Bator. Maybe the cold is responsible everywhere and that is not well
> measured or known.
>
> Then, that “colder hypothesis” would infirm what was found in this study,
> that air pollution from stoves was the main cause. Prof. Lodoysamba was one
> of the co-writers of this study:
>
> http://www.urbanemissions.info/wp-content/uploads/docs/2013-
> 09-AQAH-Ulaanbaatar-PM-Pollution.pdf
>
>
>
> “Attributing something as a cause does not mean that removing the
> attributed cause avoids the problem. Suppose the attribution was in error
> by 80%?”
>
> Sure, it could well be that: “oh, every household has an electric stove
> now, but still the number of bronchitis cases are high.”
>
> Science is never definitive, always evolving.
>
>
>
> “Regarding proximity to highways: who lives next to noisy and polluted
> highways in California: the well fed and exercised with good medical
> treatment? Or poor people with poor health coverage, bad diets and no
> access to recreational facilities?  Correlation is not  causation. “
>
> We’d need to look at the study methodology to know if they took this
> factor into account. Maybe they did. Maybe they compared poor people next
> to highways, to poor people remote from highways.
>
>
>
> “There must be children for whom it is the worst environmental risk, and
> others for whom it is now.”
>
> Sure, but if there are 10 000 children in the first group and 2000 in the
> second group, then air pollution is the biggest environmental risk for
> children in UB.
>
>
>
> “The major impediment to achieving this is the parade of baseless claims
> that coal cannot be burned cleanly”
>
> Sure, if coal stoves can burn cleanly like or almost like electric stoves,
> that’s fine by me.
>
>
>
> “That is unbelievable. The “main source”? The cause? That is a clear claim
> that second hand smoke causes bronchitis.”
>
> Well, cause, by association. Actually, it doesn’t necessarily makes a
> hierarchy between causes, it also says: “Second, other potential risk
> factors of LRTI-related hospital admissions might have been overlooked in
> our investigation, such as the type of fuel used in household stoves,
> nutrition, antenatal cigarette smoke exposure, and nursery attendance,
> where children might contract an infection from others.Therefore, caution
> should be taken in interpreting these study findings.“
>
>
>
> ”Think about that. The record low for Ulaanbaatar is -54 C (2002). The
> annual average is -2C. Is it possible that people earning $2500 per year
> live in a chronically underheated home? Ya think??”
>
> If millions of dollars should go to preventing under-heating rather than
> clean stoves, then that is worth a medical study, to attribute deaths to
> cold. If there is no such study, it is understandable public deciders well,
> decide, to focus on air pollution.
>
> It seems to me that the good news is that solving the issue of cold in
> homes and IAP go hand-in-hand.
>
>
>
> ”Some say 45% depending on where you measure it. It was improved *uuugely*.
> Yet people popped up to say nothing was achieved by the programme. Short
> memories.”
>
> For sure, celebrating successes and giving credit where credit is due is
> really important. Otherwise we tend to think we live in a bleak world where
> nothing happens.
>
>
>
> ”I am sure asthma attacks decreased because air pollution aggravates
> asthma. I do not have stats, however. It just seems likely.”
>
> It seems to me also. And until you have a cohort of doctors,
> statisticians, scientists to make more studies with a large number of
> variables, and check, this is the best a public decider can get.
>
>
>
> ”Now we need to address the low pressure boilers which are more and more
> common and burn 4 times as much fuel as the ger stoves, at least. They were
> not included in the ger stove programme. We are working on the at the
> moment.”
>
> That seems exciting! Good luck with that.
>
>
> Best,
>
>
> Xavier
>
>
>
>
>
>
>
> *De :* Stoves [mailto:stoves-bounces at lists.bioenergylists.org] *De la
> part de* Crispin Pemberton-Pigott
> *Envoyé :* mercredi 9 mai 2018 00:20
> *À :* Discussion of biomass cooking stoves
> *Objet :* Re: [Stoves] Air pollution kills
>
>
>
> Dear Xavier
>
>
>
> Thank you for being skeptical. Science works on challenges, *nullis in
> verba*.
