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Premature mortality from current ambient fine particulate (PM 2.5 ) exposure in India is large, but the trend under climate change is unclear. Here we estimate ambient PM 2.5 exposure up to 2100 by applying the relative changes in PM 2.5 from baseline period (2001–2005) derived from Coupled Model Inter-comparison Project 5 (CMIP5) models to the satellite-derived baseline PM 2.5 . We then project the mortality burden using socioeconomic and demographic projections in the Shared Socioeconomic Pathway (SSP) scenarios. Ambient PM 2.5 exposure is expected to peak in 2030 under the RCP4.5 and in 2040 under the RCP8.5 scenario. Premature mortality burden is expected to be 2.4–4 and 28.5–38.8% higher under RCP8.5 scenario relative to the RCP4.5 scenario in 2031–2040 and 2091–2100, respectively. Improved health conditions due to economic growth are expected to compensate for the impact of changes in population and age distribution, leading to a reduction in per capita health burden from PM 2.5 for all scenarios except the combination of RCP8.5 exposure and SSP3. Modulation of ambient PM 2.5 exposure and premature mortality burden in India under climate change scenarios is unclear. Here the authors show that the premature mortality burden is projected to decrease in 2100 relative to present day under all possible combined climate change and socioeconomic pathways scenarios.

As part of the 12th Five-Year Plan, the Chinese government has developed air pollution prevention and control plans for key regions with a focus on the power, transport, and industrial sectors. Here, we investigate the contribution of residential emissions to regional air pollution in highly polluted eastern China during the heating season, and find that dramatic improvements in air quality would also result from reduction in residential emissions. We use the Weather Research and Forecasting model coupled with Chemistry to evaluate potential residential emission controls in Beijing and in the Beijing, Tianjin, and Hebei (BTH) region. In January and February 2010, relative to the base case, eliminating residential emissions in Beijing reduced daily average surface PM2.5 (particulate mater with aerodynamic diameter equal or smaller than 2.5 micrometer) concentrations by 14 ± 7 μg·m−3 (22 ± 6% of a baseline concentration of 67 ± 41 μg·m−3; mean ± SD). Eliminating residential emissions in the BTH region reduced concentrations by 28 ± 19 μg·m−3 (40 ± 9% of 67 ± 41 μg·m−3), 44 ± 27 μg·m−3 (43 ± 10% of 99 ± 54 μg·m−3), and 25 ± 14 μg·m−3 (35 ± 8% of 70 ± 35 μg·m−3) in Beijing, Tianjin, and Hebei provinces, respectively. Annually, elimination of residential sources in the BTH region reduced emissions of primary PM2.5 by 32%, compared with 5%, 6%, and 58% achieved by eliminating emissions from the transportation, power, and industry sectors, respectively. We also find air quality in Beijing would benefit substantially from reductions in residential emissions from regional controls in Tianjin and Hebei, indicating the value of policies at the regional level.

Arsenic is a toxic pollutant commonly found in the environment. Most of the previous studies on arsenic pollution have primarily focused on arsenic contamination in groundwater. In this study, we examine the impact on human health from atmospheric arsenic on the global scale. We first develop an improved global atmospheric arsenic emission inventory and connect it to a global model (Goddard Earth Observing System [GEOS]-Chem). Model evaluation using observational data from a variety of sources shows the model successfully reproduces the spatial distribution of atmospheric arsenic around the world. We found that for 2005, the highest airborne arsenic concentrations were found over Chile and eastern China, with mean values of 8.34 and 5.63 ng/m³, respectively. By 2015, the average atmospheric arsenic concentration in India (4.57 ng/m³) surpassed that in eastern China (4.38 ng/m³) due to the fast increase in coal burning in India. Our calculation shows that China has the largest population affected by cancer risk due to atmospheric arsenic inhalation in 2005, which is again surpassed by India in 2015. Based on potential exceedance of health-based limits, we find that the combined effect by including both atmospheric and groundwater arsenic may significantly enhance the risks, due to carcinogenic and noncarcinogenic effects. Therefore, this study clearly implies the necessity in accounting for both atmospheric and groundwater arsenic in future management.

Air pollution from the use of solid household fuels is now recognized to be a major health risk in developing countries. Accordingly, there has been some shift in development thinking and investment from previous efforts, which has focused only on improving the efficiency of household fuel use, to those that focus on reducing exposure to the air pollution that leads to health impact. Unfortunately, however, this is occurring just as the climate agenda has come to dominate much of the discourse and action on international sustainable development. Thus, instead of optimizing approaches that centrally focus on the large health impact, the household energy agenda has been hampered by the constraints imposed by a narrow definition of sustainability-one primarily driven by the desire to mitigate greenhouse emissions by relying on renewable biomass fueling so-called improved cookstoves. In reality, however, solid biomass is extremely difficult to burn sufficiently cleanly in household stoves to reach health goals. In comparison to the international development community, however, some large countries, notably Brazil historically and more recently, India have substantially expanded the use of liquefied petroleum gas (LPG) in their household energy mix, using their own resources, having a major impact on their national energy picture. The net climate impact of such approaches compared to current biomass stoves is minimal or non-existent, and the social and health benefits are, in contrast, potentially great. LPG can be seen as a transition fuel for clean household energy, with induction stoves powered by renewables as the holy grail (an approach already being adopted by Ecuador as also discussed here). The enormous human and social benefits of clean energy, rather than climate concerns, should dominate the household energy access agenda today.

