The Partnership for Clean Indoor Air (PCIA) was launched at the World Summit on Sustainable Development in 2002 in Johannesburg to address the increased environmental health risk faced by billons of people across the developing world who burn traditional biomass fuels and coal indoors for cooking and heating. More than 1.6 million people, mainly women and children, die prematurely each year from breathing elevated levels of indoor smoke. In an attempt to address this environmental health issue, the U.S. Environmental Protection Agency (EPA) awarded PCIA pilot project grants to eleven nonprofits around the world, two of which are located in China.
• The Nature Conservancy's China Program is working in Yunnan Province, addressing indoor air pollution through the prism of forestry protection. Specifically, the program attempts to reduce fuel wood consumption to promote both biodiversity protection and health benefits.
• The Institute for Environmental Health & Related Product Safety (IEHS) of the Chinese Center for Disease Control (CDC) is promoting efficient coal and biomass usage throughout rural Guizhou and Gansu provinces of China. The ultimate goal is to create multi-stakeholder programs promoting clean cook stoves that can be replicated around China.
The China Environment Forum hosted two speakers from the IEHS to discuss their extensive environmental health projects in Guizhou province. John Mitchell (U.S. EPA), who introduced the two IEHS speakers, stressed that throughout the world indoor air pollution (IAP) has been difficult to address due to its cross-cutting nature. Because solutions to IAP involve policy considerations on energy, deforestation, gender issues, health, and economic development, PCIA programs emphasize a comprehensive approach to IAP that addresses social and cultural barriers and supports sustainable, local market.
In their joint work in China, EPA and IEHS have targeted IAP by: (1) distributing energy efficient stoves, (2) incorporating health and environmental awareness into the local school curriculums, (3) promoting local clean cook stove production/distribution businesses, (4) training locals in stove maintenance methods, and (5) testing and marketing a number of other clean household energy technologies such as biogas digester systems and solar cookers.
After John Mitchell introduced the EPA and IEHS partnership in China, Dr. Jin Yinglong discussed the broad range of environmental health work carried out by IEHS and Mr. Tang Ning gave a presentation on the status of the IAP projects in Guizhou.
The Institute for Environmental Health & Related Product Safety
Established In May 2002, the Institute for Environmental Health & Related Product Safety (IEHS) is an incorporation of the former Institute of Environmental Health and Engineering (IEHE), Institute of Environmental Health Monitoring (IEHM), and Chinese Academy of Preventive Medicine (CAPM). As China's national professional institution for environmental health and products safety, it provides scientific research and technical support to help guide policy, regulations, and strategies within the Ministry of Health and provincial CDCs. It carries out on-the-ground pilot projects and assesses the safety of new technologies and products. IEHS also holds numerous national and international seminars and training workshops on environmental health matters. Besides the PCIA initiative with the EPA, IEHS has been carrying out large-scale environmental health studies and data collection initiatives throughout China that are addressing:
• Relationship between air pollution and lung cancer in 26 cities
• Health impact of air pollution from coal-burning in Taiyuan, Shanxi Province
• High incidence of lung cancer in Xuanwei County, Yunnan Province
• Transport sector's impacts on health
• Hazards of small industry pollution on human health
• Establishment of surveillance points on pollution and health impacts
• Effects of exposure to volatile organic compounds
• Effects of water defluoridation measures
• Association of water pollution and cardiovascular disease
• Selenium levels and cognition decline amongst the rural elderly
The Partnership for Clean Indoor Air Pilot Project in Guizhou
Among the 57 percent of China's population living in rural areas, indoor air pollution affects the lives of over 700 million people. A large percentage of those affected live in poor provinces such as Guizhou, where household incomes are so low residents are highly reliant on biomass and coal they mine themselves. Additionally, most of China's rural population cooks indoors with highly inefficient stoves. This creates a situation in which the combustion of coal and biomass release hundreds of pollutants at levels several times higher than general health guidelines. Notably, in Guizhou province rural residents burn coal brickettes that contain a high level of naturally occurring arsenic and fluoride.
Some of the health impacts linked with indoor air pollution include dental and skeletal fluorosis, respiratory diseases, and acute respiratory infections. It is therefore not surprising that one of the leading causes of death among rural children in China is pneumonia. In Guizhou alone, over the past couple years there were 10 million dental fluorosis patients and 640,000 skeletal fluorosis patients. Besides inhalation of the smoke, one of the main causes behind these grim statistics is the link between smoke and food preparation methods. In rural Guizhou residents dry corn, chili peppers, and meat above their coal-burning stoves; thus, people end up digesting high amounts of fluoride and arsenic. In their assessment of counties in Guizhou, the IHES researchers found that along with food preparation methods, the use of inefficient stoves and chimneys (or lack of chimneys) were all contributing to the sever indoor air pollution.
To address these severe health problems, the IEHS-EPA indoor air pilot project in China began by targeting 50,000 households in seven counties in Guizhou for dissemination of improved stoves and chimneys. The IEHS researchers first established a local team to help in the design, distribution, and follow-up education of the clean cook stove program. The team included village, township, and country government officials, as well as local representatives of the community, the Chinese Women's Federation, and the energy, finance, and agriculture sectors.
In an attempt to guarantee community commitment, rural residents were encouraged to purchase the biomass stoves through a soft-subsidy strategy. Currently, residents in the targeted rural communities put forward 30% of the cost of the stoves, with the rest being subsidized by the IEHS. In the future, the Partnership for Clean Indoor Air is hoping to push for a 50% co-pay. The soft-subsidy strategy was promoted to encourage a sense of personal investment and therefore better usage and maintenance of the stoves.
Along with the dissemination of cook stoves, IEHS and the local team set up health education activities at township and village levels. One of the more interesting methods for environmental health information dissemination was to target young children, in hopes they would then pass on their newfound knowledge to their parents and elders. Other methods included passing out leaflets, community meetings, and even artistic performances to underscore the linkage between poor cook stoves and health problems.
IEHS and the local team created a sustainable foundation for the clean cook stove program by building up local participation at all levels. Most striking was how the education efforts led many villagers to write and sign a pact laying out rules on how the stoves would be used correctly in the community. The education curriculum also targeted behavioral changes by suggesting different food preparation methods, such as sun-drying rather than smoke-drying foodstuffs, storing items in bags instead of just around coal stoves, and simply washing food better before eating.
Although the IEHS staff recognizes there are still numerous environmental health threats in rural China—such as excessive usage of pesticides and fertilizers that are contaminating ground water systems—the Guizhou IAP project represents a promosing model for the national government to engage local governments and citizens to become environmentally conscious and to become proactive about seeking the solutions to local environmental health problems. Such collaboration among government agencies and communities is still rare in China, but necessary to help promote stronger implementation of environmental protection policies and programs.
Drafted by Juli S. Kim and Jennifer L. Turner.