Indoor air pollution: 4000 deaths a day must no longer be ignored.

The United Nations Commission for Sustainable Development may not app pear, at first sight, to be a major playing field for public health. Nevertheless, when environment, energy and developp ment ministers from around the world assembled in New York on 1–12 May 2006 for the Commission’s 14th session, health concerns in relation to energy production and consumption emerged as a prominent argument in discussions on energy for sustainable development. In his opening speech, Secretary General Kofi Annan called attention to the fact that indoor air pollution from solid fuel use is one of the world’s ten major causes of mortality and morbidity.1 More than half the world’s populap tion — 3.2 billion people — still burn coal and biomass fuels such as wood, dung and crop residues to meet their basic energy needs.2 Indoor air pollution from burning these solid fuels on open fires or traditional stoves comprises a variety of healthpdamaging pollutants including particles, carbon monoxide and different carcinogens 3 and is the cause of a public health tragedy. Every year, 1.5 million people die from inhalp ing indoor pollutants that often exceed accepted guideline limits for outdoor air: in the case of fine particles, the limit is exceeded by 100 times or more.4,5 Children and women are disproporp tionately affected, with nearly 800 000 deaths attributable to indoor air pollup tion occurring among children under five years of age and more than 500 000 such deaths occurring among women.5 Preventing deaths caused by polp luted indoor air must no longer be delayed. In the short term, stoves that burn more cleanly and use fuel more efficiently, ventilation that is improved through smoke hoods or enlarged spaces in the eaves, and changes in housing design can substantially reduce pollutp ant levels. In the longer term, the use of cleaner fuels, such as liquefied petroleum gas, biogas or other modern biofuels,