Each year, more than 4 million people, mainly women and children in the developing world, are killed prematurely by exposure to smoke from cooking with solid fuels, according to the World Health Organization (WHO). To highlight some of the most promising solutions being developed to combat this issue, which the WHO has designated as one of the four most critical global environmental health problems, EOH Assistant Professors Amanda Northcross and Jay Graham organized an event held at GW’s Milken Institute School of Public Health Building.
Improving Global Health Through Clean Cooking Solutions: A Panel Discussion of Diverse Perspectives featured experts with a wide range of perspectives on clean cooking solutions and their ability to improve the health, environment and livelihoods of women and children. The weather cooperated beautifully to allow some of the newest biomass stoves developed by the Aprovecho Research Center, a nonprofit dedicated to creating affordable stoves that makes its designs publicly available, to be demonstrated after the discussion.
The speakers included Professor James Tielsch, chair of the Milken Institute School of Public Health’s Department of Global Health; as well as Ranyee Chiang, director of Standards, Technology and Fuels for the Global Alliance for Clean Cookstoves; Dean Still, executive director of the Aprovecho Research Center; and John Mitchell, coordinator of the U.S. Environmental Protection Agency’s (EPA) Clean Cooking Indoor Stoves program.
“Cooking with solid fuels like wood, charcoal, and coal is inefficient and creates a lot of smoke. Inhaling that smoke on a daily basis creates significant health impacts,” Northcross said in her introduction. “To reduce these health impacts, a key primary goal is to provide clean cooking solutions to ensure that everyone can have access to clean air within their home.” For audience members who had never experienced how food is cooked in much of the world, Mitchell added: “Imagine bringing a charcoal grill into your kitchen and cooking on it 3 times a day, unvented. That’s what we’re talking about.”
Immense need
The scale of need is immense, Chiang told the audience. Billions of people use traditional cooking fuels, she said, which can also impact the larger environment. Her organization is a public-private partnership involving over one thousand stakeholder organizations located throughout the world with the shared goals of improving lives and livelihoods, empowering women, and protecting the environment by creating a thriving global market for clean cookstoves.
The WHO recently released new guidelines to marry the goals for how cookstoves need to perform to help meet health goals. “Those guidelines are unbelievably difficult to achieve,” Mitchell commented.
Chiang pointed out that it is important to ensure that viable businesses can exist to produce stoves to meet the guidelines. Also key is ensuring that governmental policies and donor organizations support the guidelines. “We want the people who are going to be affected by the standards to be involved,” she said. All of these voices need to come together as part of the process,” she stressed. “There needs to be a realistic pathway to achieve these high goals,” she said.
Cookstove designer Still stressed that, in addition to being capable of protecting health, cookstoves must appeal to potential users—home cooks—and be priced appropriately for those consumers. This price can be as low as $10. Designing a stove that fits all these criteria “is not that easy,” he said. Aprovecho has been designing and implementing improved biomass cooking and heating technologies to meet the basic needs of refugees, impoverished people, and developing world communities for over 30 years and operates in more than 60 countries. Still credits Department of Energy funding his organization received for the past two years with helping his organization create the five different approaches to super-clean stoves that he along brought to demonstrate.
- The top-lit updraft stove burns cleanly at both high and low power, a feature which Still credited to the work of a Franciscan monk.
- The top-load forced air stove is designed to have fuel added all day. Still said it is most likely to be produced inexpensively enough to be sold for $10.
- The charcoal stove uses “good” charcoal produced in an environmentally sustainable fashion as possible. The stove’s previous issues with carbon monoxide were solved by adding foil bubble wrap. There is a large market and distribution system for charcoal, Still commented. However, the methods for producing charcoal can consume 5/8th of its energy.
- The side-feed fan stove may end up being the most practical because it uses “found fuel” such as small sticks.
- The fifth super-clean stove follows a chimney stove design.
Almost all of these stoves achieve the WHO’s 45% efficiency guideline, which Still said the stove community “thought was impossible” three years ago. They are currently being field-tested in India, China, Ghana, Kenya, Cambodia, and Peru, he said.
The U.S. government has been involved in helping to develop clean cookstoves for over 25 years, Mitchell pointed out. In addition to EPA, the government agencies involved in collecting evidence in support of clean cookstoves’ value and encouraging their use include the National Institutes of Health, the Centers for Disease Control and Prevention, the National Oceanic and Atmospheric Administration, the State Department, and U.S. AID.
More data needed
Tielsch identified himself as a cynic and told the audience that his primary interest related to cookstoves is the outcomes to exposures on maternal and child health. “I’m interested in cheap activities that can be done at community levels that affect major health outcomes, like death or serious morbidities among women and kids.” He says that he recognizes the observational data and the causal link with a variety of adverse outcomes with household air pollution is overwhelming. “It’s all about whether we can get exposures low enough on the dose-response function to make a difference,” he said.
“The standard of evidence in this field is randomized field trials,” said Tielsch, who has an ongoing trial in Nepal involving three different types of cookstoves. “We need to match up the evidence of proven impact on health to sell programs into low-income places where resources are tightly constrained. I think right now, the trial evidence is less than overwhelming,” he said. But, like all rapidly developing technologies, things could change quite quickly in the availability of high quality stoves that result in low exposures. But until then, I think our community should not over-promise on the health outcomes we can prevent with these programs.”
“The other important thing to remember is that this can’t be a market driven only intervention,” Tielsch added. “That will leave out the poorest segments of society and work against the upcoming major push on equity that we’ll see in the new sustainable development goals.”
Collecting data on the links between household air pollution and disease is important, Chiang pointed out. Data is being gathered on childhood pneumonia and a number of other diseases, she said. Event organizer Northcross has helped collect important data by evaluating pollution monitors for a cookstove study on children’s respiratory health in Guatemala. She is currently involved in a randomized trial in Nigeria investigating whether replacing pregnant women's wood-fired cookstoves with clean-cooking ethanol stoves can reduce adverse pregnancy outcomes such as premature delivery and low birth weight.
In addition to the health impacts, some kinds of cooking fuel have social impacts, Chiang said. People can spend up to five hours a day collecting fuel, and in some places this can put women and children at risk. In addition to ensuring that the new cleaner-burning cookstoves that are being developed are reliable and robust in realistic situations, we need to sure that they are being adopted and used in place of traditional cooking fuels, she said.