Making the Clean Available:

Old and new paradigms for addressing the largest environmental health risk in the world:

smoke from cookfuels

Kirk R. Smith, MPH, PhD Professor of Global Environmental Health

University of California, Berkeley

World Bank, August 5, 2015

Declarations of Bias

• A focus on health, with other objectives secondary

• A focus on India, which does not represent all parts of the world

• Moment in time during ongoing shifts in thinking

Lost Life-Years in India (1990-2010)

Summary of Health Impacts • One of the top risk factors in the world for ill-health. • Largest known environmental health risk factor • Biggest impact in adults –3.4 million premature

deaths (two-thirds the DALYs) • Still important for children ~500,000 deaths (one-

third the DALYs) • About one million premature deaths in India • Biggest single risk factor of any examined for

Indian women and girls • Impact going down slowly because background

health conditions improving

What has been done-#1

• Wait for development to work. • Bottom line

– Percent using solid fuel slowly declines with development alone (no special policies)

– But not always number of people exposed – But can decline much faster with targeted clean

fuel policies

Low- and Middle-Income Countries

1990: 85%: 700 million people using solid fuels 2010: 60%: 700 million people ~1980 700 million people in entire country

700 million people in the Chulha Trap

Increasing Prosperity and Development

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Very Low Income

200 million

Low Income 400 million

Middle Income 400 million

High Income 200 million

Ag res- 15%

Coal – 1%

Kerosene -3%

PNG < 1%

Elec < 1%

Non-solid fuels

Solid Fuels

LPG – 30%

Biogas – 0.3%

Wood – 49%

--1.0

~~4

~~400

Household Energy Ladder in India

What has been done #2: Make the available clean

• Many hundreds of “improved” biomass stove programs over ~60 years

• Including major national programs in China and India in the 1980s covering ~200 million households in all

• And in India, Peru, Mexico, Nepal, Honduras, and other countries today

• Hundreds of NGOs, big and small, promoting stoves around the world over the decades

Being done, cont. • Link to climate co-benefits in carbon market • Health effects research expanding greatly • Global Alliance for Clean Cookstoves: 2010 • Standards being developed with ISO and WHO • Often improvement in fuel use has occurred • But, unfortunately,

– The cleanest models have been disseminated to only a few tens of thousands of households

– And, as yet, no biomass stove in the world comes close to the boundary – is clean enough to be truly health protective in household use

0 2 4 6 8 10 12 14 16 18

Oorja stove, Oorja pellet fuel (Dry)

Philips fan HD4012, wood fuel (Dry)

Belonio, rice hull fuel (Dry)

Berkeley Darfur, wood fuel (Dry)

Envirofit G-3300, slow feed rate, wood fuel (Dry)

Philips fan HD4012, wood fuel (Wet)

StoveTec GreenFire, slow feed rate, wood fuel (Dry)

StoveTec Charcoal, charcoal fuel (Wet)

KCJ Standard, charcoal fuel (Dry)

Jiko Metal, charcoal fuel (Dry)

Jiko Ceramic, charcoal fuel (Dry)

Mayon Turbo, rice hull fuel (Wet)

Sampada, wood fuel (Wet)

Gyapa, charcoal fuel (Dry)

KCJ Standard, charcoal fuel (Wet)

Geres, charcoal fuel(Dry)

Envirofit G-3300, wood fuel (Dry)

3 Stone carefully tended, wood fuel (Dry)

Sampada, wood fuel (Dry)

Upesi Portable, wood fuel (Dry)

Jinqilin CKQ-80I, corn cob fuel (Dry)

Upesi Portable, wood fuel (Wet)

PM emission rate (g/hour)

Figure S29. PM2.5 Emission Rate (per Time)

Simmer

Hot Start

Cold Start

Best lab performance with dry wood - ~8x WHO IAQG

Jetter et al., EST, 2012

The ACE-1 in Lao Village Homes

charging boiling water

Stove-use monitor (SUM)

Though exposures Before and After the intervention are not drastically dissimilar, with some exposures barely unchanged or higher after the concentration. “After” ACE-1 dissemination, a cluster of exposures emerges near the average outdoor ambient level, suggesting that exposures are more dictated by outdoor levels.

20

Personal PM2.5 Exposure Findings

Integrated exposure-response curves for all disease categories

The solid vertical lines show the ranges of pre-intervention and post-intervention exposures found in this study.

IHD and stroke risks flatten out above about 100 µg/m3 Risk does not increase as quickly with exposure as at lower levels.