>
>
>
> On the IAP matter in UB, there are generalisations one can make and
> specific circumstances worth noting. There is a study of the effect on
> indoor air pollution from the improved stoves (Korean study, available in
> English). The concluded that the improved stoves which reduce PM2.5 output
> by 90-98% *increased *indoor air pollution, which was so unbelievable
> that I bothered to investigate the study quite carefully.
>
>
>
> What I found was that they did indeed measure an increase, on average, in
> IAP but: the difference was well inside their margin of error (a small
> fraction of the variations measured, rendering the conclusion meaningless.
> Further, on those days when they were measuring, the ambient (outdoor) air
> pollution closely matched the claimed indoor air quality, save that in
> every case the IAP was lower than the OAP.  In short, all the Koreans
> measured was the effect on IAP from outside air.
>
>
>
> The worst aspect of the paper was that they claimed a statistically
> significant difference: the new stoves provided worse IAP than the old
> stoves – which the numbers did not support at all. There *was* a
> difference in the averages, and the new stove measurements were higher, but
> the difference was a small fraction of the Sigma 1 of their numbers, which
> is to say, the difference was *not* statistically significant.
>
>
>
> Decent chimney stoves with a correctly fitted chimney have very little
> effect on IAP. We have ample recent evidence of this in Kyrgyzstan if there
> was any doubt. Improper operation can lead to fugitive emissions from the
> stove – for example leaving the ash drawer open a bit ‘to give more power’
> breaks the draft from the chimney and the top surfaces can leak smoke into
> the room as they are no longer under negative pressure.
>
>
>
> There is correlation between OAP and IAP and infections, but they are
> associations, not causal relationships. We can ask Nikhil about which words
> to use exactly. The claim that 4.3m people ‘die from air pollution’ per
> annum is clearly false and a misrepresentation of the published evidence
> used to support the claims that air pollution shortens lives – by
> attribution (not medical evidence).
>
>
>
> « 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/0102.pdf p 12.
>
>
>
> Who simple is this statement? Did anyone measure IAP in the rural areas
> where they burn dung for heating and cooking? Many people in the rural
> areas are reasonably well fed and clothed. A lot of people in Ulaanbaatar
> were driven there by absolute poverty and live in desperate conditions,
> some depending on coal vouchers to obtain fuel. How did the temperature of
> the home affect the incidence, and what is the socioeconomic conditions of
> the families with high occurrence? Are there bronchitis epidemics in town
> that do not occur in rural areas because the possibility of transmission is
> so much lower? Yes the OAP is much lower in rural areas, but is their
> exposure to smoke, for example, lower or higher?
>
>
>
> When the Kyrgyz villagers were keeping their homes free of IAP (with
> chimneys and non-leaking stoves) *and 5 degrees warmer* the incidence of
> bronchitis dropped to zero (51 homes, 2016-17 season). I interviewed
> parents in February in the Naryn region and they all said before they got
> the new stove the children were “sick all winter” before and “much sicker
> than this winter” and so on. Chronic cold spreads disease among children.
> Bronchitis is a bacterial infection. PM2.5 is sterilized. So you are
> looking for pre-dispositions caused by PM2.5, not ‘causes’.
>
>
>
> It is dusty pretty much everywhere. The city is definitely smokier, and it
> can be quite bad if the wind drops, because below -30 the city is colder
> than the mountains around, or communities at higher elevation such as
> nearby Nalaikh where the coal comes from.  Prof Lodoysamba confirmed the
> ‘colder’ hypothesis this winter using a pretty sophisticated monitoring
> station at his home in Nalaikh with thermometers at different heights above
> the ground. The city, below -30, is colder, smokier, has a poorer diet and
> more fugitive dust than rural areas. But a traditional stove burning dung
> can be pretty smoky, and we have zero measurement of IAP in rural homes.
>
>
>
> «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.»
>
>
>
> They can conclude that but that is no proof. That is an association. It is
> why Nikhil keeps pointing out that you cannot make claims for causes and
> avoidances without knowing a heck of a lot about the sub-population you are
> examining.  Attributing something as a cause does not mean that removing
> the attributed cause avoids the problem. Suppose the attribution was in
> error by 80%?
