Clearing the Smoke: Improving Health Using Smokeless Chulhas
By Yusuke Taishi | Yusuke is a CMF Research Associate who has been researching the health benefits of improved cooking stoves.

Take a guess. What do you think is the biggest killer among children under 5 years in India and elsewhere in developing countries (besides deaths from various perinatal conditions such as asphyxia or birth trauma)? Malnutrition? Unsafe water? Malaria? HIV/AIDS? No. The answer is acute lower respiratory infections (ALRI) ¹. Never heard of it? You can't really blame yourself.

ALRI refers to various infections of lower respiratory tract—mainly caused by bacteria in developing countries—the most serious case of which is pneumonia. Although ALRI is estimated to claim the lives of 256,000 Indian children each year ², only limited effort has been made to bring it to the attention of international community—much less than what has been done for the fight against the other problems you might have guessed. "Air pollution kills infants in the US" says Michael Greenstone, of MIT (one of the professors involved in a CMF study and an international expert on the health impacts of pollution) "but it is even more deadly in developing countries, such as India. Yet, this issue is not very often discussed there and as a consequence reliable solutions remain elusive."

According to the WHO, 36% of all ALRI is attributed to indoor air pollution (IAP) ³ from the use of biomass fuels (fuelwood, animal dung, crop residues, etc.) for cooking, heating and lighting ⁴. In a typical household cooking with biomass fuels, the level of particulate matter (PM10), which is one of the health damaging pollutants due to IAP, is as high as 300-3,000?g/m, two to twenty times higher than what the U.S. Environmental Protection Agency considers a safe level ⁵.

And ALRI is not the only burden due to IAP. Studies have shown that chronic obstructive pulmonary disease (COPD) in women above 45 years has a strong and consistent association with IAP. COPD is estimated to claim 106,000 Indians every year ⁶. Other outcomes for which evidence is moderate or tentative include otitis media, asthma, low birth weight, tuberculosis, cataract, perinatal mortality, and nasopharyngeal cancer and laryngeal cancer ⁷.

IAP affects India more than other countries. It is estimated that 86% of rural and 24% of urban households still rely on biomass fuels ^8,9 and that about 400,000-550,000 premature deaths are attributed annually to solid fuel ¹⁰.

The victims of these diseases are predominantly women and very young children reflecting the fact that women are responsible for cooking in many parts of the society where IAP widely prevails and the youngest child in a family is often carried on mother's back during cooking. Furthermore, in addition to these health impacts, there are indirect negative effects associated with the use of biomass fuels. Studies show that women and children spend one and a half to two hours a day collecting fuel ¹¹. The burden of IAP is disproportionately higher among the most vulnerable populations in the society—women and children—and IAP and there is a vicious circle between IAP and poverty. Worsened health leads to higher health expenses and lower productivity, and thus lower income. Poverty exacerbates the dependence on more polluting energy sources and means less resource for pollution abatement and health care.

Interventions to eradicate IAP require orchestrated actions that range from changes in national energy policy and infrastructure of energy supplies, to the changes at grass-root levels such as promoting trained health workers or changes in housing structure (more well-ventilated houses) and cooking behaviors. Some of these actions are resource intensive. Others may require decades to actualize.

One of the solutions that many believe can have an immediate effect is the adoption of smokeless chulhas (cooking stoves). The smokeless chulha is simple in design and mechanism and, and operates similarly as the traditional chulhas families are used to, except that it has a chimney. Its fuel efficiency is also higher ¹².

In the 1980s and 1990s, both India and China have implemented large scale smokeless chulhas program. But despite the scale of the Indian and the Chinese programs, or similar programs elsewhere, only very few evaluations of its effectiveness, in terms of health impact, reduction in fuel usage, or economic outcomes, has been conducted up to date. This is particularly important for the following reasons: smokeless chulhas is a much cheaper option (a chulha itself costs about Rs.200-300 or $4-6) for rural populations compared to alternative interventions, such as LPG or electrification of rural India. It requires simple skills to build or repair, which is one of the primary factors for higher take-up and continuous use. Therefore, it has a high potential, if proven to be effective, as a remedy for and relief from the burden of IAP in India at least until these people will finally receive the benefit of much cleaner fuels.

The project that the Centre for Microfinance is currently undertaking in collaboration with the Abdul Latif Jameel Poverty Action Lab at MIT (J-PAL), the Joint Program on Science and Policy of Global Change at MIT, and Gram Vikas—an Orissa-based NGO—is the second study to date to rigorously evaluate the impact of intervention for IAP ¹³, and it is the first such study with a focus on the impact of IAP on economic outcomes, such as labor supply, accumulation of wealth, health expenditure, through a large scale randomized evaluation. "This project as the potential to clearly demonstrate what many have hypothesized, but no one has shown so far: sustained improvement in health and economic well being among beneficiaries" says Esther Duflo, the director of J-PAL and one of the professors involved in the study.

But why does the Centre for "Micro Finance" care about IAP?

Through this project, we hope to see indisputable evidence that smokeless chulhas bring about better health and economic conditions. Subsequently, many MFIs will be able to market them to their clients with loans. Better yet, MFIs with health insurance services may be able to offer lower premiums to their clients with smokeless chulhas if it is shown that they lower the likelihood of contracting certain diseases like ALRI or COPD. We hope to see that smokeless chulhas provide users better health and higher productivity and help them become more solvent borrowers.

The Centre sees far into the future for the development of microfinance industry, and above all, for the rural populations who are suffering from this killing smoke everyday.