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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-fareast-language:EN-US">Dear Friends<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-fareast-language:EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-fareast-language:EN-US">From the SNV article on the fish smokers:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;mso-fareast-language:EN-US"><o:p> </o:p></span></p>
<p class="MsoNormal">“<a href="http://www.who.int/en/" target="_blank">The World Health Organization</a> estimates that harmful cookstove smoke is the fifth leading cause of death in developing countries.”<o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">That is literally unbelievable. Just for good measure I checked what they say about smoking deaths (presumed to be mostly endured indoors). They
<a href="http://www.who.int/fctc/mediacentre/news/2016/commonwealth-parliamentarians-plan-tackle-tobacco-epidemic/en/">
say</a> 10m people will be ‘killed’ per year in this century. Add 10m to 4.3m and you get 14.3m – so are these deaths or premature deaths? And why is this number, two causes only, larger than the total (>12m) for all premature deaths for all pollution (not
just air). Hmm… the investigation starts:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">According to the WHO site linked,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><a href="http://www.who.int/mediacentre/factsheets/fs292/en/">http://www.who.int/mediacentre/factsheets/fs292/en/</a> “</span>Over 4 million people die prematurely from illness
attributable to the household air pollution from cooking with solid fuels.”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">This shows Nikhil is correct with the ‘attributed’ comment.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">It is somewhat contradicted by<o:p></o:p></p>
<p class="MsoNormal"><a href="http://www.who.int/mediacentre/factsheets/fs313/en/">http://www.who.int/mediacentre/factsheets/fs313/en/</a> “Ambient (outdoor air pollution) in both cities and rural areas was estimated to cause 3 million premature deaths worldwide
in 2012.”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">The claim is refined here<o:p></o:p></p>
<p class="MsoNormal"><a href="http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/">http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/</a> “Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific
Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">What does ‘linked’ mean and how did the 3m <i>premature</i> deaths worldwide become 3.3m
<i>deaths</i> in just part of the world? <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">This is instructive (emphasis added):<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">“The new <b>estimates</b> are based on the latest WHO mortality data from 2012 as well as
<b>evidence</b> <b>of health risks</b> from air pollution <b>exposures</b>. <b>Estimates</b> of people’s
<b>exposure</b> to outdoor air pollution in different parts of the world were formulated through a new global data mapping. This incorporated satellite data, ground-level monitoring measurements and data on pollution emissions from key sources, as well as
<b>modelling</b> of how pollution drifts in the air.”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">So Nikhil was right again, the deaths are not attributed by looking at people dying, but by making estimates based on GBD numbers. This is how they allocated the diseases and deaths (same article):<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">“Indoor air pollution-caused <b>deaths</b> – breakdown by disease:<o:p></o:p></p>
<ul type="disc">
<li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo1">
34% - stroke; <o:p></o:p></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo1">
26% - ischaemic heart disease; <o:p></o:p></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo1">
22% - COPD; <o:p></o:p></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo1">
12% - acute lower respiratory infections in children; and<o:p></o:p></li><li class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;mso-list:l0 level1 lfo1">
6% - lung cancer. <o:p></o:p></li></ul>
<p class="MsoNormal">There is not a single death in this, it is an assignment of <i>
premature deaths</i> to causes based on various models of exposure (not actual exposure tied to medical consequences). Why are they called ‘deaths’? No wonder why people are confused. The WHO is confused and their numbers not only add up, they more than add
up!<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">“After analysing the risk factors and taking into account revisions in methodology, WHO estimates indoor air pollution was linked to 4.3 million deaths in 2012 in households cooking over coal, wood and biomass stoves.”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Is this an increase, in the same year, from 3m (globally) or 3.3m (in part of the world)? This asserts in direct contradiction to the other WHO site that they are not premature deaths, they are actual deaths caused by HH cooking smoke.
I think it understand how it was done: Perhaps the 3m premature deaths were upgraded to ‘3m deaths’ which somehow corresponds to “4.3m premature deaths” – is that possible?
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">“Later this year, WHO will release indoor air quality guidelines on household fuel combustion…”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">This begs the question, “What does the WHO know about household fuel combustion?” Are they not the people who said that only ‘processed coal’ could be allowed as a domestic fuel in the belief that somewhere inside, coal contains smoke?
Yes, they are! Ron Larsen cited them. According to some people I met this year in Asia, coal not only has a lot of smoke in it, it has a ‘high CO content’. Really?? Yeah, and they pointed to coals on sale that had ‘different CO contents’. ‘That one has a
<i>lot</i> of CO!”<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Thoughtfully the WHO provides contact information so we can raise (pretty basic) question about the information above.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">+++++++++++<o:p></o:p></p>
<h4>For more information, contact<o:p></o:p></h4>
<p>Mr Tarik Jasarevic <br>
Mobile: +41 79 367 6214<br>
Telephone: +41 22 791 5099<br>
E-mail: <a href="mailto:jasarevict@who.int">jasarevict@who.int</a><o:p></o:p></p>
<p>Glenn Thomas<br>
Telephone: +41 22 791 3983<br>
Mobile: +41 79 509 0677<br>
E-mail: <a href="mailto:thomasg@who.int">thomasg@who.int</a> <o:p></o:p></p>
<p>Nada Osseiran<br>
Communications Officer, Department of Public Health, Environmental and Social Determinants of Health<br>
Telephone: +41 22 791 4475<br>
Mobile: +4179 445 1624<br>
E-mail: <a href="mailto:osseirann@who.int">osseirann@who.int</a><o:p></o:p></p>
<p class="MsoNormal"><b>++++++++<o:p></o:p></b></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Regards<o:p></o:p></p>
<p class="MsoNormal">Crispin<o:p></o:p></p>
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