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    <div class="moz-cite-prefix">Marc,<br>
      <br>
      I am delighted to see your involvement with these stove issues.   
      (To all:   Marc and I go back many years with earlier TLUD
      work!!   He is a great asset for the efforts!!)<br>
      <br>
      I am also please to be able to (I think) point out an error in
      your calculations (helps some, but does not resolve the major
      issue, still being discussed).   Marc wrote:  <br>
      <blockquote type="cite">
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><b>Conclusions:
            just how small?</b></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">We can do a
            back-of-the-envelope analysis to tell the story of the
            numbers presented here. If we assume six billion people use
            primitive stoves, then one hundred million of them is 1/60
            of the total. 1/60 of the four million deaths worldwide is
            ~67,000. Rocket stoves would save 20% of those lives
            according to the exposure-response model: just 13,400.</span><br>
        </p>
      </blockquote>
      <blockquote type="cite"><span
          style="line-height:12.8000001907349px">So, you get out
          100,000,000 stoves, and you save 13,400 lives. This also
          assumes that you achieve the PM emissions reductions in
          practice. There are mountains of evidence (academic and
          practical) that this is not the case. </span></blockquote>
      The error is assuming 6 billion people use primitive stoves.  
      Actually, about 3 billion would be a useful number.    And those
      people are living in HOUSEHOLDS, in which perhaps 6 people have
      food cooked on one stove.   That would be 500 million households
      needing seriously improved stoves.    That changes your
      calculations.   If you agree with me, please redo your
      calculations and send again.<br>
      <br>
      Commentary:   The highly worthy goal of the GACC to "deliver" 100
      million improved stoves by 2020 would accomplish the stove task
      for 20% (or 1/5th) of the needed stoves.   And we have MUCH work
      to do just to reach that 100 million goal.   Thank goodness we
      have started the efforts.   And I suspect that we (the world wide
      efforts) could make it by 2020.   <br>
      <br>
      But of those in need, that leaves 80% not reached.   And the
      initial 20% could probably be the easiest 100 million households
      to reach.  Simply stated, those who do stove efforts are truly
      challenged by the magnitude of the task.<br>
      <br>
      AND we are faced with the issue that the stoves are NOT performing
      well enough to have the desired impact on health.   (Favorable
      Impacts regarding deforestation / environment habitat for
      endangered species, and job creation and carbon balance issues /
      CO2 / black carbon, etc, etc. etc. are important and are also
      forces that stimulate the stove efforts, BUT we are discussing
      mostly the health issues.).<br>
      <br>
      From the health data (ala Kirk Smith and others) that is shown in
      the graph that Marc provided with his comments, there is an
      important gap between the CURRENT BEST of biomass-fueled stoves
      and the DESIRED low level of emissions (represented by the LPG
      stoves, and electric stoves.).   Current best (as labeled) are
      stoves with fans, better states as FA for Forced Air or Fan
      Assisted.   Well, perhaps SOME stoves that have fans could be low
      in emissions.   Simply having a fan does not make a stove perform
      well.   <br>
      <br>
      From the health perspective, it seems unlikely that ND (Natural
      Draft) stoves are going to have emissions low enough for the
      desired health impacts.   Even ND stoves that attain Tier 4
      ratings (in laboratory tests) still need to be used correctly by
      the households.  Very challenging!!!!!!!<br>
      <br>
      Let's see some replies.  I am quite happy to have others show that
      I am not correct.  <br>
      <br>
      Paul<br>
      <br>
      <pre class="moz-signature" cols="72">Doc  /  Dr TLUD  /  Prof. Paul S. Anderson, PhD  
Email:  <a class="moz-txt-link-abbreviated" href="mailto:psanders@ilstu.edu">psanders@ilstu.edu</a>   
Skype: paultlud      Phone: +1-309-452-7072
Website:  <a class="moz-txt-link-abbreviated" href="http://www.drtlud.com">www.drtlud.com</a></pre>
      On 9/5/2014 12:23 AM, Marc-Antoine Pare wrote:<br>
    </div>
    <blockquote
cite="mid:CAJLc9BMW2twnxfDcio0Jm3FpJuSaWn+1MUeBQAvfSgyhQVc8kA@mail.gmail.com"
      type="cite">
      <div dir="ltr">
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px"><font color="#000000">Hi
              everyone,</font></span></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:normal">Thanks for
              the discussion so far. </span><span
              style="line-height:12.8000001907349px">I've looked at the
              health numbers for improved cook stoves in some more
              detail.</span><span style="line-height:12.8000001907349px"><br>
            </span></font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">I
              found two major approaches to quantifying the impact on
              health by stoves: long term studies and modeling based on
              exposure response.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">They
              both point to the same overall conclusion: improved
              biomass cook stoves will only reduce a small number of the
              “4 million deaths” you hear about from indoor air
              pollution.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000">Also, it appears that there isn't an
            existing biomass technology that will!</font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000">Please bear in mind that this is just a few
            days of compiling results from research. All of these
            conclusions are tentative. I welcome any and all criticism.
