Household air pollution and health

1. Household air pollution and
health
22 September 2021
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Key facts
● Around 2.6 billion people cook using polluting open fires or simple stoves fuelled by
kerosene, biomass (wood, animal dung and crop waste) and coal.
● Each year, close to 4 million people die prematurely from illness attributable to
household air pollution from inefficient cooking practices using polluting stoves
paired with solid fuels and kerosene.
● Household air pollution causes noncommunicable diseases including stroke,
ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and lung
cancer.
● Close to half of deaths due to pneumonia among children under 5 years of age are
caused by particulate matter (soot) inhaled from household air pollution.
Indoor air pollution and household energy: the forgotten
2.6 billion
Around 2.6 billion people still cook using solid fuels (such as wood, crop wastes, charcoal, coal and
dung) and kerosene in open fires and inefficient stoves. Most of these people are poor, and live in
low- and middle-income countries.

2. These cooking practices are inefficient, and use fuels and technologies that produce high levels of
household air pollution with a range of health-damaging pollutants, including small soot particles that
penetrate deep into the lungs. In poorly ventilated dwellings, indoor smoke can be 100 times higher
than acceptable levels for fine particles. Exposure is particularly high among women and young
children, who spend the most time near the domestic hearth.
Impacts on health
Over 3.8 million people a year die prematurely from illness attributable to the household air pollution
caused by the inefficient use of solid fuels and kerosene for cooking. Among these 3.8 million
deaths:
● 27% are due to pneumonia
● 18% from stroke
● 27% from ischaemic heart disease
● 20% from chronic obstructive pulmonary disease (COPD)
● 8% from lung cancer.
Pneumonia
Exposure to household air pollution almost doubles the risk for childhood pneumonia and is
responsible for 45% of all pneumonia deaths in children less than 5 years old. Household air
pollution is also risk for acute lower respiratory infections (pneumonia) in adults, and contributes to
28% of all adult deaths to pneumonia.
Chronic obstructive pulmonary disease
One in four or 25% of deaths from chronic obstructive pulmonary disease (COPD) in adults in low-
and middle-income countries are due to exposure to household air pollution. Women exposed to
high levels of indoor smoke are more than twice as likely to suffer from COPD than women who use
cleaner fuels and technologies. Among men (who already have a heightened risk of COPD due to
their higher rates of smoking), exposure to household air pollution nearly doubles that risk.
Stroke

3. Twelve percent of all deaths due to stroke can be attributed to the daily exposure to household air
pollution arising from cooking with solid fuels and kerosene.
Ischaemic heart disease
Approximately 11% of all deaths due to ischaemic heart disease, accounting for over a million
premature deaths annually, can be attributed to exposure to household air pollution.
Lung cancer
Approximately 17% of lung cancer deaths in adults are attributable to exposure to carcinogens from
household air pollution caused by cooking with kerosene or solid fuels like wood, charcoal or coal.
The risk for women is higher, due to their role in food preparation.
Other health impacts and risks
More generally, small particulate matter and other pollutants in indoor smoke inflame the airways
and lungs, impairing immune response and reducing the oxygen-carrying capacity of the blood.
There is also evidence of links between household air pollution and low birth weight, tuberculosis,
cataract, nasopharyngeal and laryngeal cancers.
Mortality from ischaemic heart disease and stroke are also affected by risk factors such as high
blood pressure, unhealthy diet, lack of physical activity and smoking. Some other risks for childhood
pneumonia include suboptimal breastfeeding, underweight and second-hand smoke. For lung
cancer and chronic obstructive pulmonary disease, active smoking and second-hand tobacco smoke
are also main risk factors.
Impacts on health equity, development and climate change
Without a substantial policy change, the total number of people lacking access to clean fuels and
technologies will remain largely unchanged by 2030 (International Energy Agency, 2017 (1)) and
therefore hinder the achievement of the 2030 Agenda for Sustainable Development.
● Fuel gathering increases the risk of musculoskeletal damage, consumes considerable time
for women and children, limits other productive activities (such as income generation) and

4. takes children away from school. In less secure environments, women and children are at risk
of injury and violence during fuel gathering.
● Black carbon (sooty particles) and methane emitted by inefficient stove combustion are
powerful climate change pollutants.
● Many of the fuels and technologies used by households for cooking, heating and lighting
present safety risks. The ingestion of kerosene is the leading cause of childhood poisonings,
and a large fraction of the severe burns and injuries occurring in low- and middle-income
countries are linked to household energy use for cooking, heating and/or lighting.
● The lack of access to electricity for 1 billion people (many of whom then use kerosene lamps
for lighting) exposes households to very high levels of fine particulate matter. The use of
polluting lighting fuels introduces other health risks, such as burns, injuries, poisonings, and
constrains other opportunities for health and development, like studying or engaging in small
crafts and trades, which require adequate lighting.
WHO response
WHO provides technical support to countries in their own evaluations and scale-up of
health-promoting household fuels and technologies. WHO is building capacity at the country and
regional level to address household air pollution through direct consultations and workshops on
household energy and health. This is further complemented by the ongoing development of the
Clean Household Energy Solutions Toolkit (CHEST) to support the implementation of WHO
Guidelines for indoor air quality: household fuel combustion. CHEST is a suite of tools and
information resources that help countries identify stakeholders working on household energy and/or
public health to design, implement and monitor policies addressing household energy.
Guidelines for indoor air quality: household fuel combustion
To ensure healthy air in and around the home, WHO’s Guidelines for indoor air quality: household
fuel combustion provide health-based recommendations on the types of fuels and technologies to
protect health as well as strategies for the effective dissemination and adoption of such home
energy technologies. These build upon existing WHO outdoor air quality guidelines and WHO
guidance on levels of specific indoor pollutants.
Household energy database

