| Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions Junfeng (Jim) Zhang1 and Kirk R. Smith2 1School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA; 2School of Public Health, University of California, Berkeley, California, USA Abstract
Objective: Nearly all China's rural residents and a shrinking fraction of urban residents use solid fuels (biomass and coal) for household cooking and/or heating. Consequently, global meta-analyses of epidemiologic studies indicate that indoor air pollution from solid fuel use in China is responsible for approximately 420,000 premature deaths annually, more than the approximately 300,000 attributed to urban outdoor air pollution in the country. Our objective in this review was to help elucidate the extent of this indoor air pollution health hazard. Data sources: We reviewed approximately 200 publications in both Chinese- and English-language journals that reported health effects, exposure characteristics, and fuel/stove intervention options. Conclusions: Observed health effects include respiratory illnesses, lung cancer, chronic obstructive pulmonary disease, weakening of the immune system, and reduction in lung function. Arsenic poisoning and fluorosis resulting from the use of "poisonous" coal have been observed in certain regions of China. Although attempts have been made in a few studies to identify specific coal smoke constituents responsible for specific adverse health effects, the majority of indoor air measurements include those of only particulate matter, carbon monoxide, sulfur dioxide, and/or nitrogen dioxide. These measurements indicate that pollution levels in households using solid fuel generally exceed China's indoor air quality standards. Intervention technologies ranging from simply adding a chimney to the more complex modernized bioenergy program are available, but they can be viable only with coordinated support from the government and the commercial sector. Key words: burden of disease, cancer, household fuels, improved stoves, indoor air pollution, poisonous coals, respiratory disease. Environ Health Perspect 115: 848–855 (2007) . doi:10.1289/ehp.9479 available via http://dx.doi.org/ [Online 27 February 2007]
Address correspondence to J. Zhang, University of Medicine and Dentistry of New Jersey (UMDNJ) , School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854 USA. Telephone: (732) 235-5405. Fax: (732) 235-4004. E-mail: jjzhang@eohsi.rutgers.edu Supplementary Material is available online (http://www.ehponline.org/docs/2007/9479/suppl.pdf) . This article is based on a review article prepared as a plenary presentation for the 10th International Conference on Indoor Air Quality and Climate, 4–9 September 2005 in Beijing, China. We appreciate the assistance of X. He, W. Hu, R. Chapman, E. Larson, M. Ezzati, L. Tian, and J. Sinton. The authors declare they have no competing financial interests. Received 3 July 2006 ; accepted 27 February 2007.
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