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Health and Household Air Pollution from Solid Fuel Use: The Needfor Improved Exposure Assessment
Clark, M., J. Peel, K. Balakrishnan, P. Breysse, S. Chillrud, L. Naeher, C. Rodes, A. Vette, AND J. Balbus. Health and Household Air Pollution from Solid Fuel Use: The Needfor Improved Exposure Assessment. ENVIRONMENTAL HEALTH PERSPECTIVES. National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, 121(10):1120-1128, (2013).
This review paper identifies research priorities to evaluate the health effects from exposure to household air pollution derived from combustion of solid fuels used with cookstoves. The rapidly increasing investment in cookstove replacement programs around the world holds promise for addressing a long-standing public health crisis, but it also adds urgency to the need to better characterize the range of health effects related to household air pollution and the risks associated with specific exposure levels. Reducing the public health impacts from exposure to cookstoves emissions hinges on a better understanding of the exposure-response relationship to answer the fundamental question “how clean is clean enough?” Certainly challenges exist in characterizing health outcomes in developing countries, but the historical tendency towards simple (categorical-qualitative) exposure assessment is inadequate to guide the design of improved cookstoves and to understand health benefits and emission reductions of such stove interventions in real-world settings. A coordinated approach of field-based emissions characterization, increased research that will facilitate modeling approaches for characterizing spatial and temporal variability, including use and behavioral factors, and nested in-depth exposure assessments within larger intervention trials to facilitate site-specific model development will leverage research resources and enable increased sophistication of a wide range of studies. Without an improved understanding of this quantitative relationship, there will continue to be unacceptable uncertainty regarding the level of emissions reduction necessary to meet the health targets of major cookstove replacement interventions. As a result, these interventions may do little to improve health and could represent a squandering of limited resources available for public health programs in developing country settings.
Background: Nearly half the world’s population relies on solid fuel combustion to meet basic household energy needs (e.g., cooking and heating). Resulting air pollution exposures are estimated to cause 3% of the global burden of disease. Large variability and a lack of resources for research and development have resulted in highly uncertain exposure estimates, limiting the ability to estimate health benefits from cookstove interventions. Objectives: This paper identifies research priorities for exposure assessment methods necessary to accurately and precisely evaluate health effects of household air pollution. Methods: As part of a May 2011 international workshop, an expert group characterized the state of the science of exposure assessment for household air pollution and developed recommendations for approaches to reduce uncertainty. Discussion: Individual-level and household-level characteristics contribute to variations in personal exposure. Studies of acute and chronic health effects will require different exposure assessment approaches. Further work is needed to elucidate the relevant pollutants from biomass and coal combustion and their relative toxicity. Personal monitoring and area measurements of air pollutants may not adequately reflect absorbed dose; validated biomarkers, currently limited in availability, could play an important role in improving dose estimates. Uncertainty in exposures must be reduced to accurately characterize dose-response relationships. Conclusions: A coordinated approach of field-based exposure characterization, behavioral research to develop models of spatial and temporal variability, and nested in-depth exposure assessments is needed. This approach will require increased allocation of study funds. Without improved understanding of the exposure-response relationship, the level of reduction necessary to meet the health targets of cookstove replacement interventions will continue to be uncertain.