Cablegate: Summary of Responses to Cable On Indoor Air


DE RUEHC #4727 2891754
P 161743Z 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 United States at the 2002 World Summit on Sustainable
Development and registered with the UN Commission for
Sustainable Development. For more information on PCIA please

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 organizations 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 5-8)
Priority Countries for 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
and registered with the UN Commission for Sustainable
Development. 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 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. About 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 of the
information-seekers were referred to multiple agencies. It
seems likely that ambiguous ministerial responsibility
contributes to government inaction on indoor air pollution in
some cases.

8. INDOOR AIR POLLUTION INTERVENTIONS: Posts highlighted many 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 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
back 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. No governments
in Central or South America are Partnership members.


A. El Salvador (SAN SALVAD 158): GOES Ministry of Public
Health (MSP) appears to be the most directly engaged with IAP
issues, and its efforts are primarily educational. The
Ministry of Environment and Natural Resources (MARN) may be
more receptive to the deforestation aspect of IAP. Both
ministries could benefit from PCIA membership. Many of the
NGOs working on IAP-related projects in El Salvador are PCIA
members; thus the partnership also provides an opportunity
for the GOES to coordinate its efforts with the NGOs. WHO
estimates that El Salvador's national burden of disease
attributable to solid fuel use is 1.0%, and accounts for 200
deaths per year in children under five years of age. 33% of
El Salvador's population uses solid fuels.

B. Guatemala (no response): The Guatemalan NGO HELPS
International has one of the most effective IAP mitigation
programs in the world and is a PCIA member. GOG is not
currently a member of PCIA. WHO estimates that Guatemala's
national burden of disease attributable to solid fuel use is
3.1%, and accounts for 1200 deaths per year among children
under five years of age. 62% of Guatemala's population uses
solid fuels.

C. Nicaragua (no response): WHO estimates that Nicaragua's
national burden of disease attributable to solid fuel use is
2.3%, and accounts for 1,000 deaths per year in children
under five years of age. 64% of Nicaragua's population uses
solid fuels. In June 2007, EPA participated in the technical
meeting &Firewood Impacts on Energy, Environment and
Health8 hosted by the Nicaraguan Ministry of Energy and
Mines. They expressed interest in joining the Partnership,
but have not yet registered. They are collaborating with the
NGO Prole$a in promoting clean and efficient stoves to
households and tortilla makers.

D. Panama (PANAMA 90): GOP's response indicated that it is
not concerned about IAP because most biomass cooking is
outdoors. However studies have shown that women and children
standing close to an outdoor cooking fire are exposed to
dangerously high levels of fine particles, carbon monoxide
and human carcinogens. Furthermore, outdoor fires are often
inefficient and the collection of fuel wood contributes to
increased deforestation. GOP expressed interest in learning
more about PCIA. WHO estimates that Panama's national burden
of disease attributable to solid fuel use is 2.3%, and
accounts for 1,000 deaths per year in children under five
years of age. 33% of Panama's population uses solid fuels.


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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