Indoor Air Pollution in India

Aims and Objectives

1. Background

2. Recent and Future Trends

3. Health and Financial Impact

4. Risk-factors and Wider Determinants

5. Policies, Strategies and their Challenges

6. Recommendations

7. Conclusions

2. Recent and Future Trends

So what did you think?

Studies and surveys identified a number of risk factors:

• under 5 years old
• female sex
• rural residence
• poor education
• lower caste
• no availability of separate kitchen - povery related
• poor quality of roof, walls and floor constuction
• large families leading ot indoor crowding
• geographic region

Studies illustrate higher exposure to smoke correlated with disease prevalence

5. Policies, Strategies and their Challenges

The Plancha (improved stove)

• Example: Guatemala
• Multisectoral support, including WHO
• RCT
• Control: no intervention
• Intervention: use plancha
• 500 households
• Aim: measure change in ALRI incidence in young children after intervention

Government of India (GOI) and many non-governmental organisations have implemented clean stove programmes

1980-90s the GOI alone subsidized and distributed 32 million improved stoves

• Focus on REPLACING stoves and fuels, less on BEHAVIOUR CHANGE and EDUCATION
• Did not take into account women's perspective
• Lack of maintenance - meant stoves had 2-3 year life span
• Few field-tested strategies
• Highly subsidised schemes:

- stoves have not been valued

- schemes have faltered when subsidies have ran out

6. Recommendations

7. Conclusion

We asked you:

1.What does 'indoor air pollution' mean to you?

2. Who do you think are most affected by it?

3. How much of a global burden do you think it is?

India's National Burden of Disease

4%

Global burden of disease caused by using solid fuels

Advocacy

Economic

Education

Multi-sectoral

women and children

Non-discriminatory

Research

Innovative

Commercialization

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1. Background

3. Health and Financial Impact

Financial Impact:

• indirect and direct health costs - individual and national
• reduced productivity - morbidity limiting physical activity
• opportunity costs particularly for women
• poverty trap

Health Impact:

• COPD*
• ALRI*/pneumonia
• Asthma
• Blindness / cataracts
• TB
• Ischaemic Heart Disease?
• Adverse Preganancy outomes?

Aims and Objectives

Indoor Air Pollution in India

Chronic Obstructive Pulmonary Disease

Acute Lower Respiratory Infections

Guatemala Study

RCT

500 househoulds - plancha stove or no intervention

first exposure-response trail

incidence of acute lower respiratory infections in young children after introduction of improved stoves

Methods of Primary Prevention

Interventions on the source of pollution

• Improved cooking stoves
• Alternative fuel-cooker combinations
• Reduced needs for the fire

Interventions to the living environment

• Improved ventilation CHIMNNEYS
• Kitchen design and placement of stove

Interventions to user behaviour

• Reduction by avoiding smoke
• Flood preparation
• Reduced exposure through operation of source

4. Risk factors and Wider Determinants

Poverty is a risk factor for using unclean fuels

Conceptual framework

Demonstrating the relationship between IAP and poverty

India's National Stove Programme

Description

1. India's National Stove Programme (1983, distributing stoves)

Gram Vikas

Description

Gram Vikas

India's National Stove Programme

Two very similar strategies, the Gram Vikas with a stronger educational component

Challenges

Lack of maintenance - stoves had 2-3 year life span

Few field-tested strategies

Distribution to rural areas challenging and insufficient

Highly subsidised schemes:

- stoves have not been valued

- schemes have faltered when subsidies have ran out

A rural development organisation

Works with marginalized groups in rural Orissa, India

Plan: subsidize improved "chulhas" for 15, 000 households

Easily constructed stoves, made from locally available mud

Burn fuel with increased efficiency, lower biofuel and include a chimney

Cost: 30rs (around 40p)

2. Gram Vikas

(stove distribution and educational component)

Deepam Scheme

Description

Deepam Scheme

Challenges

"As long as free or cheap biomass is available, households will continue to use traditional fuels rather than LPG in the short run"

Objectives:

• Reduce drudgery among women and children from wood collection and cooking
• Improving the health of household members by reducing exposure to cooking smoke
• Protecting forests from further degradation

Findings showed significant correlation between amont of LPG used and income and rural/urban settings

Health System's response and responsibilities

World Bank, India: Household Energy, Indoor Air Pollution, and Health, 2002,

Method:

• cover capital cost of LPG connection (Rs 1000) for households below poverty line
• Target rural areas first
• Implement through women self-help groups

Deepam Scheme

World Bank, India: Household Energy, Indoor Air Pollution, and Health, 2002,

Exposure of Different Household Members: Solid Fuel Versus Gas, AP, India

4/5 respodents cited clean and health as the main advantage.

1/2 cited time saved

1/3 reasons included time made available for labor

1/10 social status associated with LPG

"Cleanliness" appered to be understood as cleaning soot from pans, not smoke.

Costly

Poor distributionto rural areas, particularly with subsidised schemes

World Bank, India: Household Energy, Indoor Air Pollution, and Health, 2002,

3. Deepam scheme

(promoting liquified petroleum gas)

Description

Households with good kitchen ventilation were less likely to have high concentrations - in both kitchen and living areas - than households with moderatre or poor ventilation.

Challenges

4. Ventilation

Three variables:

• fuel type
• kitchen type
• kitchen ventilation

House construction

People's education and lack of understanding

Cooking outdoors doesn't eliminate the problem: 24hour concentrations and exposures can be significantly higher than those advised in air quality health guidelines

Gaps in current and previous prevention policies