Averted DALYs and Deaths for an ACE-1 Intervention under Lao health and population conditions

Assuming same performance over three years as observed in the feasibility study

Averted DALYs and premature deaths by disease for an exposure reduction from 119 µg/m3 to 77 µg/m3

25,000 Lao households; 75% usage; no stacking; 3-year lifetime

ALRI COPD IHD Lung Cancer Stroke Total

DALYs Deaths DALYs Deaths DALYs Deaths DALYs Deaths DALYs Deaths DALYs

Deaths

Central Estimate 885 10 95 2 125 5 35 1 80 4 1220 22

Lower Interval 400 5 25 1 60 3 15 1 35 2 535 12

Upper Interval 1450 17 150 4 205 9 55 2 145 7 2005 39

About 13% of total HAP impact is reduced in each scenario – leaving ~87%

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Very Low Income

200 million

Low Income 400 million

Middle Income 400 million

High Income 200 million

Crop Waste Dung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels

Liquefied Petroleum Gas

Biogas

Wood

Conceptual Indian Energy Ladder

?

Current Health Evidence • Shows now that even major reductions

(<90%) in emissions still lead to relatively small health improvements

• Posing a large technical challenge to solid fuels to reach 99% or greater reductions over open fires in actual households

• This is difficult with any solid fuel • But still worth pursuing

Paradigm #1

Making the clean available

Five New Paradigms

Public health and environment 27 |

Secretary Vivek Rae • Doubled number of distributors for the next

year ~10 million new people • Brought together heads of marketing for the 3

national oil companies to hear the lecture • Ministry is developing a plan to triple LPG

access in rural India by 2025 • Requiring a major effort related to imports,

finances, infrastructure, distribution modes, etc.

• And, importantly, fixing the subsidy system

Indian LPG Expansion

• Premises – Seven billion USD LPG subsidy cannot

increase, indeed must reduce – Imports should not increase

• Solutions – Greatly reduce leakage – Target subsidies only to poor

Stage 1: 2015 (underway) • All LPG now sold at market rate.

• Subsidy deposited directly to customer bank accounts, but only when a cylinder is purchased

• Large national media campaign to persuade middle class and rich to voluntarily forego subsidies – Modi involved

• Link each customer dropping subsidy to an additional BPL customer receiving it

Results so far

• Estimated ~ one billion USD to be saved annually from reduced leakage

• To date, 1.5 million customers have voluntarily given up subsidy

• This is continuing at ~100,000 per month • Goal is to persuade 10 million customers to

do so • Total reduced subsidy: ~2 billion USD/y

Other activities

• Smaller cylinders to better match poor consumer needs

• Better distribution networks in rural areas • Reconsider planned changes in domestic

refinery balances

Next Stage

• Change from op-out to op-in system – Estimated additional savings: 2 billion USD/y

• Provide incentives to encourage urban customers to shift to natural gas and electricity and thus give up LPG subsidy – Large potential over next decade

• Consider ways to encourage more efficient LPG technologies

Up to 25% more efficient

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Very Low Income

200 million

Low Income 400 million

Middle Income 400 million

High Income 200 million

Crop Waste Dung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels

Liquefied Petroleum Gas

Biogas

Wood

Conceptual Indian Energy Ladder

?

Paradigm #2

Stepping out of the box

“If you don’t need your father’s land line for a phone,

why your mother’s stove?”

• Electrification is an essential human need – brings many social and economic benefits

• Electrification also allows a wide range of highly efficient cooking devices

• Every time a switch is flicked, instead of a match, it is good for health

Rural Gujarat - 2014

Induction Cookstove

What is an induction cookstove? • Electric, yes, but entirely different technology

from traditional electric stoves • High frequency magnetic field induces heat in pot

alone • More efficient ~90% instead of ~60% • Faster cooking ~1.5x • Safer and cooler– surface is warm but does not

burn or cause fires • Long-lived, easy to clean • Large economies of scale in manufacture like

other electrical devices

Cooking with Induction

Safer – the stove does not get hot

- - Bajaj Electrical Ltd. - Compton Greaves Ltd. - Eurolux

- Glen Appliances Pvt. Ltd. - Inalsa - Jaipan Industries Ltd. - Kenwood Ltd. - Khaitan Electrical Ltd - Morphy Richards - Panasonic Corp.

- Phillips - Preethi Kitchen Appliances, Ltd. -Sunflame -TTK Prestige Ltd. -Usha International Ltd.

-Westinghouse

Induction Cooktop Market in India 2012-2016 Published: March 2013 Infiniti Research Limited 35.4% per year growth predicted: 2012-2016

Factor of nearly five increase!

