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Majid Ezzati¹ and Daniel M. Kammen²

¹Risk, Resource, and Environmental Management Division, Resources for the Future, Washington, DC, USA; ²Energy and Resources Group and Goldman School of Public Policy, University of California, Berkeley, California, USA

Abstract

Globally, almost 3 billion people rely on biomass (wood, charcoal, crop residues, and dung) and coal as their primary source of domestic energy. Exposure to indoor air pollution (IAP) from the combustion of solid fuels is an important cause of morbidity and mortality in developing countries. In this paper, we review the current knowledge on the relationship between IAP exposure and disease and on interventions for reducing exposure and disease. We take an environmental health perspective and consider the details of both exposure and health effects that are needed for successful intervention strategies. We also identify knowledge gaps and detailed research questions that are essential in successful design and dissemination of preventive measures and policies. In addition to specific research recommendations, we conclude that given the interaction of housing, household energy, and day-to-day household activities in determining exposure to indoor smoke, research and development of effective interventions can benefit tremendously from integration of methods and analysis tools from a range of disciplines in the physical, social, and health sciences. Key words: developing countries, exposure assessment, exposure-response relationship, household energy, indoor air pollution, intervention, public health. Environ Health Perspect 110:1057-1068 (2002) . [Online 10 September 2002]

http://ehpnet1.niehs.nih.gov/docs/2002/110p1057-1068ezzati/ abstract.html

Address correspondence to M. Ezzati, Resources for the Future, 1616 P Street NW, Washington, DC 20036 USA. Telephone: (202) 328-5004. Fax: (202) 939-3460. E-mail: ezzati@rff.org

We thank B. Singer and M. Tanner for helpful discussions on study design and program evaluation. We also thank two anonymous reviewers for valuable comments.

Received 24 September 2001 ; accepted 5 March 2002.

Globally, almost 3 billion people rely on biomass (wood, charcoal, crop residues, and dung) and coal as their primary source of domestic energy (1,2) . Biomass accounts for more than one-half of domestic energy in many developing countries and for as much as 95% in some lower income ones (1,3) . There is also evidence that in some countries the declining trend of household dependence on biomass has slowed, or even reversed, especially among poorer households (2,4) .