            The reading has been quite educational so far.</font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">One
              note at the start: the studies here consider the negative
              effects on respiratory health by particulate matter (PM).
              The studies I read note that this is by far the largest
              contributor to the burden of disease from indoor air
              pollution.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><b><font
              color="#000000">Long-term studies</font></b></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><i style="line-height:normal">Effect of
              reduction in household air pollution on childhood
              pneumonia in Guatemala (RESPIRE): a randomised controlled
              trial (2011)</i><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000">523 households involved. About half get an
            improved plancha stove, which reduces exposure about 50%.
            Eighteen months later, there was a 22% reduction in cases of
            pneumonia.</font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Note
              that in this population, there were 9 deaths attributed to
              pneumonia. This is important later.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Also
              important to note is that aid workers regularly coached
              these households in usage and maintenance.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><i><font
              color="#000000">A Recipe for Success?<b> </b>Randomized
              Free Distribution of Improved Cooking Stoves in Senegal</font></i></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">98</span><span
              style="line-height:12.8000001907349px"> households get a
              stove for one year. Respiratory disease symptoms for
              cooking women drop by 8%.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><i
            style="line-height:12.8000001907349px"><font color="#000000"><br>
            </font></i></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><i style="line-height:12.8000001907349px">UP
              IN SMOKE: THE INFLUENCE OF HOUSEHOLD BEHAVIOR ON THE
              LONG-RUN IMPACT OF IMPROVED COOKING STOVES</i><br>
          </font></p>
        <p style="margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000" face="arial, helvetica, sans-serif"><span
              style="line-height:12.8000001907349px">5 years, 15,000
              Indian households </span><span
              style="line-height:12.8000001907349px">(!) </span><span
              style="line-height:12.8000001907349px">“</span><font
              style="line-height:12.8000001907349px"><font>We find no
                evidence of improvements in lung functioning.”</font></font><br>
          </font></p>
        <p style="margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><font face="arial, helvetica, sans-serif"><font
                style="line-height:12.8000001907349px"><font>T</font></font><font
                style="line-height:12.8000001907349px"><font>he critique
                  of this study is that they used </font></font><font
                style="line-height:12.8000001907349px"><font>mud stoves
                  with chimneys that </font></font><font
                style="line-height:12.8000001907349px"><font>weren't </font></font><font
                style="line-height:12.8000001907349px"><font>all that </font></font><font
                style="line-height:12.8000001907349px"><font>clean-</font></font><font
                style="line-height:12.8000001907349px"><font>burning</font></font><font
                style="line-height:12.8000001907349px"><font>.</font></font></font><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><b style="line-height:12.8000001907349px">What
              the long-term studies tell us</b><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">I
              was surprised that the number of stoves required to impact
              health was so high. In the Guatemala study, you need 250
              stoves to prevent about 10 cases of pneumonia.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Another
              interesting thing to note is that I didn't find any
              studies that monitor big enough populations for long
              enough to quantify how many </span><i
              style="line-height:12.8000001907349px">deaths </i><span
              style="line-height:12.8000001907349px">are prevented by
              improved stoves. Again, in the Guatemala study, the stoves
              saved somewhere between 1-5 lives. This number is so small
              that it's really tough to extrapolate it </span><span
              style="line-height:12.8000001907349px">at all.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Clearly
              something funny is going on here. Why exactly are the
              numbers so small? Did people use the stoves incorrectly?
