Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.Compared to these other killers, it has almost no public profile and no-one has found a viable, long-term solution. It is estimated that each year an estimated 1.5 million people die prematurely as a direct result of inhaling indoor smoke, according to WHO. This figure, it says, could be far higher given that Indoor Air Pollution is likely to be linked to many other health outcomes. Women and children are particularly vulnerable because in developing countries they predominantly light the fires and do the cooking. The World Health Organization (WHO) says breathing in elevated levels of cooking smoke more than doubles a childs risk of serious respiratory infection and may also be associated with adverse pregnancy outcomes [such as stillbirth and low-weight babies]”. Solutions Using cleaner fuels such as gas or electricity is undoubtedly healthier than the use of traditional biomass fuels, but for most poor people in the developing world, these energy sources remain unrealistic alternatives due to lack of affordability or accessibility. For this reason, the development and provision of stoves that burn traditional fuels more efficiently, producing less smoke, are the focus of attention, with reductions in pollution, and its impact on health, achieved as secondary benefits. Ultimately, success depends on developing and delivering a product that meets the cultural, social and economic conditions and requirements of the users, securing their active involvement in the process. Falling through the cracks Despite its lethal effect, IAP has tended to fall between the cracks of responsible bodies looking at health, environment and energy,” says Eva Rehfuess, a scientist with WHO. Since the 1980s, when it was first identified as a health risk, there have been numerous attempts to find a solution – see section 3 Who has been working on IAP. But a number of factors combined to reduce interest in the issue. These include: Difficulties measuring the health impact Sufficient evidence was only recently gathered to demonstrate the link between IAP and poor health or death. WHOs Eva Rehfuess says, even today, there remain gaps in research, particularly in relation to cancer, children and pregnancy. We know indoor air pollution is linked to three serious health problems: pneumonia in young children; chronic obstructive pulmonary disease such as chronic bronchitis in adults, and particularly the elderly; and finally lung cancer. But then there is a whole range of other issues in relation to biomass smoke – tuberculosis, lung cancer, asthma for children, peri-natal health outcomes such as low birth weight, still birth, cardiovascular disease and cataracts – for which there might be a link, but we dont as yet have enough scientific evidence to allow us to draw conclusions.” Competition with other health initiatives IAP is not a traditional health issue that can be tackled through simple interventions such as vaccinations and treatments. It also struggles to compete for attention with acute and high profile conditions such as HIV/AIDS and malaria. Low status among victims Women and children – the main victims – may spend several hours each day by the fire, exposed to smoke, but often have low status within their communities. IAP-specialist NGO Practical Action says: Their work and contribution to society and the economy is rarely calculated in national economic planning. Therefore, the poverty alleviation benefits of improved, clean cooking have not been fully recognised.” Lack of a single product solution The type of fuel used varies enormously – from wood, to dung, to crop residues. This complicates the issue because it rules out the creation of a one product solution, such as a single stove design. Also stoves must reflect diverse local culinary demands – from rotis, bread popular in India, to injera, a sour pancake preferred in Ethiopia. Complex market characteristics reduce the likelihood of a commercial solution To date there has been no widespread commercial solution. This is partly because stoves are seen as an unnecessary luxury, when an open fire seems to do the same job. Also many of the people worst affected live in remote rural areas. This makes for a complex supply-chain, with high transport costs and shortages of spare parts. Hope on the horizon Despite current challenges, the issue received a significant boost in 2002 with the publication of WHOs burden of disease” report (World Health Report 2002) offering tangible evidence of IAPs global scale and scope. For example, whereas between 1%-2% of deaths in Europe and the Americas were attributed to IAP, significantly higher levels were listed for Africa (24%), Southeast Asia (35%) and the Western Pacific (31%). This helped to push IAP up the international agenda, focusing attention on both the issue and the many small and geographically-dispersed efforts to quantify and combat it. The report also provided impetus for greater collaboration and a more holistic approach with new global initiatives being introduced under the umbrellas of WHO, the United Nations Development Programme, and the US Environmental Protection Agency, which is leading the PCIA (Partnership for Clean Air). Also important are the efforts of a wide range of other organisations – including the Shell Foundation – working with communities impacted by IAP, to identify, implement and scale-up appropriate solutions.