Chest
Ahead of the CurveHousehold Air Pollution Is a Major Avoidable Risk Factor for Cardiorespiratory Disease
Section snippets
The Indian Subcontinent
More than 75% of households in India use dried cattle dung (Fig 2), crop residue, and firewood for domestic fuels that are most commonly burned in open three-stone fires.4 In exposure studies, the use of dung was associated with high concentrations of indoor pollutants, followed by other fuel types.5 Similarly, pollutant concentrations in kerosene-using houses were twice those seen in gas-using homes. Mixed-fuel use in India is common in most kitchens. There is poor efficiency of energy
Health Impacts of HAP
There is an increasing body of epidemiologic evidence to show that the spectrum of adverse health effects from HAP is the same as that for tobacco smoking. The magnitude of the exposure effect is somewhere between passive and active tobacco smoke exposure.17,18 Here we highlight some of the evidence to associate household smoke exposure with pneumonia, COPD, asthma, cancer, TB, and cardiovascular disease.
Opportunities for Research
There are important gaps in our understanding of HAP disease associations that need to be addressed to identify clearly the health risks and the specific strategies that can be implemented to offset premature death and disabilities for millions. In particular, a better understanding of the risk of pneumonia in adults, TB, lung cancer, and cardiovascular diseases in people exposed to HAP is needed. At the same time, faced with an avoidable risk factor that is responsible for potentially as many
Toward Solutions
Alongside the need for research, there is a clear need for decisive action. The challenge this represents is not unlike the major challenges of the past that have required science, clinical medicine, and public health measures to decrease the global burden of disease. TB in the first one-half of the 20th century and tobacco-related illnesses in the second one-half serve to remind us of the challenges and the decades of commitment required to improve human health. The scale of the HAP problem is
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Other contributions: The authors thank Christa Roth, food and fuel consultant, for providing the photograph from Ethiopia used in Figure 1; Duncan Fullerton, PhD, Liverpool School of Tropical Medicine, for the photograph from Malawi in Figure 1; and Jamie Rylance, BMBS, Wellcome Trust
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