1. Indoor & Outdoor Air Pollution
E6025: Public Health Activity 10.3
Student Number:
Kathryn Hanly
November 2012

2. Overview Health Effects of Air Pollution- Indoor & Outdoor
Disease Burden- Indoor & Outdoor
Outdoor Air Pollution
Guidelines, Legislation & Agreements
Precautionary Principle
Indoor Air Pollution
Disease Burden
Energy Ladder
Solutions
Air pollution is defined as any visible or invisible particle or gas found in the air that is not part of the original, normal composition. Air pollution, both indoors and outdoors, is a major environmental health problem affecting everyone in developed and developing countries alike. Most people agree that to curb global indoor & outdoor air pollution, a variety of measures need to be taken.

3. Outdoor Air Pollution
Short video I put together demonstrating the effects of outdoor air pollution……Loaded on u tube : UCC MPH K Hanly Link:
Industries, households, cars and trucks emit complex mixtures of air pollutants, many of which are harmful to health. Most fine particulate matter comes from fuel combustion, both from mobile sources such as vehicles and from stationary sources such as power plants, industry, households or biomass burning.

4. Health Effects of Air Pollution
Low birth weight
Adverse pregnancy outcomes
Human beings need a regular supply of food and water and an essentially continuous supply of air. Free access to air of acceptable quality is a fundamental human right. The lung is a critical interface between the environment and the human body. An average person takes about 10 million breaths a year, and toxic substances in air can easily reach the lung and other organs where they can produce harmful effects.
Particles with diameters below 10 microns (PM10), and particularly those less than 2.5 microns in diameter (PM2.5), can penetrate deeply into the lungs and seem to have the greatest potential for damaging health. Particulate matter, which can penetrate into the lungs and may enter the bloodstream, can cause a multitude of adverse health effects. WHO (2006) explains that exposure to indoor smoke has been linked to asthma; cataracts; tuberculosis; adverse pregnancy outcomes, in particular low birth weight; ischaemic heart disease; interstitial lung disease, and nasopharyngeal and laryngeal cancers. Nearly half of deaths among children under five years old from acute lower respiratory infections (ALRI) are due to particulate matter inhaled from indoor air pollution from household biomass fuels. The WHO (2006) estimates that smoke from indoor fires in developing countries is the equivalent to consuming two packs of cigarettes a day. A health effect is determined not just by the pollution level but also, and more importantly, by the time people spend breathing polluted air, i.e. the exposure.
Lung, nasopharyngeal,
Laryngeal CA
IHD

5. Reliable and comparable analysis of risks from both indoor & outdoor air pollution to health are essential for quantifying the underlying causes of disease and death, and for prioritizing preventive interventions.The WHO global burden of disease (GBD) measures burden of disease using the disability-adjusted life year (DALY). This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health.
Urban outdoor air pollution is estimated to cause 0.4% DALYs worldwide per year (WHO 2002). Those living in middle-income countries disproportionately experience this burden. Exposure to outdoor air pollutants is largely beyond the control of individuals and requires action by public authorities at the national, regional and even international levels.
Globally, almost 3 billion people rely on biomass and coal as their primary source of domestic energy. Exposure to indoor air pollution (IAP) from the combustion of biomass (wood, charcoal, crop residues, and dung) and coal is an important cause of morbidity and mortality in developing countries.The WHO (2002) unveiled indoor air pollution from burning solid fuel as one of the top ten global health risks. The aptly coined "kitchen killer" may be responsible for almost 2 million deaths and 2.7% of the global burden of disease and accounts for 41 million DALYs annually. In poor developing countries, only malnutrition, unsafe sex and lack of clean water and adequate sanitation were greater health threats than indoor air pollution.

6. The World Health Organization states that 2
The World Health Organization states that 2.4 million people die each year from causes directly attributable to air pollution, with almost 2 million of these deaths attributable to indoor air pollution.
The effects of particulate matter (PM) on health occur at levels of exposure currently being experienced by most urban and rural populations in both developed and developing countries.
Particulate matter pollution is an environmental health problem that affects people worldwide, but middle-income countries disproportionately experience this burden.
Approximately 76% of total global exposure to airborne particulate matter (PM) occurs indoors in developing nations.
Approximately half the world’s population and up to 90% of rural households in developing countries still rely on unprocessed biomass fuels in the form of wood, dung and crop residues.

