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Cablegate: Summary of Responses to Cable On Indoor Air

DE RUEHC #4711/01 2891733
P 161723Z OCT 07




E.O. 12958: N/A

REF: 2006 STATE 192623

1. This is an action request. See Paragraph 3.


2. SUMMARY: Reftel asked posts in countries where greater
than 20 percent of the population uses biomass and coal to
meet basic energy needs to assess host countries, commitment
to addressing the health concerns posed by indoor air
pollution (IAP) and to identify opportunities for
strengthening U.S. diplomatic outreach on the issue. This
cable provides a synopsis of the responses, identifies
priority countries for outreach, and asks posts to encourage
these countries to join the Partnership for Clean Indoor Air
(PCIA), one of the public-private partnerships launched by
the U.S. at the World Summit on Sustainable Development
registered with the UN Commission for Sustainable
Development. For more information on PCIA please visit END SUMMARY.

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3. ACTION REQUEST: Department asks Posts to share information
about PCIA with relevant host government ministries and
agencies (e.g. health, environment, energy, women and
children, economic development) and to encourage them to join
the Partnership. Posts may use the general comments in
Paragraphs 12-16 and also country specific comments in
Paragraph 17 in developing talking points for their
respective host governments. Department would appreciate
post,s consideration of hosting roundtable meetings for
relevant civil society organization and government ministries
to encourage awareness about IAP, to introduce them to PCIA,
and to encourage membership in it. Organizations can register
to become a partner on the PCIA website. Department
appreciates Posts, assistance and support for U.S. efforts
to mitigate indoor air pollution and improve global health.
Please contact OES/IHB,s Lindsey Hillesheim
( or 202-647-6922) or Dano Wilusz
( or 202-647-6817) with Mission,s response
and for any necessary additional background information.

Department requests a response by November 30, 2007


4. Summary (Paragraph 2)
Point of Contact (Paragraph 3)
Synopsis of Responses from 21 Countries (Paragraphs 5-9)
Encouraging Government PCIA Membership (Paragraphs 10-11)
General Background on IAP (Paragraph 12-15)
General Background on PCIA (Paragraph 16)
Country Specific Comments (Paragraph 17)
Further Resources (Paragraph 18)


5. Reftel asked posts in countries where greater than 20
percent of the population uses biomass and coal to meet basic
energy needs to assess host countries, commitment to
addressing the health concerns posed by indoor air pollution
(IAP) and to identify opportunities for strengthening U.S.
diplomatic outreach on the issue. As of June 2007 Department
had received responses from posts in 21 countries. These 21
countries represent approximately 50% of the estimated 3
billion people who burn solid fuel for cooking and heating.
While the content and depth of individual responses varied
significantly, we were able to make conclusions in four
areas: host government commitment; ministry responsibility;
public and non-governmental activities related to IAP; and
host government interest in the Partnership for Clean Indoor
Air (PCIA), one of the public-private partnerships launched
by the U.S. at the World Summit on Sustainable Development
registered with the UN Commission for Sustainable
Development. Since 2003, PCIA partner organizations have
succeeded in influencing 1.31 million households to adopt
clean and efficient cooking and/or heating practices;
resulting in 11 million with reduced exposure to harmful
indoor air pollution. The U.S. Environmental Protection
Agency (EPA) coordinates PCIA and leads USG efforts within it.

6. GOVERNMENT COMMITMENT: Host government commitment to
reducing indoor air pollution and the negative health effects
associated with it varied considerably. Approximately half

STATE 00144711 002 OF 005

of the response cables could not identify any government
action plan, besides further study, to address indoor air
pollution. Approximately one-quarter of the cables noted
that host government officials in relevant ministries did not
think IAP was a major problem in their country.

7. MINISTRY RESPONSIBILITY: The government ministry
responsible for indoor air pollution varied significantly
from country to country; three-quarters of responding posts
said their questions about IAP were referred to the Ministry
of Environment and one-quarter to the Ministry of Health.
Approximately three-quarters reported that they were referred
to multiple agencies. It seems likely that ambiguous
ministerial responsibility contributes to government inaction
on indoor air pollution in some cases.

important public and private country-level efforts aimed at
reducing indoor air pollution from solid fuel use.
Approximately half of the responses indicated that private or
government projects to distribute improved cooking stoves had
taken place in the host country. Approximately half also
indicated that host countries have had private or government
projects to encourage cleaner alternative fuels. However, it
is important to note that the vast majority of intervention
projects were carried out by private organizations and not by
the host governments. Almost no responses reported private or
government projects to educate people about the significant
and negative health impacts due to IAP.

9. PCIA INTEREST: Six of twenty-one host governments were
previously or have joined the Partnership. Another
one-quarter said that host governments were interested in
learning more.


