VZCZCXRO0933
PP RUEHDBU
DE RUEHC #4711/01 2891733
ZNR UUUUU ZZH
P 161723Z OCT 07
FM SECSTATE WASHDC
TO RUEHLM/AMEMBASSY COLOMBO PRIORITY 2288
RUEHKA/AMEMBASSY DHAKA PRIORITY 7602
RUEHDBU/AMEMBASSY DUSHANBE PRIORITY 6615
RUEHIL/AMEMBASSY ISLAMABAD PRIORITY 9641
RUEHKT/AMEMBASSY KATHMANDU PRIORITY 9731

UNCLAS SECTION 01 OF 05 STATE 144711 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: BG CE IN NP PK SENV TBIO TI
SUBJECT: SUMMARY OF RESPONSES TO CABLE ON INDOOR AIR 
POLLUTION AND FOLLOW ON ACTIONS 
 
REF: 2006 STATE 192623 
 
¶1. This is an action request. See Paragraph 3. 
 
SUMMARY 
 
 
¶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 U.S. at the World Summit on Sustainable Development 
registered with the UN Commission for Sustainable 
Development. For more information on PCIA please visit 
www.pciaonline.org.  END SUMMARY. 
 
¶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 organization 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 
(HillesheimLN@state.gov or 202-647-6922) or Dano Wilusz 
(WiluszDC@state.gov or 202-647-6817) with Mission,s response 
and for any necessary additional background information. 
 
Department requests a response by November 30, 2007 
 
TABLE OF CONTENTS 
 
¶4. Summary (Paragraph 2) 
   Point of Contact (Paragraph 3) 
   Synopsis of Responses from 21 Countries (Paragraphs 5-9) 
   Encouraging Government 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) 
 
SYNOPSIS OF RESPONSES TO REFTEL 
 
¶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 
registered with the UN Commission for Sustainable 
Development. Since 2003, PCIA partner organizations have 
succeeded in influencing 1.31 million households to adopt 
clean and efficient cooking and/or heating practices; 
resulting in 11 million with reduced exposure to harmful 
indoor air pollution. 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 
 
STATE 00144711  002 OF 005 
 
 
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; 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 reported that they 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. 
 
ENCOURAGING GOVERNMENTS TO JOIN PCIA 
 
¶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. 
 
GENERAL BACKGROUND ON INDOOR AIR POLLUTION 
 
¶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 
 
STATE 00144711  003 OF 005 
 
 
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 backs 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. 
GENERAL BACKGROUND ON PCIA 
 
¶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: 
http://www.pciaonline.org 
 
COUNTRY SPECIFIC COMMENTS 
 
¶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. 
 
 
STATE 00144711  004 OF 005 
 
 
** COUNTRIES NOT CURRENTLY PCIA MEMBERS ** 
 
¶A. Bangladesh:  There are four active PCIA members 
implementing effective household energy programs in 
Bangladesh, including the LocalGovernment Engineering 
Department, one of the largest engineering departments in 
Bangladesh. It provides technical support to the Local 
Government Institutions, reinforcing diversified application 
of renewable energy technologies in the off-grid areas. Very 
recently LGED has engaged with a study on 'Bangladesh Indoor 
Air Pollution' which is sponsored by the World Bank.  The 
other organizations are Practical Action Bangladesh, Village 
Education Resource Center and Barendra Advancement Integrated 
Committee. WHO estimates that Bangladesh,s national burden 
of disease attributable to solid fuel use is 3.6%, and 
accounts for 32,000 deaths per year among children under five 
years of age and 46,000 deaths total. 89% of Bangladeshis use 
solid fuels. 
 