Estimating the burden of disease attributable to long-term exposure to fine particulate matter (PM2.5) in ambient air requires knowledge of both the shape and magnitude of the relative risk (RR) function. However, adequate direct evidence to identify the shape of the mortality RR functions at the high ambient concentrations observed in many places in the world is lacking. We developed RR functions over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children < 5 years of age. We fit an integrated exposure-response (IER) model by integrating available RR information from studies of ambient air pollution (AAP), second hand tobacco smoke, household solid cooking fuel, and active smoking (AS). AS exposures were converted to estimated annual PM2.5 exposure equivalents using inhaled doses of particle mass. We derived population attributable fractions (PAFs) for every country based on estimated worldwide ambient PM2.5 concentrations. The IER model was a superior predictor of RR compared with seven other forms previously used in burden assessments. The percent PAF attributable to AAP exposure varied among countries from 2 to 41 for IHD, 1 to 43 for stroke, < 1 to 21 for COPD, < 1 to 25 for LC, and < 1 to 38 for ALRI. We developed a fine particulate mass-based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available.

The Intergovernmental Panel on Climate Change (IPCC) released its latest report on March 31, 2014. This report was the second instalment of the Fifth Assessment Report, prepared by Working Group 2, on impacts, vulnerability, and adaptation to climate change. In this Comment, we, as contributors to the chapter on human health, explain how the IPCC report was prepared and highlight important findings.

Relations between demographic change and emissions of the major greenhouse gas carbon dioxide (CO2) have been studied from different perspectives, but most projections of future emissions only partly take demographic influences into account. We review two types of evidence for how CO2 emissions from the use of fossil fuels are affected by demographic factors such as population growth or decline, ageing, urbanisation, and changes in household size. First, empirical analyses of historical trends tend to show that CO2 emissions from energy use respond almost proportionately to changes in population size and that ageing and urbanisation have less than proportional but statistically significant effects. Second, scenario analyses show that alternative population growth paths could have substantial effects on global emissions of CO2 several decades from now, and that ageing and urbanisation can have important effects in particular world regions. These results imply that policies that slow population growth would probably also have climate-related benefits.

In the comparative risk assessment (Lim et al. 2012), performed as part of the Global Burden of Disease (GBD) 2010 Project, air pollution ranked as a leading contributor to the burden of disease in South Asia. Estimates of the burden in India show approximately 1.04 million premature deaths and 31.4 million disability-adjusted life years (DALYs) to be attributable to household air pollution (HAP) resulting from solid cooking fuels, and 627,000 premature deaths and nearly 17.8 million DALYs to be attributable to ambient air pollution (AAP) in the form of fine particulate matter 2.5 mm in aerodynamic diameter (PM2.5). HAP and AAP account for 6% and 3%, respectively, of the total national burden of disease, and together they exceed the burden from any other risk factor of the > 60 examined. This burden, borne disproportionately by poor populations who rely on solid fuels for cooking, poses an enormous challenge for air quality management within public health programs in India. There is a need to integrate research and intervention across HAP and AAP exposures in India in order to reduce disease burdens and to efficiently improve health by using intervention efforts.

Objective: Nearly all China's rural residents and a shrinking fraction of urban residents use solid fuels (biomass and coal) for household cooking and/or heating. Consequently, global meta-analyses of epidemiologic studies indicate that indoor air pollution from solid fuel use in China is responsible for approximately 420,000 premature deaths annually, more than the approximately 300,000 attributed to urban outdoor air pollution in the country. Our objective in this review was to help elucidate the extent of this indoor air pollution health hazard. Data Sources: We reviewed approximately 200 publications in both Chinese- and English-language journals that reported health effects, exposure characteristics, and fuel/stove intervention options. Conclusions: Observed health effects include respiratory illnesses, lung cancer, chronic obstructive pulmonary disease, weakening of the immune system, and reduction in lung function. Arsenic poisoning and fluorosis resulting from the use of \"poisonous\" coal have been observed in certain regions of China. Although attempts have been made in a few studies to identify specific coal smoke constituents responsible for specific adverse health effects, the majority of indoor air measurements include those of only particulate matter, carbon monoxide, sulfur dioxide, and/or nitrogen dioxide. These measurements indicate that pollution levels in households using solid fuel generally exceed China's indoor air quality standards. Intervention technologies ranging from simply adding a chimney to the more complex modernized bioenergy program are available, but they can be viable only with coordinated support from the government and the commercial sector.

This Series has examined the health implications of policies aimed at tackling climate change. Assessments of mitigation strategies in four domains—household energy, transport, food and agriculture, and electricity generation—suggest an important message: that actions to reduce greenhouse-gas emissions often, although not always, entail net benefits for health. In some cases, the potential benefits seem to be substantial. This evidence provides an additional and immediate rationale for reductions in greenhouse-gas emissions beyond that of climate change mitigation alone. Climate change is an increasing and evolving threat to the health of populations worldwide. At the same time, major public health burdens remain in many regions. Climate change therefore adds further urgency to the task of addressing international health priorities, such as the UN Millennium Development Goals. Recognition that mitigation strategies can have substantial benefits for both health and climate protection offers the possibility of policy choices that are potentially both more cost effective and socially attractive than are those that address these priorities independently.