Energy and health transitions in development: fuel use, stove technology, and morbidity in Jarácuaro, México

The ‘‘energy ladder’’ relating improvements in socioeconomic status with transitions to m ore sophisticated stoves and to higher quality, less polluting fuels is often invoked as a theoretical model for analyzing household energy management practices. We report here on an integrated study of the energy, health and economic implications of fuel switching in the small village of Jaracu aro, Michoacan State, Mexico, that challenges and extends the traditional energy ladder model. We monitored fuel and stove use, economic status, exposure to respirable suspended particulates (RSP) and trace gases (CO, CO2, NOx, SO2), and morbidity during both wet and dry seasons for a sample of 141 persons living in 21 homes. The families surveyed utilized simple ‘‘three stone’’ fires, tra ditional enclosed or improved stoves, and gas ranges or a combination of these technologies. In Jaracuaro, people who cook regularly are twice as likely as non-cooks to exhibit acute respiratory infection (ARI), (relative risk = 2.0, 95% CI = 1.3 - 2.7). The use of improved stoves correlates with reductions in indoor concentrations of RSPs and CO, and decreases in reported cases of ARI, eye infections, and intestinal disorders. These changes are consistent with the technology component of the energy ladder, relating improvements in stove and fuel type to emissions and then to r espiratory ailments. This suggests an associated ‘‘health ladder’’ for families adopting improved stoves or kitchen designs. We find that the energy ladder framework, while useful, is also an oversim plification that masks some of the strategies used in household decision-making. This is reflec ted in Jaracuaro where the socioeconomic correlate of stove ‘‘quality’’ and income breaks down: the more affluent families do not necessarily use cleaner fuel and stove combinations or invest in kitchens that are more healthy or energy efficient. Some of the most affluent households even exhibited the highest RSP and CO concentrations. These findings lead to a more eclectic model of fuel and stove adoption and use that has implications for integrated health and development policies. One direct conclusion from this study is the need and the opportunity for educational programs to faci litate transitions to more efficient stoves and cleaner fuels for the rich and poor alike.