Up in Smoke: the Influence of Household Behavior on the Long-Run Impact of Improved Cooking Stoves

It is conventional wisdom that it is possible to reduce exposure to indoor air pollution, improve health outcomes, and decrease greenhouse gas emissions in the rural areas of developing countries through the adoption of improved cooking stoves. This belief is largely supported by observational field studies and engineering or laboratory experiments. However, we provide new evidence, from a randomized control trial conducted in rural Orissa, India (one of the poorest places in India), on the benefits of a commonly used improved stove that laboratory tests showed to reduce indoor air pollution and require less fuel. We track households for up to four years after they received the stove. While we find a meaningful reduction in smoke inhalation in the first year, there is no effect over longer time horizons. We find no evidence of improvements in lung functioning or health and there is no change in fuel consumption (and presumably greenhouse gas emissions). The difference between the laboratory and field findings appear to result from households' revealed low valuation of the stoves. Households failed to use the stoves regularly or appropriately, did not make the necessary investments to maintain them properly, and usage rates ultimately declined further over time. More broadly, this study underscores the need to test environmental and health technologies in real-world settings where behavior may temper impacts, and to test them over a long enough horizon to understand how this behavioral effect evolves over time.

[1]  Nigel Bruce,et al.  Personal child and mother carbon monoxide exposures and kitchen levels: Methods and results from a randomized trial of woodfired chimney cookstoves in Guatemala (RESPIRE) , 2010, Journal of Exposure Science and Environmental Epidemiology.

[2]  Ken R. Smith,et al.  Impact of improved biomass cookstoves on indoor air quality near Pune, India , 2007 .

[3]  Daniel M. Kammen,et al.  Mortality and Greenhouse Gas Impacts of Biomass and Petroleum Energy Futures in Africa , 2005, Science.

[4]  Ken R. Smith Biofuels, Air Pollution, and Health: A Global Review , 2012 .

[5]  Roger I. Glass,et al.  A Major Environmental Cause of Death , 2011, Science.

[6]  E. Boy,et al.  Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala. , 1998, International journal of epidemiology.

[7]  David I. Levine,et al.  The effect of solar ovens on fuel use, emissions and health: results from a randomised controlled trial , 2013 .

[8]  F. Binka,et al.  Impact of spatial distribution of permethrin-impregnated bed nets on child mortality in rural northern Ghana. , 1998, The American journal of tropical medicine and hygiene.

[9]  S. Lindsay,et al.  The effect of insecticide-treated bed nets on mortality of Gambian children , 1991, The Lancet.

[10]  Robert Bailis,et al.  Low demand for nontraditional cookstove technologies , 2012, Proceedings of the National Academy of Sciences.

[11]  Erik Snowberg,et al.  Selective Trials: A Principal-Agent Approach to Randomized Controlled Experiments , 2012 .

[12]  Alison Brettle,et al.  Evidence of Impact , 2014 .

[13]  N. Bruce,et al.  Indoor air pollution in developing countries: a major environmental and public health challenge. , 2000, Bulletin of the World Health Organization.

[14]  M. Kandlikar,et al.  A perspective paper on black carbon mitigation as a response to climate change. , 2009 .

[15]  Jaswadi,et al.  Causal Effect of Health on Labor Market Outcomes: Experimental Evidence , 2006 .

[16]  P. Dupas Health Behavior in Developing Countries , 2011 .

[17]  Ken R. Smith Indoor Air Pollution , 1999 .

[18]  C. Chandramouli,et al.  The Census of India , 1932, Nature.

[19]  S. Jayachandran Air Quality and Early-Life Mortality: Evidence from Indonesia's Wildfires , 2008 .

[20]  Majid Ezzati,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[21]  Radhika Menon,et al.  A rapid assessment randomised-controlled trial of improved cookstoves in rural Ghana , 2012 .

[22]  M. Greenstone,et al.  Evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River policy , 2013, Proceedings of the National Academy of Sciences.

[23]  K. Balakrishnan,et al.  Prevalence of chronic obstructive pulmonary disease in rural women of Tamilnadu: implications for refining disease burden assessments attributable to household biomass combustion , 2011, Global health action.

[24]  Erik Snowberg,et al.  Selective Trials: A Principal-Agent Approach to Randomized Controlled Experiments , 2010 .

[25]  N. Ellison,et al.  The Merck Manual of Diagnosis and Therapy. 17th ed. , 1999 .

[26]  Alexander Pfaff,et al.  Demonstrating bias and improved inference for stoves' health benefits. , 2011, International journal of epidemiology.

