Indoor Air Pollution: Key Determinants

Problem Definition: Every year, 3-4% of all deaths around the world are linked to Indoor Air Pollution.  

As you can see, I have changed my problem definition again, however, not as drastically this time.  I realized that my previous problem statement did not really focus on the major issue behind indoor air pollution, which is the overwhelmingly mortality rates associated.  My new problem definition captures that and allows me to discuss decreases in indoor air pollution as intervention strategies. 

With indoor air pollution, there are many ways that death can result.  In other words, there are many key determinants and many intervention strategies.  Therefore, we must consider all carefully and then determine which one has the best possibility of helping. 

The first determinant that comes to mind is the use of biomass fuels such as dung and wood instead of kerosene or other gaseous fuels.  This can be split into two different categories.  This can be seen as an environmental determinant because they do not have access to better fuels (Legros et al, 2009).  In other words, the people in these developing countries may be using the best of what is around them.  If they have no access to fuels such as kerosene, then they cannot be expected to use them.  This determinant can also be seen as an economic one because better fuels are more expensive.  On an individual level, the families may not be able to afford the better fuel and so may just stick with the biomass because it is cheap and still gets the job done.  In fact approximately 3 billion people fall under this category (Duflo et al, 2008).  On a societal level, the country may not have the proper economic infrastructure to support the proper implementation of these new fuels.

A second determinant could be proper ventilation, which would fall under the category of environmental.  In many rural villages in developing countries, the homes have neither windows nor chimneys (Jamison et al, 2006).  This means that when cooking, the smoke enters the room and has no place to leave but the door.  Smoke builds up quickly in these homes and continues to persist for extended periods.  People living in the homes, especially women and children, are left exposed to this smoke for hours a day.

On a more sociocultural level, many behaviors exist in these developing countries related to cooking that increase the levels of inhalation.  First, women who cook tend to stand over the stove, where the concentration of airborne particulates is highest in the home.  They put themselves at a much higher risk of developing adverse health affects by doing this.  Additionally, they put their children at risk by holding them while cooking or keeping them in a carrier on their chest or back.  In this situation, they not only put themselves in the greatest density of smoke, but also the young ones.  Essentially, women and children are at highest risk because they spend the most time around the stove and in polluted rooms (Ezzati et al, 2001).

Duflo, E., Greenstone, M., Hanna, R. (2008) Indoor air pollution, health and economic well-being. S.A.P.I.EN.S. 1: 7-16.

Ezzati, M., Kammen, D.M. (2001) Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. The Lancet 358: 619-624.

Jamison, D.T., et al. (2006) Disease control priorities in developing countries. New York, NY: Oxford University Press.

Legros, G., Havet, I., Bruce, N., Bonjour, S. (2009) The Energy Access Situation in Developing Countries. Geneva, Switzerland: WHO.

Internal Air Pollution in Developing Countries: Magnitude

As you may note, the subject for my paper has changed.  I realized as I really delved into the research that I was having trouble finding concrete indicators of magnitude.  Additionally, I looked ahead and found myself at a loss when it came to solutions.  I am no environmental engineer and so had no idea how to fix the problem of trichloromethanes in our drinking water.  Thus, my paper topic has changed to something I find very interesting and one that I know with have a wealth of research for me: Indoor Air Pollution(IAP) in Developing Countries.  Most of the time, IAP is forgotten behind the daunting efforts put in place to improve water sanitation. IAP leads to overwhelming death and, therefore, should also be a focus of public health policy makers and activists.

With a change in topic, my problem statement has changed as well.  My new problem statement is as follows:

For the past decade, indoor air pollutant levels in developing countries where solid biomass constitutes the main fuel source have exceeded the WHO and EPA recommended limit by twenty times.

With these extremely high levels of indoor air pollution comes extremely high levels of associated diseases and even mortality.  In fact, according to the WHO, since 200, internal air pollution has been the cause of approximately 1.6 million deaths a year.  In other words, around 3-4% of all deaths around the world can be linked to IAP (Oluwole, 2012).  As can be seen by these numbers, indoor air pollution is a major health problem. 

The problem of indoor air pollution is mostly found in rural parts of developing nations and not developed nations, so our focus should be directed there.  90% of rural households in developing countries use solid biomass as their only source of energy for activities such as cooking.  It has been noted that in these rural households, internal air pollution levels exceed EPA standards daily and by ten to twentyfold (Bruce, 2002).  Also, it has been noted that approximately 80% of all global exposure to particulate matter happens inside the home in developing nations (Ezzati, 2001). 

Now we have come full circle back to the problem statement.  Indoor air pollution is very high inside of rural households in developing countries.  This air pollution leads to great morbidity and mortality.  In essence, the magnitude of the problem reaches across the world and affects a great amount of the world population.

The data presented most likely come from active surveillance.  With little to no health infrastructure in most of these developing nations, public health data are sparse and therefore many studies must be done by visiting the nations and doing studies there.  Given the nature of these studies, the majority of the data presented will be estimations.  They cannot reach out to every single person in every developing nation.  They can, however, obtain data from multiple locations in multiple developing nations and generalize it to the whole population.  Still the data are very sound because they have come from direct measurements.

