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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal>Nikhil,<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>You complain that there is no demonstrated causality between emissions metrics (HAPS, PM2.5) and mortality and argue that therefore a stoves program shouldn’t be based on models and estimates of mortality. For many years the doctors in this community have advocated for more physiological studies. Direct causes are difficult to get from death records. For example, my father’s death certificate lists a cause that was the consequence of the treatment rather than the cancer that he suffered from so he might not show up in a cancer statistic. I do know that wherever I travel people in industry and in government are concerned about PM 2.5 levels from any combustion source. Real or imaginary a relationship is assumed and PM 2.5 is regulated. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>The stove policies and programs are based on a strong statistical correlation between PM 2.5 and reported mortality due to respiratory or cardiovascular causes. That correlation has been validated for some developed and developing countries. (Every study I have seen cautions about the shortcomings of the statistics but the correlations are strong.) If I were a policymaker I would find enough justification in the statistical correlation to promote healthier environments through programs like improved cookstoves of all kinds. The estimates that you complain about are likely based on the global rather than local statistics. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>You have told us at least weekly for almost a year that you are unhappy with using health indicators to justify improved stoves programs but you have not offered any alternative. (Listening to your complaints has been like listening to a broken record.) What do you propose? And, what should the stoves community do about it? <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Tom <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal> <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><b>From:</b> Stoves [mailto:stoves-bounces@lists.bioenergylists.org] <b>On Behalf Of </b>Nikhil Desai<br><b>Sent:</b> Thursday, October 12, 2017 10:50 AM<br><b>To:</b> Discussion of biomass cooking stoves <stoves@lists.bioenergylists.org><br><b>Subject:</b> [Stoves] Ghana news: Second Lady named GACC ambassador; HAP deaths "alarming"<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><div><p class=MsoNormal style='margin-bottom:12.0pt'>On the one hand, we have GBD (2016) saying deaths attributable to HAP from solid fuels declined from 3.3 m in 2006 to 2.6 m in 2016 and DALYs attributable to HAP over these ten years declined from 109 m to 77 m. <br><br>And here we see a claim not about attribution but causality - <o:p></o:p></p><blockquote style='margin-left:30.0pt;margin-right:0in'><p class=MsoNormal>"<span style='font-size:10.0pt;font-family:"Arial",sans-serif;color:#262626'>According to the World Health Organization, household air pollution from cooking kills over 4 million people every year and sickens millions more."</span><o:p></o:p></p></blockquote><p class=MsoNormal style='margin-bottom:12.0pt'><br>I would like WHO to give us HAP deaths by level of exposure, cause of death, and age/sex deciles by country for every 10-year interval since 1980. <br><br>Coming to Ghana, from WHO data I have, in 2008 some 37% of Ghana households reported using charcoal, 46% wood, and 11% LPG. WHO has no data on fuel use shares since. <br><br>What about deaths? World Bank says Ghana population is some 28 million, and crude death rate 8 per 1,000 which means a total of some 1.76 million deaths per year. So the alleged 17,000 deaths attributable to HAP are less than 1%. <br><br>Ghana Statistical Service <a href="http://www.statsghana.gov.gh/docfiles/publications/CRVS%20Assessment%20Report%20Final_%2018.04.17.pdf">reports</a> that its Civil Registration system is do deficient, <o:p></o:p></p><blockquote style='margin-left:30.0pt;margin-right:0in'><p class=MsoNormal style='margin-bottom:12.0pt'>"Each year, about one third of births go unregistered, adding to the growing number of its population who live and die without leaving a trace of their existence and/or their characteristics on any legal document or statistical record. Also, only one in five deaths each year gets recorded. " <o:p></o:p></p></blockquote><p class=MsoNormal>No worries. We have WHO to kill by assumptions and Ajay Pillarisetti to save by assumptions. <br><br>Nikhil<o:p></o:p></p><h1 style='mso-margin-top-alt:7.5pt;margin-right:0in;margin-bottom:5.25pt;margin-left:0in'><span style='font-size:10.0pt;font-family:"Arial",sans-serif;color:#262626;font-weight:normal'><a href="https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Samira-Bawumia-named-ambassador-of-Global-Alliance-for-Clean-Cookstoves-589941">Samira Bawumia named ambassador of Global Alliance for Clean Cookstoves</a> Ghanaweb 12 October 2017</span><span style='font-family:"Arial",sans-serif;color:#262626'><o:p></o:p></span></h1><p class=MsoNormal> <o:p></o:p></p></div></div></body></html>