Over the past two years, the United States has pledged
$105 million to fighting the cookstove problem. Secretary of State Hillary Clinton has repeatedly spoken about it. And of course, no global health issue is complete without a Hollywood advocate; in this case, it’s Julia Roberts.
The main goal of the effort is to replace traditional cookstoves with “clean cookstoves,” which are more efficient and often feature chimneys to direct fumes out of the home.
An ambitious goal
The Global Alliance for Clean Cookstoves, which the U.S. government helped found in 2010, aims to help 100 million households replace their stoves with clean alternatives by 2020. But there’s a potential problem with this ambitious goal: A new study suggests the replacement stoves may not make any difference.
Clean cookstove advocates have based their strategy on two kinds of studies. In observational studies, researchers compare the prevalence of pneumonia, lung cancer, low birthweight, etc., in traditional-cookstove houses with rates in houses that use clean cookstoves. That’s a good place to start, but it’s subject to all sorts of confounders. Families with better cookstoves are likely to have more money, better nutrition and superior access to health care. So the differences in health status may have little or nothing to do with the stoves.
There has also been a single large-scale prospective study, known as RESPIRE. (The name stands for Randomized Exposure Study of Pollution Indoors and Respiratory Effects.) The study showed that clean cookstoves improved air quality and health, although not nearly as much as was suggested in the observational studies.
There are several reasons, though, to question RESPIRE’s results. First, the brick and metal stoves tested in its study were the Cadillacs of clean cookstoves. They cost $100 to $150 apiece, which is more than the average annual per capita income in many poor villages. Rolling out these stoves to
100 million homes would be hugely expensive.
More problematically, the conditions of the RESPIRE study probably weren’t realistic. Field workers trained families on the use and care of the test stoves, and returned weekly to make sure the stoves were being used properly. When the stoves broke down, the field workers arranged for repair. Such intensive intervention would be nearly impossible on a large scale.