Roti being made on an induction Stove: New Delhi

Chaiwallah In Odisha

Flying off the shelves in China

Costs coming down dramatically

US $7.80 each (with warranty): The cost of two coffee lattes

(in lots of 500)

Considerations • Power now only reliable in major cities and

2-3 full states, but on the march nationally. • Cooking would add serious additional

demand, but at great benefit, and not large compared to need in general

• To whatever degree ICs substitute for biomass or even LPG, the calculus for electrification benefits changes dramatically

The Ecuador Story • Switched out nearly 100% from biomass to

LPG in late 1980s • Now changing out every stove in country to

induction • 95+% households electrified • Soon to have 8 new hydropower plants:

“Green Cooking” • Primary motivation: eliminate 700M

USD/year in LPG subsidies

Ecuador cont. • Low income and other deserving

households to obtain free stoves and utensils (~30% of total)

• Rest to receive stoves at zero or low interest paid on electric bill

• All households to be wired for a 220 V circuit

• All households with ICS to receive first 80 kWh/mo free.

Ecuador, cont. • $250 million from Chinese ExIm Bank to

buy Chinese ICs built under Ecuador specs • LPG equipment already increasing in price

due to change in tariffs • In 2-3 years, LPG subsidies start to be

removed • Field studies showed high social acceptance • Local research and manufacturing to

develop utensils for local cooking habits • Widespread sophisticated social marketing

Increasing Prosperity and Development

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Very Low Income

200 million

Low Income 400 million

Middle Income 400 million

High Income 200 million

Crop Waste Dung

Natural Gas

Electricity

Non-solid fuels

Solid Fuels

Liquefied Petroleum Gas

Biogas

Wood

Conceptual Indian Energy Ladder

?

Modern Electric Cooking • Not just induction stoves, but a wide range

of efficient task-specific appliances as well: rice cookers, water kettles, etc.

• Two possible conceptual roles: • Step up the energy ladder from LPG

– Ecuador • Leap-frog over LPG

– Paraguay? – Laos??

Game Changer? • PV microgrids are proliferating in India to

supply villages with power • Technically doable to provide sufficient

power for induction cooking, • Barrier is not cost of PV or stove, but

battery • New Tesla “PowerWall” battery coming

into top end of range to make Solar Induction Cooking cost comparable to LPG

Paradigm #3: It takes a village

Village pollution in Gujarat

Changing out one chulha at a time is not as effective as

changing out whole villages • Learned in sanitation programs years ago • There are both household and community

benefits to clean fuels/stoves and latrines. • And with community interventions, a new

set of incentives and social pressures become possible.

Paradigm #4: All Indians cook in the same kitchen!

%PM2.5 from “Residential” Emissions : NASA

57 Source: Asian Emission Inventory for NASA INTEX_B 2006 Chafe, et al. 2014

~25% of primary particle

pollution in India is from

household fuels

~25% of ambient PM comes from household combustion

Increasing Prosperity and Development

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Very Low Income

200 million

Low Income 400 million Middle Income

400 million

High Income 200 million

Ag res- 15%

Coal – 1%

Kerosene -3%

PNG – 1%

Elec – 1%

Non-solid fuels

Solid Fuels

LPG – 30%

Biogas – 0.3%

Wood – 49%

India’s Kitchen - 2012

169 million households

92 million households

Paradigm #5: It is a health issue

• Not primarily an energy, climate, or employment issue

• Health sector finds the most effective solutions possible and makes them available

• Treats all the same: we do not have rural vaccines and urban vaccines

• Not stopped by taste, custom, poverty, special interests, or political correctness

• Not afraid of advanced tech that works

Increasing Prosperity and Development

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Hou

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Very Low Income

200 million

Low Income 400 million

Middle Income 400 million

High Income 200 million

Crop Waste Dung

Coal

Kerosene

Natural Gas

Electricity

Non-solid fuels

Solid Fuels

Liquefied Petroleum Gas

Biogas

Wood

Conceptual Indian Energy Ladder

How do we help people move into

this realm?

Smith/Pillarisetti, 2014

India: What If? Millions

9% instead of 5.5%/yr for 20 years

India: What If? Millions

9% instead of 5.5%/yr for 20 years

A Chulha Trap or a

Clean Fuel Gap?

Of course • Just providing affordable access does not

mean people instantly switch • Fact that 60% of world uses gas and/or

electricity argues strongly that the rest will. • The experience of Ecuador and others show

that at some price, everyone will forgo gathered biomass fuel

• Is clearly what is needed in long term – why not sooner rather than later?

Subsidy or ?

• Health sector does not refer to programs to vaccinate or provide maternal care to the poor as “subsidies” but rather

• Social investments • In order for public support of clean fuels to be

termed social investments, they need to be far better targeted than in the past.

• Modern IT technology provides ways to do so

Five Paradigm Shifts

• Make the clean available, as well as make the available clean

• Embrace/enhance transformational leap-frog technologies

• Look for community solutions • Enhance displacement of clean fuels from

richer to poorer households • Act recognizing that it is primarily a health

issue

Many thanks Publications and presentations on website – easiest to just “google” Kirk R. Smith