Household air pollution and other environmental determinants of health in the context of the World Humanitarian Summit
Author: Niall Roche
As someone who, in the lead up to the World Humanitarian Summit, participated in the Irish Humanitarian Consultative process and workshops on the topic of Protection (child protection and the protection of civilians), I fear a glaring gap as we look to shape the future of humanitarian action. The focus of my fear is with respect to Household Air Pollution and other environmental factors that contribute to the burden of disease in crisis situations. But, I also see how this gap could be filled by a greater emphasis on the value of evidence to identify the scale and consequences of the problems, and to evaluate possible solutions.
WHO estimate that a quarter of all deaths are directly caused by environmental factors (WHO 2016). This equates to 12.6 million deaths a year, or 1,400 people every hour of every day. The hardest hit are those in Low and Middle Income Countries, the very countries most likely to be affected by a disaster, be it a natural disaster or complex emergency.
If we look specifically at air pollution, ambient and indoor air pollution accounts for more than 7 million deaths per year, with household air pollution said to account for 4.3 million premature deaths annually (WHO Feb 2016). This is more than 3 times the number of deaths (1.2 million in 2014) attributed to HIV/AIDS. (WHO Nov 2015).
Approximately one in eight of the household air pollution deaths are due to pneumonia (WHO Feb 2016), which is one of the two leading causes of death in children under 5 and according to Sphere (Sphere 2011) one of the four big killers (accounting for 60 – 90% of deaths) affecting people in conflict affected settings (diarrhoea, malaria and measles being the other three). WHO indicate that more than 50% of deaths due to pneumonia among children under 5 are caused by the particulate matter inhaled from household air pollution (WHO Feb 2016).
Approximately 3 billion people globally are dependent on biomass (wood, crop waste and dung for example) stoves to cook and heat their homes (WHO Feb 2016). The poorest and most vulnerable are at the bottom of the energy ladder, using highly polluting fuels such as crop waste and dung and are, therefore, most exposed to the fine particulate matter that is injurious to health. These are also the people at highest risk from disasters and, following a disaster, they will continue to be dependent on biomass fuels. The humanitarian sector needs to recognise this problem and we need evidence to guide solutions. But, at the moment, despite the logic that those at risk of a disaster and those affected by a disaster are using highly polluting biomass fuels and therefore prone to the ill health effects that affects so many, there seems to be little attention in humanitarian action to this threat.
In my 25 years working in humanitarian action, I have rarely if ever seen any concerted attempt to address household air pollution as a priority during any phase in the response to a disaster or afterwards in early recovery. A quick review of the Sphere Minimum Standards Handbook and the Minimum Standards for Child Protection in Humanitarian Action reveals nothing explicit with respect to this environmental risk, and, yet, it is an area in which research can be done, evidence generated and guidance developed.
The WHO recently announced reforms it is making in the area of outbreaks and emergencies. They state that this new programme is designed to be comprehensive, addressing all hazards (WHO 30th January 2016). The Special Session on Global Health at the WHS also talks about managing risks (WHS 2016). The questions I ask are, will all those risks or hazards be identified, will sufficient priority be given to household air pollution and other key environmental risk factors in humanitarian contexts and how will evidence be used to identify the scale and consequences of these problems, to evaluate possible solutions and to implement those that will help.
- The Sphere Project, Humanitarian Charter and Minimum Standards in Humanitarian Response, Practical Action Publishing, 2011
- Minimum Standards for Child Protection in Humanitarian Action, Child Protection Working Group (CPWG), 2012
- Preventing disease through healthy environments, A global assessment of the burden of disease from environmental risks, WHO, 2016
- Director General’s Office, Global Policy Statement on reforms of WHO work in outbreaks and emergencies 30th January 2016 http://www.who.int/dg/speeches/2016/reform-statement/en/
- Household Air Pollution and Health, WHO Fact Sheet No. 292, Updated February 2016 http://www.who.int/mediacentre/factsheets/fs292/en/
- HIV/AIDS, WHO Fact Sheet No. 360 November 2015 http://www.who.int/mediacentre/factsheets/fs360/en/
- World Humanitarian Summit WHS – Global Health Special Session https://consultations.worldhumanitariansummit.org/bitcache/599b42308ad2b6f244d1c9c3539535b5a5ccaa2a?vid=574075&disposition=inline&op=view
Niall Roche is a WaSH/Environmental Health Consultant and Adjunct Assistant Professor at the Centre for Global Health in Trinity College Dublin. He has worked in responding to and evaluating humanitarian action, primarily with NGOs for nearly 25 years across sub-Saharan Africa, South Asia and South East Asia. While at home, he teaches or trains on global health and humanitarian action at a number of academic and training institutions across Ireland, the UK and Denmark.
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