Estimating the health benefits of national clean cooking fuel scale-up: A case study in Ecuador using national health data

PROJECT SUMMARY / ABSTRACT Using data from a unique policy experiment in Ecuador, we propose to test whether a nationwide replacement of traditional solid fuel stoves with clean fuels resulted in large-scale improvements in child health. One-third of the world relies on burning solid fuels for their daily cooking and heating needs, leading to high levels of household air pollution exposure (HAP) and more than four million premature deaths each year. High HAP exposure is a leading cause of mortality for children under-5 globally, primarily from lower respiratory infections (LRIs) like pneumonia. Each year, about one million children under-5 die from LRIs, 45% of which are attributable to HAP exposure. Although HAP exposure can be addressed through interventions like cooking with clean fuels like liquefied petroleum gas (LPG) or electricity, nationwide transitions to clean cooking fuels are rare among low- and middle-income countries, due to high costs. The proposed study leverages (1) high- quality cause-specific mortality data and (2) a rare policy experiment of a decades-long subsidy on cooking gas to efficiently estimate the impacts of increases in clean cooking fuel use on child health. More than 90% of Ecuadorian households have transitioned from using wood-burning stoves to cooking with LPG in the last four decades facilitated in part by large subsidies. This proposal employs public use data on cooking fuel use and cause-coded mortalities from 1990 to 2014 to characterize the association between clean cooking fuel use and the rate of under-5 LRI mortalities at the canton (county) level in Ecuador. We will estimate averted mortalities from increased clean cooking and use this estimate to empirically validate the existing method for predicting the health benefits of cleaner cooking from published exposure-response curves. Currently, governments in India, Cameroon, Ghana, and elsewhere are investing billions of dollars in clean cooking each year. This innovative study is urgently needed to inform the potential child health gains from scaling up the use of clean cooking fuels like LPG or other interventions that reduce HAP. Ongoing programs may seek efficient and low-cost strategies to assess the health benefits of their LPG scale-up efforts; here, we offer methods for both empirical and theoretical estimation. Our empirical evaluation of the health benefits of a nationwide clean energy transition may also inspire greater evidence-based investment in clean cooking fuels around the world. This study responds directly to NIEHS Strategic Plan goals, including, Theme 1 Goal 7 (Data Science and Big Data, ?Development of innovative data science and data-driven approaches?), Theme 2 Goal 3 (Evidence-Based Prevention and Intervention, ?Research to develop, test, and validate evidence-based prevention and intervention strategies, to reduce or avoid exposures and their resulting health impacts?), and Theme 3 Goal 6 (Impact Evaluation, ?Use of evaluation science in EHS ? includ[ing] economic, social, and health impacts of policies ? aimed at promoting health by preventing environmental exposures?).