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Chances are you have seen the smoky pall that often blankets townships and rural villages. It is likely that you have also noticed the heavy soot billowing out of the smokestacks of South Africa’s coal-fired power plants, or the smog belching out of taxi, truck and car exhausts.
You would be forgiven for believing that industries and vehicles are this country’s worst air polluters. Far worse, however, is the toxic air poor people breathe inside their homes every day. It accounts for more life years lost (to ill health, disability or early death) than all sources of outdoor air pollution combined.
One-third of South African households burn wood, vegetable waste, dung or coal to cook and keep warm, producing noxious smoke indoors. André Joubert is among the millions of poor people who live in urban townships and rural villages without electricity.
This unemployed man in his late 60s shares a one-room corrugated iron shack with his wife, daughter and four grandchildren in Concordia, a township on the wooded slopes above Knysna in the Western Cape. Each day he or his wife spend two hours scavenging the nearby forest looking for wood to burn in their indoor fireplace built with cinder blocks.
“My eyes are bad, and so are my wife’s eyes,” Mr Joubert complains. “I think it is because of the smoke in the house every day.”
Acute lower respiratory tract infection
Around 20% of South African households suffer the health effects of exposure to this indoor pollution, Rosana Norman wrote in the SA Medical Journal in 2007. Illnesses that are caused or made worse by inhaling this foul smoke include lung disease, cancer, tuberculosis, cataracts and other respiratory infections.
Most seriously, household air pollution causes acute lower respiratory tract infection, which is among the top killers of children under five in South Africa, accounting for 1 400 deaths per year. Young children are disproportionately affected because their bodies are not fully developed and they spend hours next to their mothers while they are cooking.
Women are also victims, breathing in the fireplace fumes, wasting hours of their day and exposing themselves to danger while gathering wood in the nearby bush.
Siyavuya Sigutya, a young factory worker, also lives in Concordia. Many of his neighbours burn wood to cook and heat their tiny homes. “Sometimes they make the fire outdoors, because smoke makes it hard to breathe indoors,” he says.
“But when it rains, or when the night is cold, many people here bring their fires indoors. People are suffering and going to hospital because they do not have electricity.”
Compounding the problem
Draughty stoves, low-quality fuels and inadequate ventilation compound the problem of indoor air pollution. The smoke from these home fires spews toxins similar to those produced by industrial fuel combustion: benzene, carbon monoxide, formaldehyde, inhalable particles, sulphur, various hydrocarbons and volatile organic compounds.
The Institute for Race Relations (IRR) recently commissioned this writer to examine South Africa’s air quality and its effects on the poor. Although deaths as a result of air pollution are very difficult to assess, deaths caused by indoor air pollution are almost certainly underestimated, according to the Medical Research Council (MRC).
Even so, dirty household air accounts for 0.4% of all healthy life years lost, ahead of outdoor air pollution, which accounts for 0.3%, according to the MRC. Respectively, indoor and urban air pollution rank 15th and 17th on its list of life years lost to disability or premature death.
Air pollutant emissions
By comparison, unsafe sex and sexually transmitted infections, interpersonal violence, alcohol and tobacco smoking together account for more than 50% of all healthy life years lost.
Household fuel burning represents 68% of health costs resulting from air quality problems, according to PhD research undertaken by Yvonne Scorgie through the University of Johannesburg. In contrast, vehicle emissions account for 13%, industrial and commercial fuel burning for another 13%, and power generation for about 6%. Globally, the World Health Organisation blames exposure to air pollution for 8 million deaths per year, of which more than half - 4.3 million - are caused by indoor smoke.
The MRC study explains that, “Although attention to air pollutant emissions is dominated by outdoor sources, human exposure is a function of the level of pollution in places where people spend most of their time. Human exposure to air pollution is therefore dominated by the indoor environment.”
Polluted indoor air may perpetuate the poverty trap. Many poor people cannot afford electricity, efficient stoves or low-smoke fuels. Like the Jouberts, they spend several hours each day collecting firewood. Others become ill. This affects their productivity at work, at school or in the home. It becomes a vicious cycle in that poor health and poverty begets further poor health and poverty.
Household fuel use is also depleting South Africa’s woodlands as people strip their surrounding landscape of anything that will burn. Small home fires sometimes turn into infernos consuming swathes of dense shack settlements built of flammable materials.
Innovative and effective solutions to prevent or reduce hazardous indoor air pollution would directly help South Africa’s urban and rural poor. The first step, however, begins with recognising that the contaminated air inside people’s homes is both more dangerous and more widespread than industrial air pollution.
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