7. The Precautionary Principle
Throwing Caution to the Wind?
China, the world’s second largest emitter of air pollution behind the U.S. has agreed to continue its attempts to reducing population instead, arguing that emissions are directly proportional to population and that their low emissions rate per capita should leave them and other highly populated nations such as India free from obligation to reduce emissions under the Kyoto Protocol.
According to McMichael (2000), if China were to comply with the 1997 Kyoto Protocol, by 2020 the annual number of premature deaths from ambient (external) air pollution that could be avoided would range from 2000 to ; the number of deaths that could be avoided by simultaneously reducing indoor exposures (where coal is currently the main domestic fuel and exposures are often extreme) would range from to The width of these ranges reflects both the existence of alternative technological approaches to emission reductions and the uncertainties of the dose-specific risks to health.
Irreparable mistakes must be avoided, such as those related to tobacco or asbestos, when people waited for definitive evidence far too long before springing to action. The Precautionary Principle urges a willingness to take action in advance of scientific proof of evidence of the need for the proposed action on the grounds that further delay could prove ultimately most costly to society and nature, and, in the longer term, selfish and unfair to future generations. The Precautionary Principle has been used widely in Europe to guide policy makers’ decisions regarding environmental and health issues, and it serves as the foundation of the EU’s environmental policy.

8. Indoor Air Pollution (IAP) Statistics
3 billion people cook and heat their homes burning biomass (wood, animal dung and crop waste) and coal.
2 million deaths annually
41 million disability adjusted life years worldwide 2008.
2.7 % global burden of disease
56% of IAP deaths among children under five
1 million people a year die from chronic obstructive respiratory disease (COPD) due to indoor air pollution
Both women and men exposed to heavy indoor smoke are 2-3 times more likely to develop COPD.
Kills 1 person every 16 seconds
Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. That few studies have measured indoor air pollution or exposure presents the possibility of serious misclassification of exposure, and means that very little information is available to quantify the relationships between exposure level and risk.
The inefficient burning of solid fuels on an open fire or traditional stove indoors creates a dangerous cocktail of hundreds of pollutants, primarily carbon monoxide and small particles, but also nitrogen oxides, benzene, butadiene, formaldehyde, polyaromatic hydrocarbons and many other health-damaging chemicals.
Indoor air quality is influenced by
Outdoor air pollution (Urban V Rural)
Secondhand tobacco smoke
Fuels used for heating and cooking
Confined and poorly ventilated spaces
Overcrowded homes and insufficient living space
Customs, habits, traditions
Level of economic development:
Industrialized ≠ developing countries
Source: World Health Organisation

9. Source: World Health Organisation
Disease burden (DALYs) due to indoor air pollution by level of development
The importance of indoor air pollution as a public health threat varies drastically according to the level of development: in low income countries, indoor air pollution is responsible for up to 4.0% of the burden of disease, while the same risk factor no longer features among the top 10 risk factors in industrialized countries. (WHO 2006).
Unequal distribution of health risks from air pollution over populations raises concerns of environmental justice and equity.
Despite this, public health awareness on indoor air pollution has lagged behind that on outdoor air pollution.
Work on assessing the health effects of indoor air pollution has lagged behind that on outdoor air pollution for a number of reasons, including:
Science and policy communities have focused on the public health impacts of air pollution in wealthy developed countries, while often disregarding the larger burden of disease due to indoor air pollution from solid fuel burning in the developing world.
Policy development in the air pollution field has focused on outdoor air pollution as a result of the correctly perceived need to deal with the high levels of outdoor air pollutants associated with both coal smoke and photochemical smog.
The ready applicability of standards to outdoor concentrations of air pollutants; the feasibility of monitoring concentrations of outdoor air pollutants on a large scale.
Focus of epidemiologists on defining coefficients linking outdoor concentrations of air pollutants with effects on health.
Source: World Health Organisation

10. Indoor Air Pollution- Solutions
In Class sample of clean cookstove reverse engineered from tin cans, this was the winner of the Irish Young Scientist award 2010
Critique of intervention
It should be noted that where interventions such as cleaner cook stoves have been evaluated the residual levels of pollution are still well above those indicated in current air quality guidelines (Bruce 2000). Bruce also warns that as pollution levels are reduced it is possible that people will spend more time indoors or nearer the sources of pollution. Some observers have critiqued current energy development programs for adopting a “minimalist” approach that expanded access to basic lighting and new cook stoves, but did not contribute to real poverty reduction or improvements in standards of living. As this assessment noted, these existing programs “keep people where they are,” they do not “make them better off” (Sovacool 2012). Widespread education and government funding will be necessary to shift cultural practices to more sustainable energy use. For example, in an area in South Africa, even though access to electricity was available, many residents continued to use biomass fuels for cooking and heating due to cost of electrical appliances and cultural practices.