>
>
>
> Regarding proximity to highways: who lives next to noisy and polluted
> highways in California: the well fed and exercised with good medical
> treatment? Or poor people with poor health coverage, bad diets and no
> access to recreational facilities?  Correlation is not  causation.
>
>
>
> “UNICEF says: « Outdoor air pollution is the most significant
> environmental risk faced by children in Ulaanbaatar.”
>
>
>
> Hmm…  Is alcohol an environmental risk? What about smoking?  The air
> pollution is awful on some days, and visible, and variable from place to
> place. There must be children for whom it is the worst environmental risk,
> and others for whom it is now. The point is that we can remove virtually
> all of it with improved combustion of the very same fuels they now use. The
> major impediment to achieving this is the parade of baseless claims that
> coal cannot be burned cleanly, and therefore they must ban it – the only
> fuel available at a price they can afford. The sheer stupidity of blaming
> the fuel for the performance of the stove cannot have a greater effect on
> the people. Those advocates of fuel bans based on the misbelief that the
> fuel is the problem, are partnering with the advocates of ‘alternatives’
> costing multiple times as much and which provide no additional benefit save
> in some cases, convenience. Free electricity is lovely – if the nation can
> afford it. No nation I know of can, so how can Mongolia?  Other countries
> are now depending on the great progress made in coal stove designs from
> Mongolia. How is it possible that the Mongolians are deprived of the
> benefits of this work? Advocates, that’s how. Advocators of heat pumps,
> subsidised electricity, dimethyl ether, natural gas, LPG, wood pellets,
> processed coal – every and anything that costs a lot, but not
> ultra-clean-burning coal stoves developed right up the road *in a
> university-owned, government-supported stove development centre*!
>
>
>
> “For bronchitis, this study points to indoor smoking from parents as the
> main source of children’s bronchitis cases:”
>
>
>
> That is unbelievable. The “main source”? The cause? That is a clear claim
> that second hand smoke causes bronchitis.
>
>
>
> “I didn’t see anywhere that respiratory diseases were due to the cold in
> Mongolia.”
>
>
>
> Think about that. The record low for Ulaanbaatar is -54 C (2002). The
> annual average is -2C. Is it possible that people earning $2500 per year
> live in a chronically underheated home? Ya think??
>
>
>
> « 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. »
>
>
>
> That is 2013. Times have changed. The stove programme was in full swing in
> 2013. The % dropped from 88% (2010) in one district to an average of 45% in
> 2015 (in winter).  In summer the air is very clean (12 µg/m3, for
> example).
>
>
>
> 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?
>
>
>
> Preaching against smoking is everywhere. The number f people smoking in
> developing countries is increasing rapidly because they are targeted by
> vendors. The advertising has been driven out of developed country media. It
> is *very* reasonable to call for clean stoves. Very clean. Why not? The
> benefits are huge, but it is not the entire problem. Without doubt the
> strangest country I have worked in is Mongolia because the clean burning
> solutions were developed there, tested there, supported financially yet are
> maligned for political purposes. Everyone wants to blame others for “not
> solving the air pollution problem”. After the stove replacement programme
> stopped at the end of 2015, air pollution was down 65%. Some say 45%
> depending on where you measure it. It was improved *uuugely*. Yet people
> popped up to say nothing was achieved by the programme. Short memories.
>
>
>
> I am sure asthma attacks decreased because air pollution aggravates
> asthma. I do not have stats, however. It just seems likely. Now we need to
> address the low pressure boilers which are more and more common and burn 4
> times as much fuel as the ger stoves, at least. They were not included in
> the ger stove programme. We are working on the at the moment.  Products
> were tested last week – efficiency was too high. I will reduce it.
>
>
>
> In the meantime, Kyrgyzstan starts rolling out improved stoves (locally
> made) to 14,000 homes, slowly at first. The coal combustors are all based
> on the Mongolian developments. South Africa localised the design and we
> have a model ready for testing since last Monday. It is a beauty, and will
> incorporate lessons learned from the use of the plastic refractory
> materials in Ulaanbaatar last year. It is a game-changer.
>
>
>
> Keep pushing! Rocks don’t move by themselves.
>
> Crispin
>
>
>
>
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