By Sara Mishamandani
Nearly half of the world’s population uses inefficient stoves fueled by wood, coal, or dung to cook daily meals. The high levels of exposure to household air pollution from cooking, especially for women and children, contribute to approximately 4.3 million estimated annual deaths. Two programs, launched by NIEHS and its partners through the NIH Fogarty International Center, are aimed at understanding and addressing these issues while building research capacity in low- and middle-income countries (LMICs).
“I see supporting clean cooking as an extremely important way to advance health and environmental activities around the world to address a major global health problem,” said Josh Rosenthal, Ph.D., a senior scientist in the Division of International Epidemiology and Population Studies at the NIH Fogarty International Center. “In that same vein, clean cooking also addresses significant environmental issues and has positive near and long-term impacts on sustainability.”
By emphasizing collaboration between LMICs and U.S. institutions, the Global Environmental and Occupational Health (GEOHealth) and Household Air Pollution Implementation Science Network (ISN) programs are providing unique and innovative approaches to reduce the burden of disease from household air pollution. Collaboration between the programs is also encouraged to boost training and capacity building activities within LMICs through joint workshops and other activities.
GEOHealth: A Focus on Building Research Capacity for Clean Cooking
The GEOHealth program supports the development of regional hubs in LMICs to enhance research, training, and policy support. GEOHealth grants are awarded to two institutions: one from the United States to coordinate research training, and one from the host country focused on conducting research projects. These hubs create and build upon key capabilities within LMIC institutions to address high priority environmental and occupational health issues with a range of research and training approaches.
Because inefficient cooking technologies are a problem worldwide, research and training focused on household air pollution is at the forefront of many of the GEOHealth hubs. Bringing together multiple disciplines from two institutions improves training for researchers from the LMIC to address household air pollution in their country. Four current GEOHealth hubs include a component to investigate household air pollution:
- In Bangladesh, researchers are investigating cardiopulmonary outcomes and other health effects of burning biomass as well as concerns related to climate change and occupational health of garment industry workers.
- The Peru hub focuses on household air pollution in relation to cardiovascular outcomes, outdoor air pollution in relation to cardiorespiratory disease, and climate change in relation to future predicted health effects in Peru and nearby countries.
- The hub in India focuses on characterizing and collecting data on indoor and outdoor air pollution in India.
- The Eastern Africa hub is investigating indoor and outdoor air pollution and developing the Eastern Africa Children’s Health Study.
The GEOHealth program is also facilitating collaboration and capacity building with other organizations and across hubs to enhance indoor air pollution research and training. This includes a partnership with the Global Alliance for Clean Cookstoves. In July 2016, the Global Alliance for Clean Cookstoves, the University of California, Berkeley, and the University of Southern California, in coordination with the Eastern Africa GEOHealth Hub and the Horn of Africa Environmental Regional Center and Network, are hosting a three-day training workshop in Ethiopia on household air pollution and exposure monitoring. The workshop is targeted toward members of GEOHealth Hubs that include a focus on household air pollution as well as investigators currently engaged or interested in household air pollution research and exposure monitoring.
The Implementation Science Network: Advancing the Use of Clean Cooking Technology
Understanding how clean new cooking technology needs to be to improve health is just the first step in tackling the problems with indoor air pollution. The second step is understanding the best ways to promote adoption and continued use of the technologies. The Household Air Pollution ISN was launched to advance the science of uptake and scale up of clean cooking technology in the developing world. Rosenthal coordinates the steering committee for the Household Air Pollution ISN, which includes staff from Fogarty, NIEHS, other NIH institutes, as well as the US Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA) and the Global Alliance.
“The ISN aims to build the science on implementation around clean cooking technology with active participants, both investigators and policy makers in developing countries,” said Rosenthal. “One of the main objectives is to develop consensus around the indicators of success for adoption and use to create a common understanding of what the scientific and programmatic needs are in developing countries to make this successful, and how local context affects that.”
The ISN working group includes active members from Ghana, India, Peru, Mexico, Bangladesh, and other LMICs. By promoting collaboration with NIH and other partners, the working group pinpoints needs in LMICs and identifies resources and training for LMICs to promote clean cooking interventions and enhance research capacity.
Promoting Implementation Science Research
The ISN recently funded three projects to support adoption of clean cooking technologies. The projects focus on identifying ways to enhance the use of clean cooking technologies in specific developing countries. Study results may also help determine what aspects of implementation are generalizable in developing countries and identify influences that are unique to certain communities, such as cultural needs, fuel availability, socioeconomic constraints, and other concerns.
The three projects supporting clean cooking technologies are:
- Researchers led by Katherine Dickinson, Ph.D., from the University of Colorado, Boulder, and the National Center for Atmospheric Research, focus on how adoption of liquefied petroleum gas (LPG) can be expanded in Ghana. Dickinson’s team is conducting an in-depth assessment of barriers and applying targeted interventions across urban and rural areas.
- Led by Kirk Smith, Ph.D., researchers from the University of California, Berkeley are exploring whether modest incentives in rural India will increase usage of LPG for pregnant women.
- Researchers led by Gautam Yadama, Ph.D., from Washington University, are studying how below-poverty households in rural India who have adopted LPG vary from those who have not adopted LPG by investigating factors such as affordability, accessibility, and LPG awareness.
“The best technology in the world is unlikely to produce health benefits unless it is used properly. To date, the cleanest technologies have not reached enough people, nor have they been utilized sufficiently or properly to really make a difference,” said Rosenthal. “While we are working to improve the technologies, it is critically important that we understand how to implement these so that they will be used sustainably to improve health outcomes.”