¶B. India:  An estimated 90% of rural Indian families use a 
three-stone fire or a rudimentary stove indoors for cooking, 
leading to 425,000 premature deaths each year.  The 3rd 
Biennial Partnership Forum was held in Bangalore in March of 
this year.  More than 120 partners from around the world 
gathered to celebrate the tremendous progress made and set 
ambitious goals for the coming years.  Since 2003, PCIA 
partners, efforts have led more than 1.4 million households 
to adopt clean and fuel-efficient cooking or heating 
practices, resulting in more than 7.6 million people with 
reduced exposure to harmful indoor air pollutant.  In the 
next 2-3 years, the Partnership,s goal is for another 5.8 
million households to adopt clean and fuel-efficient cooking 
practices; of these households more than 2 million will be in 
India.  EPA has funded two highly successful pilot projects 
in India with local NGOs Appropriate Rural Technology 
Institute and The Society for Development Alternatives. 
Another leading partner, the Shell Foundation, is also 
actively supporting projects in India.  In addition, private 
sector partners such as BP India and Philips are actively 
promoting clean and efficient cooking technologies that will 
reduce people,s exposure to indoor air pollution and improve 
their quality of life. 
 
¶C. Pakistan:  EPA is in the process of awarding a grant to 
the Aga Khan Foundation to support the promotion of 5,500 
improved cook stoves in addition to other energy efficient 
and home improvement products (e.g., water warming 
facilities, solar geysers, wall and roof insulations) in the 
northern areas and Chitral. WHO estimates that Pakistan,s 
national burden of disease attributable to solid fuel use is 
4.6%, and accounts for 52,000 deaths per year among children 
under five years of age and 71,000 deaths total. 81% of 
Pakistanis use solid fuels. 
 
¶D. Tajikistan (DUSHANBE 200): WHO estimates that 
Tajikistan,s national burden of disease attributable to 
solid fuel use is 3.5%, and accounts for 1000 deaths per year 
among children under five years of age and 2000 deaths total. 
75% of Tajiks use solid fuels. 
 
** PCIA MEMBER COUNTRIES ** 
 
¶E. Nepal (KATHMANDU 201): There are currently several IAP 
projects occurring in Nepal, including a USEPA-funded project 
designed and implemented by the NGO Practical Action. WHO 
estimates that Nepal,s national burden of disease 
attributable to solid fuel use is 2.7%, and accounts for 8000 
deaths per year, including 5000 children under five years of 
age. 81% of Nepal,s population uses solid fuels. The 
Ministry of Environment, Science and Technology,s 
Alternative Energy Promotion Centre/Energy Sector Assistance 
Programme is a PCIA member. GON could be encouraged to take a 
more active role in raising regional awareness for the 
health, environmental, economic and gender-based consequences 
of IAP. 
 
¶F. Sri Lanka (COLOMBO 228): WHO estimates that Sri Lanka,s 
national burden of disease attributable to solid fuel use is 
1.3%, and accounts for 3000 deaths per year, including 100 
children under five years of age. 67% of Sri Lanka,s 
population uses solid fuels. GSL,s efforts to address IAP 
have largely been focused on assessment of the problem, while 
most IAP mitigation projects are carried out by NGOs. It is 
not clear how coordinated these related efforts are. It is 
worth noting that ARECOP and IDEA are PCIA members. Thus, GSL 
membership in the partnership could provide a forum for 
better coordination, as well as provide GSL officials 
training in program development, implementation and 
assessment. The GSL Air Resource Management Center (AirMAC) 
 
STATE 00144711  005 OF 005 
 
 
is a PCIA member. The Economics and Global Affairs Division 
of the Ministry of Environment and Natural Resources, 
identified in the response cable as the responsible GSL 
office for handling IAP issues, is not a member. 
 
 
¶18. FURTHER RESOURCES: 
USG,s Sustainable Development Partnerships Website 
http://www.sdp.gov 
WHO General information on IAP 
http://www.who.int/indoorair/en/ 
Fuel for Life report 
http://www.who.int/indoorair/publications/fue lforlife/ 
en/index.html 
WHO National burden of disease estimates for IAP 
http://www.who.int/indoorair/publications/nat ionalburden/ 
en/index.html 
Partnership for Clean Indoor Air resources 
http://www.pciaonline.org/resources.cfm 
RICE