              Would better stoves have helped? And why did nothing
              happen in India?</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">One
              approach to answering these questions is to dig in to the
              mechanism for saving lives with stoves. We do this with
              the exposure response to pollutants.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><b><font
              color="#000000">Modeling based on exposure-response</font></b></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Health
              impact from exposure to PM is well studied. Exposure
              amount predicts quite accurately future health problems.
              This is great because it let's us start answering the
              question: just how clean do stoves need to get to
              meaningfully impact health?</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">We
              can really get into a lot of detail here. It's a
              dissertation's worth of calculation to come up with these
              numbers (see: THE DEVELOPMENT OF NUMERICAL TOOLS FOR
              CHARACTERIZING AND QUANTIFYING BIOMASS COOKSTOVE IMPACT)</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000"><span style="line-height:12.8000001907349px">Kirk
              Smith presented a summary of what exposure-response can
              tell us about stoves at the Clean Cooking Conference just
              this May.</span><br>
          </font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px"><font color="#000000">Here's
              the graph:</font></span></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><font
            color="#000000">[attached]</font></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">The key note is that
            a rocket stoves “leaves ~80% of the burden [of disease]
            untouched”. That means that even if we give everyone a
            rocket stove, only 20% of the 4,000,000 deaths from IAP will
            be affected.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">Here's the reasoning.
            The red line in the graph is called the “exposure-response
            relationship”. It's a log-linear relationship. That means
            that most of the damage from PM exposure occurs from zero
            exposure to a very small amount of exposure.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">It turns out that
            improved cook stoves – even the very fancy fan stove
            developed by Phillips – don't reduce emissions below that
            initial amount of very dangerous exposure.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">Kirk Smith provided
            this summary in London: “Current Health Evidence shows now
            that even major reductions (<90%) in emissions still lead
            to small health improvements”</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><b>Conclusions:
            just how small?</b></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">We can do a
            back-of-the-envelope analysis to tell the story of the
            numbers presented here. If we assume six billion people use
            primitive stoves, then one hundred million of them is 1/60
            of the total. 1/60 of the four million deaths worldwide is
            ~67,000. Rocket stoves would save 20% of those lives
            according to the exposure-response model: just 13,400.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">So, you get out
            100,000,000 stoves, and you save 13,400 lives. This also
            assumes that you achieve the PM emissions reductions in
            practice. There are mountains of evidence (academic and
            practical) that this is not the case. </span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">I am trying to find
            what I am missing here. I really expected the link to be
            much more clear and significant. Is there some other reason
            that stoves are promoted besides health benefit? Is there
            some overarching strategic goal that I'm missing?</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">Really, I'm looking
            for some number to tell the story. All the numbers I have
            found point to the fact that stoves, even the very best ones
            we have, won't move the needle on deaths from IAP.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">I would be very happy
            to be wrong about this. I know that development issues can
            be confoundingly complex, and I would welcome another
            perspective on this.</span><br>
        </p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px"><span
            style="line-height:12.8000001907349px">One silver lining to
            all of this is that I think it would be great for technology
            developers to hear that current technologies are totally
            inadequate. There's nothing like an impossible challenge to
            galvanize the inventor :)</span></p>
        <p
style="font-family:arial,sans-serif;font-size:13px;margin-bottom:0in;line-height:12.8000001907349px">-
          Marc Paré</p>
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      <pre wrap="">_______________________________________________
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