11. Energy Ladder Source: World Health Organisation
The United Nations Development Program (2010) defines energy poverty as the “inability to cook with modern cooking fuels and the lack of a bare minimum of electric lighting to read or for other household and productive activities at sunset”.
Being poor condemns half of humanity to dependence on polluting household energy practices. Dependence on biomass produces a series of cumulative negative social and environmental consequences. With increasing prosperity, cleaner, more efficient and more convenient fuels are replacing, step-by-step, traditional biomass fuels and coal. Climbing up the energy ladder tends to occur gradually as most low- and middle-income households use a combination of fuels to meet their cooking needs. Energy ladders suggest a meaningful difference between how the rich and poor consume energy—with implications on equity and affordability.
The importance of interventions to reduce energy poverty and exposure to indoor air pollution is reflected in the Millennium Development Goals. Although the MDGs do not explicitly refer to energy, none can be achieved without the availability of adequate and affordable Energy. Tackling indoor air pollution will help achieve the Millennium Development Goals (MDGs), in particular MDG 4 (reduce child mortality) and MDG 5 (improve maternal health). It will also contribute to gender equality (MDG 3) as well as freeing women's time for income generation that helps eradicate extreme poverty and hunger (MDG 1). Finally, clean household energy can help ensure environmental sustainability (MDG 7). WHO reports annually on the proportion of the population using solid fuels for cooking as a key indicator for assessing progress in health and development. (Sovacool 2012).
Source: World Health Organisation

12. 3 objectives to be achieved by 2030
Coming clean: modern fuels, modern stoves UN Sustainable Energy for All
3 objectives to be achieved by 2030
Providing universal access to modern energy services.
Doubling the global rate of improvement in energy efficiency.
Doubling the share of renewable energy in the global energy mix.
Sustainable energy for all is a global initiative launched by the United Nations that brings all key actors to the table to make sustainable energy for all a reality by The United Nations General Assembly declared 2012 the International Year of Sustainable Energy for All, enphazing that “…access to modern affordable energy services in developing countries is essential for the achievement of the internationally agreed development goals, including the Millennium Development Goals, and sustainable development, which would help to reduce poverty and to improve the conditions and standard of living for the majority of the world’s population.” (United Nations Sustainable Energy for all:
In Conclusion, organisations need not only focus on making high quality, standardised technology that works well, they must also get the price and financing right, shift cultural values and expectations, raise awareness, align political regulations, and build institutional capacity. Because the barriers to expanding energy access are multifactorial and seamlessly connected, policies aimed at promoting them must also be robust.

13. References
Bruce, N, Perez-Padilla, R & Albalak, R. (2000) The health effects of indoor air pollution exposure in developing countries. Bulletin of the World Health Organization 2000, 78:1078–1092.
McMichael, A.J (2000)The urban environment and health in a world of increasing globalisation: issues for developing countries. Bulletin of the World Health Organisation, 78,
Smith, K.R (1993) Fuel Combustion Air Pollution, Exposure and Health: the Situation in Developing Countries, Annual Review of Energy and the Environment, 18:
Sovacool, B (2012) The Political economy of energy poverty: A review of key challenges, Energy for Sustainable Development, 16 (2012)
United Nations Development Program. (2010) Human development report New York: United Nations.
United Nations Sustainable Energy for All (available on last visited 11th November 2012)
World Health Organization. (2002) .World Health Report Geneva: World Health Organization.
World Health Organization (2004) Outdoor Air Pollution, Assessing the environmental Burden of Disease at National and Local level, Geneva: World Health Organization
World Health Organization (2005) WHO air quality guidelines: global update Geneva: World Health Organization (available on: last visited 9th November 2012)
World Health Organization (2012) Global Burden of Disease due to indoor air pollution. Geneva: World Health Organization( available on: last visited 11th November 2012)
World Health Organization (2006). Fuel for life: household energy and health. Geneva: World Health Organization