Smoking, Fuel Use in China Projected to Cause Millions of Deaths

If current levels of smoking and biomass and coal fuel use in homes continues, between 2003 and 2033 there will be an estimated 65 million deaths from chronic obstructive pulmonary disease (COPD) and 18 million deaths from lung cancer in China, accounting for 19 percent and 5 percent of all deaths in that country during this period.

Researchers at the Harvard School of Public Health (HSPH) predict that the combined effects of these two major factors alone will be responsible for more than 80% of COPD deaths and 75 percent of lung cancer deaths in China over a 30-year period. But interventions to reduce smoking and household use of biomass fuels and coal for cooking and heating could significantly reduce the number of deaths.

The findings are from a study that will appear online on October 4 and in the October 25 print issue of The Lancet. It is the first quantitative analysis to look at the combined effects of smoking and household fuel use on COPD, lung cancer and tuberculosis (TB).

Respiratory diseases are among the 10 leading causes of deaths in China. About half of Chinese men smoke and in more than 70 percent of homes in China residents cook and heat their homes with wood, coal and crop residues. Smoking and pollution from indoor burning of these fuels are major risk factors for COPD and lung cancer and have been linked with tuberculosis (TB). Globally, more than 900 million of the world's 1.1 billion smokers currently live in low-income and middle-income countries and about one half of the world's population uses biomass fuels and coal for household energy.

Using data on smoking, fuel use and current as well as projected levels of COPD, lung cancer and TB, the authors set out to estimate the effects of modifying smoking and fuel use on future COPD and lung cancer deaths and TB incidence. They grouped the results into scenarios based on whether interventions involved moderate control of smoking and fuel use, aggressive control or a complete cessation of exposures to the pollutants.

They found that reducing those two risk factors would significantly decrease deaths from COPD and lung cancer. If smoking and biomass and coal use were to be eliminated gradually over the next 30 years, an estimated 26 million COPD deaths (40 percent of projected COPD deaths) and 6 million lung cancer deaths (34 percent of projected lung cancer deaths) would be avoided. For moderate and aggressive control scenarios, deaths from these diseases could be reduced by an estimated 17 percent to 34 percent among men and 18 percent to 29 percent among women. There will also be major benefits for TB, above and beyond those that can be achieved through treatment.

Hsien-Ho Lin, a graduate student in the department of epidemiology at HSPH and the lead author of the study, says "this analysis shows that smoking and fuel use, which affects hundreds of millions of people in China, will be a defining feature of future health in that country."

Policy responses and specific interventions could help reduce the enormous disease burden from smoking and household fuel use. In the article, the authors suggest that at the national level, for example, authorities could create regulatory and economic policies that reduce smoking and promote clean household fuels. At the individual level, TB patients could be offered tobacco cessation programs.

"There are proven ways to reduce tobacco smoking and to provide homes with clean-burning energy alternatives. China can save millions of premature deaths from respiratory diseases in the next few decades if it leverages its effective policy system to implement these interventions," says Majid Ezzati, associate professor of international health at HSPH and senior author of the study.

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RAND: Army Can Boost Mission Success by Better Managing Environmental Considerations

By better managing environmental issues during deployments, U.S. Army units can gain tactical and strategic advantages that will help in combat and post-conflict operations, and boost overall mission success, according to a recent RAND Corporation study.

The study finds that commanders have not usually given environmental concerns high priority during planning, despite the effect environmental conditions can have on troop health, safety and security, and the importance they have for the local population.

Researchers recommend that Army leaders give more weight to strategic, operational and tactical aspects of environmental considerations during planning and operations, and develop comprehensive standards and best practices to address environmental issues during contingencies, an announcement of the study says.

This is consistent with the Army's new counterinsurgency doctrine, which highlights the importance of environmental improvements (especially sewage, water and trash) to gain support of the local population.

U.S. experience in Iraq suggests that providing clean water, electricity, sewage and trash management can tip the balance between the local residents supporting the U.S. mission or the insurgency, according to the study. Public opinion surveys suggest that Iraqis care about these issues almost as much as security.

Environmental considerations encompass anything related to the environment that affects the planning and execution of military operations or is affected by those operations. They include (but are not limited to) clean water, sewage-related infrastructure, soldier health, compliance with environmental laws, sustainability, protection of historical and cultural sites, and management of agricultural and natural resources.

“Perhaps the most underappreciated aspect of environmental considerations is the role that they can play in achieving U.S. national objectives in counterinsurgency and stability operations,” says report co-author David Mosher, a researcher at RAND, a non-profit research organization.

In countries where environmental conditions and infrastructure are severely degraded, clean drinking water, effective sewage and trash systems, and viable farmland are crucial to local inhabitants. Providing these things can influence whether inhabitants support the local government and U.S. goals and objectives.

“Commanders and planners can take steps in the combat phase to preserve existing environmental infrastructure and resources that will be vital once combat has ended,” Mosher says. “Determining what to preserve will demand that leaders and planners take a strategic view of the operation, including what the end result ought to be.”

The Army also can have a positive influence on the environment. In operations in Afghanistan, Iraq and the Balkans, U.S. soldiers have helped to build wells, sewage treatment plants and other water infrastructure systems, which were beneficial to both U.S. soldiers and local communities, said report co-author Beth Lachman.

In Iraq, the U.S. Army Corps of Engineers is helping to restore the Mesopotamian Marshlands that are significant to both regional and migratory bird species, and the local economy.

Environmental issues can also affect soldier health and safety, the costs of an operation, the logistical burden of supporting forces, and diplomatic relations. The study finds that long deployments and extended post-conflict operations like those in Iraq, Afghanistan, and the Balkans expose U.S. forces to a variety of environmental problems. At one base camp in Afghanistan, legacy pollution problems caused short-term respiratory illnesses for U.S. soldiers until the problem was identified and addressed.

The relationship between the Army and the environment is a two-way street, according to the study. On the one hand, soldiers and operations affect the environment; on the other, the environment affects soldiers and operations, especially because many contingency operations are often conducted in locations that have significant legacy pollution and other environmental problems, according to study authors.

The study finds that base camps raise a host of environmental issues. In most contingencies over the last 20 years, U.S. forces have remained in theater much longer than expected. As a result, base camps that were hastily constructed for temporary use are occupied for many years and often have inadequate environmental systems and procedures, such as insufficient waste management.

Pollution from base camps can affect relations with locals, cause health problems for soldiers, and require costly cleanup efforts. The authors state that Army leaders should anticipate longer stays and design and build base camps accordingly, RAND says.

Operations that require less fuel, water and other resources, and produce less waste, will reduce the logistics burden. A well-designed, efficient base camp can reduce the resources required to sustain it and free logistics assets to support U.S. troops or reduce the number of convoys that must travel along dangerous roads, the report finds.

Environmental conditions can also extend beyond national borders because air and water pollution may travel great distances, affecting diplomatic relations with countries that could be crucial to the mission's success.

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