5. The WHO Household energy database is used to monitor global progress in the transition to cleaner
fuels and stove combinations in households. It also supports assessments of disease burden from
the household air pollution generated from the use of polluting fuel and technologies. Currently the
database includes housing data from more than 1100 surveys, representing 157 countries. It has
been expanded to include information on household fuels and technologies used for heating and
lighting.
As the custodial agency for Sustainable Development Goal Indicator 3.9.1 (mortality rate from the
joint effects of household and ambient air pollution) and 7.1.2 (population with primary reliance on
clean fuels and technologies), WHO uses the Household energy database to derive estimates for
tracking progress towards achieving universal clean energy access and related health impacts.
Research and programme evaluation
WHO is working with countries, researchers and other partners to harmonize methods of evaluation
across settings so that health impacts are assessed consistently and rigorously and incorporate
economic assessment of health benefits.
Leadership and advocacy in the health, energy and climate community
Health sector
In May 2015, the World Health Assembly unanimously adopted a resolution on air pollution and
health, calling for the integration of health concerns into national, regional and local air
pollution-related policies. The following year, the World Health Assembly adopted a “Roadmap for
Enhanced Action,” calling for increased cross-sector cooperation to address the health risks of air
pollution.
Building on this mandate, WHO is working to integrate guidance and resources for supporting clean
household energy into global health initiatives and decision-support tools, such as the Global Action
Plan for Pneumonia and Diarrheal Disease (GAPPD), or Global Strategy for Women and Children’s
Health, as well as into other aspects of WHO's own health policy guidance. WHO emphasizes the
compelling health arguments for cleaner household energy in a range of global forums addressing
maternal and child health issues related to pneumonia as well as forums concerned with

6. noncommunicable diseases. This advocacy can help increase awareness of the importance of
providing and scaling up of cleaner household energy as a core preventive public health measure.
Health and climate change
WHO is a partner of the Climate and Clean Air Coalition to Reduce Short-Lived Climate Pollutants
(CCAC). As a member of the CCAC’s health task force, WHO is providing technical support for
harnessing health benefits from actions to reduce short-lived climate pollutants, and working to scale
up health sector engagement to address such pollutants and improve air quality.
Health, energy and sustainable development
Reductions in air pollution-related disease burden (both for household and outdoor) will be used to
monitor the progress towards attaining the Sustainable Development Goal on Health (SDG 3).
Ensuring universal access to clean fuel and technologies is a target of the Sustainable Development
Goal on energy (SDG 7). Achieving this goal could prevent millions of deaths and improve the health
and well-being of the billions of people relying on polluting technologies and fuels for cooking,
heating and lighting.
To better assess the health risks of household energy use, as well as differentiated gender impacts
from household energy practices, WHO is leading an effort with countries and surveying agencies
(e.g. USAID’s DHS, UNICEF’s MICS, World Bank’s LSMS) to enhance, harmonize and pilot
questions for national censuses and surveys. The effort will ensure that surveys better capture
information on all the fuels and technologies used in the home for cooking, heating and lighting, as
well as other impacts like time lost to fuel collection disaggregated by sex.
WHO also supports international initiatives to improve air pollution and related health impacts such
as the Global Alliance for Clean Cookstoves and the Climate Clean Air Coalition.
(1) WEO-2017 Special Report: Energy Access Outlook, International Energy Agency, 2017
(https://webstore.iea.org/weo-2017-special-report-energy-access-outlook)
Related

7. ● WHO Household energy database
● WHO’s work on air pollution
● Lives-Saved tool (LiST)
● Health in the green economy
● Global Alliance for Clean Cookstoves
● Sustainable Energy for All Initiative
● WHO Global Health Observatory
News
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Fact sheets
Ambient (outdoor) air pollution 22 September 2021
Facts in pictures
Why urban health matters 24 May 2019
Feature stories
Launch of WHO's Household Energy Policy Repository 6 October 2021
What are the WHO Air quality guidelines? 22 September 2021
Documents
WHO Air quality database 2022 - V7 (1246 KB)

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