[Stoves] Air pollution kills

Sun May 20 13:48:45 CDT 2018

Dear Crispin,

« I agree with the thrust of your ‎points: do something, and no one was planning to do nothing »

Happy to hear that!

It is just that, after so many posts for Nikhil, and reading his rhetoric for so long, one might get ideas. Ideas that WHO is a complete farce, that there is no problem with air pollution, that it is a massive lie, or that we don’t know, at all, if there is any problem. That everything is a smoke screen. And that premature deaths from respiratory diseases might either not exist, or if they do, they might come from cars, buildings, volcanos, sandstorms, comets, the cat …

OK, I am being a bit caricatural, but you get the picture. I am not familiar with the air pollution question and epidemiology. I have an external point of view, so the discussion gets confusing at some point. Clarification is needed like asking: « ok, there might not be exactly 7 million premature deaths from AP, but there are chances that AP has potentially a large impact on the health of many individuals, yes or no? »

This is the only point I wanted to clarify.

« The problems arise when false or exaggerated attributions substitute for knowledge. »

Indeed. However good the cause, there is never a good justification for false claims. False claims always come back to bite the good cause in the ass.

« "But force them to smoke 4 packs of cigarets a day, and many will die or be severely sick."

While is is de rigeur to compare inhalation of bad air with 'smoking cigarettes' »

Actually I wasn’t saying that AP was like smoking cigarets. I was using the image of cigarets to reply to Nikhil’s post. Nikhil’s post was giving the impression (maybe this was not what he meant) that one external factor couldn’t have a clear effect on human health, because all humans are so different anyways. I was saying individuals are different, but they have also so much in common.

I could have used the image of poison. However different the individuals, give each of them cyanure, and they will react in the same way.

« If you can claim anything, any correlation no matter how tenuous, all is 'alarm' and nothing is alarming. »

Indeed, one must have something solid before crying wolf.

For me, even with the imperfect data we have, the air pollution problem seems alarming enough.

Best,

Xavier

De : Stoves [mailto:stoves-bounces at lists.bioenergylists.org] De la part de Crispin Pemberton-Pigott
Envoyé : jeudi 17 mai 2018 18:50
À : Stoves
Objet : Re: [Stoves] Air pollution kills

Dear Xavier

I agree with the thrust of your ‎points: do something, and no one was planning to do nothing. The problems arise when false or exaggerated attributions substitute for knowledge. 

‎"But force them to smoke 4 packs of cigarets a day, and many will die or be severely sick."

While is is de rigeur to compare inhalation of bad air with 'smoking cigarettes' most people haven't a clue what that means nor if what they are being told is a complete fantasy. ‎As you know, people just make stuff up a lot of the time. 

I have reported before that a claim was made that 'living in Ulaanbaatar was like smoking two packs of cigarettes per day'. That is ridiculous. Living in Ulaanbaatar all year is like inhaling the smoke produced by 1/28th of a cigarette per day, or one per month. Not 40 or 80 per day. 

But without context, the number is not all that helpful. The WHO says (well, they say a lot of things so let's pick one) that 10 microgrammes all the time all year, PM2.5, is completely safe, in that no effect can be observed (which is not the same thing, we agree).

So they say inhaling 1/16th of 1/28th of a cigarette per day all year has no meaning effect. 

Well, if you cook indoors, boiling something, which is not that uncommon, the 1/16th of the 1/28th is going to be exceeded. Same if you sweep the floor, shake out a rug or comb the cat. It is such an extraordinarily small amount we can conclude that virtually no one on the planet is 'safe'. 

It is unfortunate that ‎there is so much defective logic and bad math underlying the alarming statements. Does no one fear exposure of the flaws? Apparently the risks are low enough that you can say pretty much what you want. 

If you can claim anything, any correlation no matter how tenuous, all is 'alarm' and nothing is alarming. 

Regards 

Crispin 

Dear Nikhil,

« You imagine "solutions are relatively straight-forward".  Not so. Localized air-quality management plans take an enormous amount of systematic work »

I’m just trying not to fall into the state of mind of: « oh, there are many factors anyways, it is very complex, so do not bother doing anything. »

We were taking the example of Ulan-Bator. We think air pollution kills? We replace inefficient stoves by « clean » stoves, we tar the roads, we work with the construction sector so it limitates its emissions, we work with the industry sector so it lowers its emissions.

Of course, this is complex and involves a lot of actors, and it represents a lot of effort and investment, but this is feasible, there is no magic involved. There aren’t 10 000 factors involved, there are a few big steps to take.

« Read today's Washington Post opinion piece by Robert Hahn about USEPA's debating of rules of scientific evidence »

Well, if Scott Pruitt’s proposal make EPA decision processes more transparent, and make science more accessible, then I could not agree more. I am a bit skeptical of Pruitt’s good intentions though.

But transparency and clarity in science and policies? Yes of course.

« Health is a property of an individual body-mind. »

OK, but what is your point? Sure individuals are all very complex, they all have very different backgrounds. But force them to smoke 4 packs of cigarets a day, and many will die or be severely sick. Their individualities and complexities can’t do much against that. Because they have a common point : human health is vulnerable, sometimes very vulnerable, to certain external factors.

So focusing on exposure, why not, but when the source of emission is clearly identified and there are hints it has an effect on health, it’s understandable policy-makers focus on the source of emission.

« lumping random epidemiological studies with "meta-analysis" pretense should be left to WHO »

It should be left to anyone who wants to do epidemiological studies. It should be left to the critics of WHO as well.

« in cohorts, contexts, confounding factors mean most epidemiological studies for HAP and disease have no reliable quantification. »

Then prove it.

The thing you could do is to write a paper, a meta-analysis of epidemiological studies and their methodology. If there are 200 studies attributing diseases to air pollution, show how their methodology is flawed, show how they prove nothing. It would be really, really useful. This would be something we can work from.

Then, with this information, we’ll be able to say: « OK, we have really no idea what causes respiratory diseases ».

We’ll be able to decide en connaissance de cause, knowing fully our knowledge gaps.

And since we cannot let children die of respiratory diseases, we’ll still have to do something, and put millions of dollars somewhere.

Best,

Xavier

De : Nikhil Desai [mailto:pienergy2008 at gmail.com] 
Envoyé : samedi 12 mai 2018 04:41
À : Xavier Brandao
Cc : Andrew Heggie; Discussion of biomass cooking stoves; Crispin Pemberton-Pigott
Objet : Re: [Stoves] Air pollution kills

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 <https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.theguardian.com%2Fsociety%2F2005%2Fapr%2F24%2Fsmoking.medicineandhealth&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=Uymy3lm%2BtkCjjV1X9YqCLWfFhhK%2BduR%2BIE5cCMx01MQ%3D&reserved=0>  

“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 <https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.urbanemissions.info%2Fwp-content%2Fuploads%2Fdocs%2F2013-09-AQAH-Ulaanbaatar-PM-Pollution.pdf&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=4rvE4pX2qiWkTninU8f2xe%2BwWavVKCJdYRb0Sswfts0%3D&reserved=0>  

“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 <https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.unoosa.org%2Fdocuments%2Fpdf%2Fpsa%2Factivities%2F2006%2Fgraz%2Fpresentations%2F0102.pdf&data=02%7C01%7C%7Ca08e1e157cf642f55b6108d5bc11de51%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636621707286994744&sdata=A3zvCFueHE5jElz4MN0gJm3AzECdrWHscM%2FGxB6WGck%3D&reserved=0>  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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