10. One quarter of respondents indicated that host
governments are interested in learning more about PCIA.
Increased government participation in PCIA has the potential
to raise awareness about environmental health issues and to
increase international action dedicated to reducing the
health effects of indoor air pollution related to solid fuel
use. The USG provides a substantial portion of the funding
and human resources required to maintain the PCIA, and the
Partnership,s capacity to address the negative health and
environmental consequences of solid fuel use for household
energy will grow with its membership base. In addition to
receiving notices for grants and Requests for Proposals
(RFPs), PCIA members also receive information about free
in-depth technical training in community outreach and
education, stove development and performance, market
development, and exposure monitoring. Another benefit of PCIA
membership is direct exchange, both regionally and globally,
between users/cooks, researchers, entrepreneurs, project
implementers, programs directors, and policy makers.

11. The Department and PCIA coordinators from EPA,s Office
of Air and Radiation have used the responses to identify
relevant government ministries to be encouraged to join PCIA,
as well as those governments that are already PCIA members
who we would like to deepen their involvement in the
partnership. Criteria for selecting these governments
include: (1) high burden of disease from indoor air
pollution, (2) capacity to join and benefit from membership,
(3) willingness to partner with the PCIA, and (4) involvement
of international donors in national indoor air pollution
programs within that country.


12. HEALTH EFFECTS: Indoor air pollution is caused by cooking
and heating with wood, dung, coal and other solid fuels on
open fires or simple stoves. IAP is a daily reality for more
than half of the world,s population and kills over 1.6
million people each year, making IAP the second biggest
environmental contributor to ill health behind unsafe water
and sanitation. The majority of those deaths occur in
sub-Saharan Africa and Southeast Asia, where 396,000 and
483,000 people are estimated to die from exposure to IAP each
year, respectively. Worldwide, 1.2 million of the 1.6 million
annual deaths due to IAP occur in just eleven countries:
Afghanistan, Angola, Bangladesh, Burkina Faso, China, the
Democratic Republic of Congo, Ethiopia, India, Nigeria,
Pakistan and the United Republic of Tanzania. The smoke
produced by solid fuel combustion in fires or stoves contains
health-damaging pollutants including carbon monoxide, human
carcinogens, and fine particles that penetrate deep into the
lungs. These pollutants cause inflammation of the airways and

STATE 00144711 003 OF 005

lungs, impair the immune system, and reduce the
oxygen-carrying capacity of the blood. The result is a
significantly increased susceptibility to pneumonia in
children and chronic respiratory disease among adults.
Globally, pneumonia and other respiratory infections are the
single greatest cause of death in children under five. Women
exposed to indoor smoke are three times as likely to suffer
from chronic obstructive pulmonary disease (COPD) than women
who cook and heat with electricity, gas or other cleaner
fuels. Because of gender norms in many societies women are in
charge of cooking and, depending on the local cuisine, spend
between three and seven hours per day near the stove. Young
children are often carried on their mother,s backs or kept
close to the hearth. Thus, indoor air pollution
disproportionately affects women and children, and in 2002,
is estimated to have resulted in 500,000 deaths among women
and 800,000 deaths among children under five years of age.

13. ENVIRONMENTAL EFFECTS: Demand for the fuel that produces
IAP causes severe land degradation and desertification in
many of the world,s poorest countries. For example,
according to the Food and Agricultural Organization (FAO),
many countries in sub-Saharan Africa have lost three quarters
or more of their forest cover to deforestation. Such
resource depletion threatens food security, which, in turn,
can upset national and regional political stability.

14. GENDER INEQUALITY: In many countries women,s domestic
responsibilities make them disproportionately exposed to IAP.
Many women must spend several hours per day collecting fuel
for cooking and heating; a recent study found that women in
Nigeria and Ethiopia spend on average more than two hours per
day collecting fuel. Alleviating this time burden would free
women,s time for childcare, education, and income-generating
activities. Women also bear the brunt of IAP-induced disease.
For example WHO reports that each year IAP kills fewer than
200,000 men but over 500,000 women. The fight against gender
inequality is one key element of the 2002 Millennium
Declaration signed by the USG and 188 other nations.
15. ECONOMIC CONSIDERATIONS: A recent WHO report, "Fuel for
Life", estimates that making improved stoves available to
half of those still burning biomass fuels and coal on
traditional stoves would save USD 34 billion in fuel
expenditure every year, and generate an economic return of
USD 105 billion every year over a 10 year period. The report
also suggests that halving the number of people worldwide
cooking with solid fuels by 2015 would cost a total of USD 13
billion per year but would provide an economic benefit of USD
91 billion per year. The majority of these costs are borne
at the household level since donor investments are used to
design appropriate technologies, set up local businesses, and
put micro-credit systems in place. However, the majority of
the benefits also occur at the household level. Addressing
household energy needs through the introduction of improved
cook stoves not only reduces rates of illness and death but
also means that household members spend less time
recuperating from illness, caring for sick family members,
collecting fuel, and cooking. With more time available,
children may be in a better position to take advantage of
educational opportunities, while their mothers could engage
in childcare, agriculture or other income-generating
activities as a way to break the cycle of poverty.

