Indoor air pollution (IAP) from biomass fuels is clearly linked to acute respiratory infections (ARI) and chronic obstructive pulmonary disease (COPD), and there is evidence of links to tuberculosis and lung cancer. Children under 5 years and adult women are particularly affected. The resulting morbidity and premature mortality can be calculated, and assessed in monetary terms through the use of the Cost of Illness (COI), the Human Capital Approach (HCA) and Value of Statistical Life (VSL) analysis. This article presents new results of the economic cost of health impacts for Indonesia, the Philippines, and Timor-Leste and discusses policy implications of these findings. These three countries, in which the World Bank recently undertook Country Environmental Analysis (CEA), were selected as they span large differences in income, population, mortality rates, and household prevalence in solid fuel use for cooking.



DALY is disability adjusted life year.


Burden of disease related to IAP refers here only to IAP from household use of solid fuels. There are often other sources of IAP with health effects, such as tobacco smoke, that are not considered in this paper.


Fuels for heating are not considered here, as the countries we study are in the tropical zone.


However, for children we use human capital approach (HCA) also as an upper-bound in Indonesia and Timor-Leste.


Desai et al. (2004) also include asthma and cataracts in Moderate II. Sufficient data are however not available to estimate these effects in the three study countries.


See Robertson et al. (2004) for a review of four studies in developing countries of RSV non-RSV lower respiratory infections in children.


Although the chimney stove in the Guatemala study removes the smoke from the kitchen, household member exposure reductions is smaller than the exposure reduction in the kitchen because smoke re-enters dwellings and people are exposed to the smoke outside dwellings. For instance, the Guatemala study found a 90% reduction in PM2.5 concentrations in the kitchen from the improved chimney stove, but only a 20% reduction in the bedroom.


Estimated here by the authors based on age-specific relative risk ratios of disease from changes in blood pressure, and RR=exp(β * Δ mmHg) where β is derived from relative risks in Lawes et al. (2004) for a 10 mmHg change in blood pressure.


Note that the distinction between acute upper and lower respiratory infections is of minimal importance in terms of mortality. According to the Global Burden of Disease estimates by WHO, less than 2% of acute respiratory mortality is from upper respiratory infections (and even less in children under-5) in South and South-East Asia (WHO 2004).


This region includes Indonesia, Sri Lanka and Thailand.


Indonesia comprises 72% of the population of SEAR B (WHO 2004).


The under-5 mortality rate was 36 per 1000 in 2005 (World Bank 2007b).


The denominator includes average duration of ARI because some cases of ARI reported in the two-week prevalence started before and ended after the two-week period. Not including the duration in the denominator would therefore result in double counting of some cases of ARI.


The relative risk of ALRI was applied to ARI. For instance, Ezzati and Kammen (2001) found a similar or higher relative risk of ARI than of ALRI.


Note that these relative risk ratios are assumed valid for indoor cooking with unimproved solid fuel stoves, i.e. without adjustment for outdoor cooking or use of improved stoves.


Several of the studies reviewed in Desai et al. (2004) control for smoking.


Atlas methodology: that is, market-based exchange rates are used, as opposed to purchasing power parity.


The range reflects valuation of mortality using the human capital approach (low end) and VSL (high end). A ventilation factor of 1.0 is applied to households cooking indoors and a factor of 0.25 to households cooking outdoors or with good indoor ventilation.

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