Health benefits from reducing indoor air pollution from household solid fuel use in China — Three abatement scenarios Heidi Elizabeth Staff Mestl a, ⁎ , Kristin Aunan a , Hans Martin Seip a,b a Center for International Climate and Environmental Research, P.O. Box 1129 Blindern, N-0318 Oslo, Norway b Department of Chemistry, University of Oslo, P.O. Box 1033 Blindern, 0315 Oslo, Norway Received 6 February 2007; accepted 26 March 2007 Available online 1 May 2007 Abstract According to the World Health Organization (WHO), indoor air pollution (IAP) from the use of solid fuels in households in the developing world is responsible for more than 1.6 million premature deaths each year, whereof 0.42 million occur in China alone. We argue that the methodology applied by WHO – the so-called fuel-based approach – underestimates the health effects, and suggest an alternative method. Combining exposure–response functions and current mortality and morbidity rates, we estimate the burden of disease of IAP in China and the impacts of three abatement scenarios. Using linear exposure–response functions, we find that 3.5 [0.8–14.7 95% CI] million people die prematurely due to IAP in China each year. The central estimate constitutes 47% of all deaths in China. We find that modest changes in the use of cooking fuels in rural households might have a large health impact, reducing annual mortality by 0.63 [0.1–3. 2 95% CI] million. If the indoor air quality (IAQ) standard set by the Chinese government (150 μg PM 10 /m 3 ) was met in all households, we estimate that 0.9 [0.2–4.8] million premature deaths would be avoided in urban areas and 2.8 [0.7–12.4] million in rural areas. However, in urban areas this would require improvements to the outdoor air quality in addition to a complete fuel switch to clean fuels in households. We estimate that a fuel switch in urban China could prevent 0.7 [0.2–4.8] million premature deaths. The methodology for exposure assessment applied here is probably more realistic than the fuel-based approach; however, the use of linear exposure–response relationships most likely tends to overestimate the effects. The discrepancies between our results and the WHO estimates is probably also explained by our use of “all-cause mortality” which includes important causes of death like cardiovascular diseases, conditions known to be closely associated with exposure to particulate pollution, whereas the WHO estimate is limited to respiratory diseases. © 2007 Elsevier Ltd. All rights reserved. Keywords: Indoor air pollution; Rural; Urban; Exposure; China; Solid fuels; Health 1. Introduction Indoor air pollution (IAP) from solid fuels (biomass and coal) is known to pose a major health risk, leading to such serious illnesses as acute lower respiratory infections (ALRI) in small children, and chronic obstructive pulmonary disease (COPD) in adults. There is also evidence that lung cancer is associated with household coal combustion (Zhao et al., 2006). Other conditions like asthma, adverse pregnancy outcomes, loss of eye sight and cardiovascular diseases may also be associated with indoor air pollution, adding to population morbidity and mortality (Smith et al., 2005). The World Health Organization (WHO) estimates that IAP is responsible for more than 1.6 million premature deaths each year in the developing world (WHO, 2002). In China alone, WHO estimates that about 420,000 die each year from the effects of IAP (Zhang and Smith, 2005). These estimates, however, were made using a method known as the fuel-based approach. The fuel-based approach uses the prevalence of fuel as an exposure surrogate and odds ratios of diseases combined with disease specific mortality and morbid- ity rates. This approach tends to underestimate the total disease burden due to both exposure misclassification and to limiting the estimates to selected diseases and population groups such as ⁎ Corresponding author. Tel.: +47 22 85 87 67; fax: +47 22 85 87 51. E-mail address: heidi.mestl@cicero.uio.no (H.E.S. Mestl). 0160-4120/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.envint.2007.03.012