16. The Partnership for Clean Indoor Air, an Administration
initiative launched at the World Summit on Sustainable
Development in Johannesburg in September 2002, addresses the
environmental health risk faced by three billion people who
burn traditional biomass fuels indoors for cooking and
heating. This voluntary Partnership brings together
governments, public and private organizations, multilateral
institutions, industry, and others to increase the use of
affordable, reliable, clean, efficient, and safe home cooking
and heating practices. The mission of the Partnership for
Clean Indoor Air is to improve health, livelihood and quality
of life by reducing exposure to air pollution, primarily
among women and children, from household energy use. More
information on PCIA can be found at:


17. The following country-specific information responds to
points raised in the individual country response cables or
provides country-specific information that could be useful in
raising awareness with host governments on the health,
environmental, economic and gender-based consequences of IAP
and recruiting host governments to join PCIA.

STATE 00144711 004 OF 005


A. Bangladesh: There are four active PCIA members
implementing effective household energy programs in
Bangladesh, including the LocalGovernment Engineering
Department, one of the largest engineering departments in
Bangladesh. It provides technical support to the Local
Government Institutions, reinforcing diversified application
of renewable energy technologies in the off-grid areas. Very
recently LGED has engaged with a study on 'Bangladesh Indoor
Air Pollution' which is sponsored by the World Bank. The
other organizations are Practical Action Bangladesh, Village
Education Resource Center and Barendra Advancement Integrated
Committee. WHO estimates that Bangladesh,s national burden
of disease attributable to solid fuel use is 3.6%, and
accounts for 32,000 deaths per year among children under five
years of age and 46,000 deaths total. 89% of Bangladeshis use
solid fuels.

B. India: An estimated 90% of rural Indian families use a
three-stone fire or a rudimentary stove indoors for cooking,
leading to 425,000 premature deaths each year. The 3rd
Biennial Partnership Forum was held in Bangalore in March of
this year. More than 120 partners from around the world
gathered to celebrate the tremendous progress made and set
ambitious goals for the coming years. Since 2003, PCIA
partners, efforts have led more than 1.4 million households
to adopt clean and fuel-efficient cooking or heating
practices, resulting in more than 7.6 million people with
reduced exposure to harmful indoor air pollutant. In the
next 2-3 years, the Partnership,s goal is for another 5.8
million households to adopt clean and fuel-efficient cooking
practices; of these households more than 2 million will be in
India. EPA has funded two highly successful pilot projects
in India with local NGOs Appropriate Rural Technology
Institute and The Society for Development Alternatives.
Another leading partner, the Shell Foundation, is also
actively supporting projects in India. In addition, private
sector partners such as BP India and Philips are actively
promoting clean and efficient cooking technologies that will
reduce people,s exposure to indoor air pollution and improve
their quality of life.

C. Pakistan: EPA is in the process of awarding a grant to
the Aga Khan Foundation to support the promotion of 5,500
improved cook stoves in addition to other energy efficient
and home improvement products (e.g., water warming
facilities, solar geysers, wall and roof insulations) in the
northern areas and Chitral. WHO estimates that Pakistan,s
national burden of disease attributable to solid fuel use is
4.6%, and accounts for 52,000 deaths per year among children
under five years of age and 71,000 deaths total. 81% of
Pakistanis use solid fuels.

D. Tajikistan (DUSHANBE 200): WHO estimates that
Tajikistan,s national burden of disease attributable to
solid fuel use is 3.5%, and accounts for 1000 deaths per year
among children under five years of age and 2000 deaths total.
75% of Tajiks use solid fuels.


E. Nepal (KATHMANDU 201): There are currently several IAP
projects occurring in Nepal, including a USEPA-funded project
designed and implemented by the NGO Practical Action. WHO
estimates that Nepal,s national burden of disease
attributable to solid fuel use is 2.7%, and accounts for 8000
deaths per year, including 5000 children under five years of
age. 81% of Nepal,s population uses solid fuels. The
Ministry of Environment, Science and Technology,s
Alternative Energy Promotion Centre/Energy Sector Assistance
Programme is a PCIA member. GON could be encouraged to take a
more active role in raising regional awareness for the
health, environmental, economic and gender-based consequences
of IAP.

F. Sri Lanka (COLOMBO 228): WHO estimates that Sri Lanka,s
national burden of disease attributable to solid fuel use is
1.3%, and accounts for 3000 deaths per year, including 100
children under five years of age. 67% of Sri Lanka,s
population uses solid fuels. GSL,s efforts to address IAP
have largely been focused on assessment of the problem, while
most IAP mitigation projects are carried out by NGOs. It is
not clear how coordinated these related efforts are. It is
worth noting that ARECOP and IDEA are PCIA members. Thus, GSL
membership in the partnership could provide a forum for
better coordination, as well as provide GSL officials
training in program development, implementation and
assessment. The GSL Air Resource Management Center (AirMAC)

STATE 00144711 005 OF 005

is a PCIA member. The Economics and Global Affairs Division
of the Ministry of Environment and Natural Resources,
identified in the response cable as the responsible GSL
office for handling IAP issues, is not a member.

USG,s Sustainable Development Partnerships Website
WHO General information on IAP
Fuel for Life report lforlife/
WHO National burden of disease estimates for IAP ionalburden/
Partnership for Clean Indoor Air resources

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