[27]  Ken R. Smith,et al.  Fuel efficiency of an improved wood-burning stove in rural Guatemala: implications for health, environment and development , 2000 .

[28]  J. Peters,et al.  A Recipe for Success? Randomized Free Distribution of Improved Cooking Stoves in Senegal , 2012 .

[29]  Martin H. Levinson The Merck Manual of Diagnosis and Therapy, 18th edition , 2000 .

[30]  Edward Miguel,et al.  Spring Cleaning: Rural Water Impacts, Valuation and Property Rights Institutions , 2009, The quarterly journal of economics.

[31]  Daniel Pope,et al.  Impact of Reduced Maternal Exposures to Wood Smoke from an Introduced Chimney Stove on Newborn Birth Weight in Rural Guatemala , 2011, Environmental health perspectives.

[32]  K. Balakrishnan,et al.  Daily average exposures to respirable particulate matter from combustion of biomass fuels in rural households of southern India. , 2002, Environmental health perspectives.

[33]  Nigel Bruce,et al.  Eye discomfort, headache and back pain among Mayan Guatemalan women taking part in a randomised stove intervention trial , 2005, Journal of Epidemiology and Community Health.

[34]  Omar Masera,et al.  Improved biomass stove intervention in rural Mexico: impact on the respiratory health of women. , 2009, American journal of respiratory and critical care medicine.

[35]  Nigel Bruce,et al.  Effect of reducing indoor air pollution on women's respiratory symptoms and lung function: the RESPIRE Randomized Trial, Guatemala. , 2009, American journal of epidemiology.

[36]  Lewis R. Lipsey,et al.  The Merck Manual of Diagnosis and Therapy , 1988, The Yale Journal of Biology and Medicine.

[37]  Alan Hubbard,et al.  Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): a randomised controlled trial , 2011, The Lancet.

[38]  A. Díaz,et al.  Chimney Stove Intervention to Reduce Long-term Wood Smoke Exposure Lowers Blood Pressure among Guatemalan Women , 2007, Environmental health perspectives.

[39]  R. Hanna,et al.  Does the Effect of Pollution on Infant Mortality Differ Between Developed and Developing Countries? Evidence from Mexico City , 2012 .

[40]  B Hileman,et al.  Indoor air pollution. , 2018, Environmental science & technology.

[41]  R. Snow,et al.  Insecticide‐treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast , 1996, Tropical medicine & international health : TM & IH.

[42]  K. Balakrishnan,et al.  Air pollution from household solid fuel combustion in India: an overview of exposure and health related information to inform health research priorities , 2011, Global health action.

[43]  Ken R. Smith,et al.  Emissions and efficiency of improved woodburning cookstoves in Highland Gatemala , 1998 .

[44]  S. P. Kachur,et al.  Efficacy of permethrin-treated bed nets in the prevention of mortality in young children in an area of high perennial malaria transmission in western Kenya. , 2003, The American journal of tropical medicine and hygiene.

[45]  K. Balakrishnan,et al.  Respiratory risks from household air pollution in low and middle income countries. , 2014, The Lancet. Respiratory medicine.

[46]  M. Rosenzweig Short- and Long-Term Health Effects of Burning Biomass in the Home in Low-Income Countries , 2010 .

[47]  A. Mobarak,et al.  Gender Differences in Preferences, Intra-Household Externalities, and Low Demand for Improved Cookstoves , 2013 .

[48]  M. Duggan Do new prescription drugs pay for themselves? The case of second-generation antipsychotics. , 2005, Journal of health economics.

[49]  J. Currie,et al.  Air Pollution and Infant Health: What Can We Learn from California's Recent Experience? , 2004, SSRN Electronic Journal.

[50]  P. Dupas Short-Run Subsidies and Long-Run Adoption of New Health Products: Evidence from a Field Experiment , 2010, Econometrica : journal of the Econometric Society.

[51]  Bhaswati Ganguli,et al.  State and national household concentrations of PM2.5 from solid cookfuel use: Results from measurements and modeling in India for estimation of the global burden of disease , 2013, Environmental Health.

[52]  K. R. Smith National burden of disease in India from indoor air pollution. , 2000, Proceedings of the National Academy of Sciences of the United States of America.

[53]  Esther Duflo,et al.  HEALTH, HEALTH CARE, AND ECONOMIC DEVELOPMENT: Wealth, Health, and Health Services in Rural Rajasthan. , 2004, The American economic review.