1. REDUCING RESPIRATORY ILLNESS THROUGH ALLEVIATING KITCHEN SMOKE IRISH FORUM FOR GLOBAL HEALTH (IFGH) BIENNIAL CONFERENCE November 29 th 2010 Liz Bates

2. Outline Health impacts Limitations - health data Need for proxy Monitoring Interventions – including examples – discussing benefits and constraints Future actions

3. Worldwide deaths from indoor smoke from solid fuel include... 64% occur in low-income countries, especially in South-East Asia and Africa. 28% of global deaths caused by indoor smoke from solid fuels occur in China. 21%Lower respiratory infections 35%Chronic obstructive pulmonary diseases 3%Lung cancers *GLOBAL HEALTH RISKS: WHO Mortality and burden of disease attributable to selected major risks 2009

4. Mortality low-income countries* 10 leading risk factor causes of death by income group 2004 * low-income < US$825 10 th in the world

5. DALYs low-income countries* 10 leading risk factor causes of DALYs by income group, 2004 * low-income < US$825 9 th in the world

6. Environmental risk factors Percentage of deaths / DALYs in low-middle income countries

7. Data included in these figures Based on data for which there is solid evidence ALRI COPD Cancer Less evidence Tuberculosis LBW & Prematurity – (cause of 29% of all newborn deaths) Cardio-vascular diseases

8. WHO 24hr air quality guidelines for particulate matter Interim targets PM 2.5 & (PM 10 ) Rationale 175 (150)15% higher long-term mortality risk relative to the AQG 250 (100)Lowers risk from (1) by ~6% 337.5 (75)Lowers risk from (2) by (2% - 11%) AQG*25 (50)Cardiopulmonary and lung cancer mortality risks not seen to increase (95% confidence level) *AQG = Air Quality Guidelines (WHO)

9. Monitoring for PM and CO PM CO

10. Typical results for CO woman & room

11. Approaches to alleviation of IAP Behavioural changes Cook and child keeping away from smoke Cooking in a separate room Cutting food small Cooking outdoors Transferring ownership of the problem to the cook and her family

12. Approaches to alleviation of IAP Not creating pollution - using clean fuels LPG Ethanol New fuels such as plant oils

13. Approaches to alleviation of IAP Venting smoke out of the house Smoke hoods Chimney stoves Eaves spaces

14. Approaches to alleviation of IAP Burning fuel efficiently Using an improved stove Using dry fuel Using a pressure cooker

15. Approaches to alleviation of IAP Burning fuel efficiently Using an improved stove Using dry fuel Using a pressure cooker

16. Reductions achieved in PM, Kenya, Nepal & Sudan – 30households

17. Issues....if people do not like a stove, or cannot afford it – the efficiency of the intervention to remove smoke is NIL

18. Quality of life benefits - Kenya

19. Quality of life benefits - Nepal

20. Quality of life benefits - Sudan

21. What works? Start project with self-sustaining perspective Starting with people where the are – not where we want them to be Encourage people to ‘own’ the problem Develop a range of options with community Develop finance systems that suit them Treating people as customers

22. New initiatives: Global Alliance for Clean Cookstoves Coordinated through the UN Foundation (UNF) - $250 goal Founding partner organizations signed up to 100 million clean cookstoves by 2020 Primary focus on development of robust global stove industry / market Unproven hypothesis -biomass stoves exist that are o clean enough to have major health/climate benefits o affordable by world's poorest half, to sustain sales - $US10 NO such device is available today Smith KR, What's Cooking? A Brief Update, Energy for Sustainable Development (2010), doi:10.1016/j.esd.2010.10.002

23. New initiatives: Global Cookstove Accelerator Facility Developing mechanism to make it easier for cookstove programmes to tap funds through CDM, or the voluntary carbon market using Gold Standard guaranteeing a price floor on future carbon credits low interest loans Smith KR, What's Cooking? A Brief Update, Energy for Sustainable Development (2010), doi:10.1016/j.esd.2010.10.002

24. New initiatives National Biomass Cookstove Initiative (NCI) Explicitly aiming to provide every household in India with combustion comparable to LPG in cleanliness and efficiency, whether from modern fuels or biomass Competition to increase efforts on R&D Carbon finance is ‘the icing on the cake’ – they are after ‘the cake’

25. Traditional kitchen

26. Improved kitchen Thank you...questions?