Ezzati, M., Kammen, D.M. (2001) Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. The Lancet 358: 619-624.

Oluwole, O., Otaniyi, O.O., Ana, G.A., Olopade, C.O. (2012) Indoor air pollution from biomass fuels: a major health hazard in developing countries. J Public Health.

Bruce, N., Perez-Padilla, R., Albalak, R. (2002) The health effects of indoor air pollution exposure in developing countries. Geneva, Switzerland: WHO.

Trihalomethanes In Our Drinking Water

Chlorination is the primary means for disinfection of filtered water in developed nations.  It keeps our water free of many different toxins that lead to high morbidity and mortality rates.  Certainly, because of chlorination, these rates have declined greatly.  The procedure, however, has also lead to the build-up of chlorination-by-products in our drinking water.  When the chlorine reacts with some of the dirt particles  Trihalomethanes are the predominant chlorination-by-product and have been associated with increased risk of cancer and adverse pregnancy outcomes, such as stillbirths. 

While this problem will only be affecting those living in developed nations that use chlorination, it still affects every person in those developed nations.  Everyone drinks water.  Water is used to clean things we eat and we touch.  Water can be found in most of life’s situations.  Therefore, it is important to have clean drinking water that is free of any toxins, including carcinogens such as trihalomethanes. 

            Think about the problem from the eyes of the consumer.  They are told many ways to stay healthy and to help prevent the development of cancer.  Obviously, staying hydrated with proper amounts of water is high on the list.  This consumer takes what they are told to heart and does everything that they can to keep themselves free of cancer.  Then, they ingest too many trihalomethanes and develop cancer.

            Essentially, the problem is twofold.  First, the problem is extremely widespread.  It affects anyone and everyone in developed nations.  As long as you drink water, you are at risk.  Second, the vector is extremely hard to avoid.  We cannot just stop drinking water from fear of getting cancer.  Therefore, we must attempt to find someway to keep trihalomethane levels low or nonexistent in all water, especially highly chlorinated water such as drinking water and swimming pool water.

            I would like to look more into this topic because I have always found clean water solutions to be one of the most interesting topics in public health.  I always thought it was amazing how just by giving an undeveloped country potable water, their disease rates decline sharply and their health is much better.  Therefore, I find it very interesting that this so-called potable water may actually be harming us more than we think.  It is always intriguing to think from the other side of things.  While it is great that we have clean water, we may be creating new types of problems in our water that can really only be avoided by using a different type of filtration and disinfection.  Who knows?  Maybe in the next few years, we will see a change in our water sanitation system because the levels of trihalomethane are too high.  And, maybe before that change, we will see a pandemic of cancer due to the high trihalomethane concentrations.  I hope this is not the case, but find it’s possibilities very interesting and so would enjoy pursuing this topic further.

Human and Maternal Rights

Every person has a different idea of what they are entitled to.  Yet there will always be overlap because, in the end, there are some things that we cannot imagine living without.  This idea that what we have is inherent and common to each one of us really defines what a human right is.  For instance, ask most anyone whether they think that everyone has the right to life and you will have trouble finding someone that says no.  Life is something we see as being innate to humanness. Without life, you cannot be human.  It sounds silly and a bit extreme, but it is true. 

Consider this: if we claim life to be a human right, then in some ways we claim health to be a human right.  Without the latter, you surely will not have the former.  From here, we see the melding of public health and human rights.  Public health essentially works to promote and preserve those human rights dealing with the preservation of life.  If we do not define what these rights are, such as the right to healthcare, then public health has little to work toward.

Take for example, in the Universal Declaration of Human Rights Article 25 it cites a standard-of-living as an inherent human right.  Without proper living conditions it would be difficult to be healthy and therefore difficult to survive.  Think about how difficult life would be without proper food, clothing, medical care, and housing.  If the goal of every human is to have lived in some capacity, then it must be that a standard-of-living be created.  Public health takes on this job.  They decide what the standard-of-living is and because of this we are all given a greater chance at survival, at life.

Human rights do not discriminate in any way and, therefore, include women.  Importantly, though, the Universal Declaration of Human Rights talks of special care and assistance during motherhood as a human right.  This idea bleeds, once again, back to this overarching idea of life as a human right.  Mothers are generally seen as the person responsible for the life of their child.  Therefore, if we hope to help preserve the life of children, it makes sense that we should provide for the mothers.  Therefore, motherhood requires some special circumstances in the realm of human rights.

This idea was brought to attention by the death of Alyne da Silva Pimentel in Brazil in 2011.  She died from pregnancy related causes that were preventable and due mainly to a misdiagnosis.  The United Nations’ Committee on the Elimination of Discrimination against Women made a statement regarding this case.  According to this committee, “States have a human rights obligation to guarantee women of all racial and economic backgrounds timely and non-discriminatory access to appropriate maternal health services.”  This overarching statement insured that all mothers were henceforth to be provided with proper healthcare.  Therefore, the life of the mother and her child was to be preserved, which as discussed earlier is seen as a human right.