VZCZCXYZ0004
PP RUEHWEB

DE RUEHC #4727 2891754
ZNR UUUUU ZZH
P 161743Z OCT 07
FM SECSTATE WASHDC
TO RUEHGT/AMEMBASSY GUATEMALA PRIORITY 0000
RUEHMU/AMEMBASSY MANAGUA PRIORITY 0000
RUEHZP/AMEMBASSY PANAMA PRIORITY 0000
RUEHSN/AMEMBASSY SAN SALVADOR PRIORITY 0000

UNCLAS STATE 144727 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: ES GT NU PM SENV TBIO
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 United States at the 2002 World Summit on Sustainable 
Development and 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 organizations 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 5-8) 
   Priority Countries for 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 FROM 21 COUNTRIES 
 
¶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 
and registered with the UN Commission for Sustainable 
Development. 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 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.  About 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 of the 
information-seekers 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 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 
back 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. No governments 
in Central or South America are Partnership members. 
 
** COUNTRIES NOT CURRENTLY PCIA MEMBERS ** 
 
¶A. El Salvador (SAN SALVAD 158): GOES Ministry of Public 
Health (MSP) appears to be the most directly engaged with IAP 
issues, and its efforts are primarily educational. The 
Ministry of Environment and Natural Resources (MARN) may be 
more receptive to the deforestation aspect of IAP. Both 
ministries could benefit from PCIA membership. Many of the 
NGOs working on IAP-related projects in El Salvador are PCIA 
members; thus the partnership also provides an opportunity 
for the GOES to coordinate its efforts with the NGOs. WHO 
estimates that El Salvador's national burden of disease 
attributable to solid fuel use is 1.0%, and accounts for 200 
deaths per year in children under five years of age. 33% of 
El Salvador's population uses solid fuels. 
 
¶B. Guatemala (no response): The Guatemalan NGO HELPS 
International has one of the most effective IAP mitigation 
programs in the world and is a PCIA member. GOG is not 
currently a member of PCIA. WHO estimates that Guatemala's 
national burden of disease attributable to solid fuel use is 
3.1%, and accounts for 1200 deaths per year among children 
under five years of age. 62% of Guatemala's population uses 
solid fuels. 
 
¶C. Nicaragua (no response): WHO estimates that Nicaragua's 
national burden of disease attributable to solid fuel use is 
2.3%, and accounts for 1,000 deaths per year in children 
under five years of age. 64% of Nicaragua's population uses 
solid fuels.  In June 2007, EPA participated in the technical 
meeting &Firewood Impacts on Energy, Environment and 
Health8 hosted by the Nicaraguan Ministry of Energy and 
Mines.  They expressed interest in joining the Partnership, 
but have not yet registered.  They are collaborating with the 
NGO Prole$a in promoting clean and efficient stoves to 
households and tortilla makers. 
 
¶D. Panama (PANAMA 90): GOP's response indicated that it is 
not concerned about IAP because most biomass cooking is 
outdoors.  However studies have shown that women and children 
standing close to an outdoor cooking fire are exposed to 
dangerously high levels of fine particles, carbon monoxide 
and human carcinogens.  Furthermore, outdoor fires are often 
inefficient and the collection of fuel wood contributes to 
increased deforestation. GOP expressed interest in learning 
more about PCIA. WHO estimates that Panama's national burden 
of disease attributable to solid fuel use is 2.3%, and 
accounts for 1,000 deaths per year in children under five 
years of age. 33% of Panama's population uses solid fuels. 
 
¶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