Comments
To the Editor:
We thank Mortimer and Balmes for their timely critique of the current evidence on household air pollution (1) and their call for a more holistic approach to reduce its burden on public health globally. We agree that oversimplification of the potential causes of household air pollution is unlikely to result in effective solutions, and that we need to step back from the focus on simple determinants of household air pollution to consider the complexity of the problem within local contexts.
The single focus on cleaner-burning cookstoves as an intervention to improve respiratory disease fails to account for the many other contributors to household air pollution, such as motor vehicles, dust, and rubbish burning. In addition, many cookstove studies fail to take adequate account of local experiences of air pollution, which are specific to time and place. Miscommunications between researchers and local communities, which occur when local perspectives are underrepresented and one-size-fits-all interventions are implemented across different geographical and sociocultural contexts, can often result in the failure of well-intentioned interventions and unforeseen adverse effects (2). An example is when traditional cultural cooking preferences, when faced with unreliable cookstove equipment, lead to many households reverting back to cooking on open fires, and where inadequate understandings of the local context lead to problems with disposal of spent batteries from cleaner-burning cookstoves.
A situated understanding of local schemes of perception is imperative to inform household air pollution interventions (3). This includes interdisciplinary working across boundaries between scientific evidence and practical, lived experience, to position researchers in dialogue with local communities around household air pollution and respiratory disease. Such an approach would allow existing knowledges to be interwoven, so that all perspectives are altered and represented (4) in the co-creation of new culturally relevant interventions (5). Close working with communities would support the development of new household air pollution interventions that are informed by local perceptions, values, and beliefs, as well as biomedical science, and are therefore feasible, acceptable, and importantly, inspiring for their target populations. Such interventions are far more likely to be adhered to, and thus to be effective in reducing air pollution and in achieving meaningful and sustained health benefits.
| 1 . | Mortimer K, Balmes JR. Cookstove trials and tribulations: what is needed to decrease the burden of household air pollution? Ann Am Thorac Soc 2018;15:539–541. |
| 2 . | Hahn RA, Inhorn MC. Anthropology and public health: bridging differences in culture and society. New York: Oxford University Press; 2009. |
| 3 . | Zuiderent-Jerak T. Situated intervention: sociological experiments in health care. Cambridge: MIT Press; 2015. |
| 4 . | Smith L. Decolonizing methodologies: research and indigenous peoples. London: University of Otago Press; 2012. |
| 5 . | Panter-Brick C, Clarke SE, Lomas H, Pinder M, Lindsay SW. Culturally compelling strategies for behaviour change: a social ecology model and case study in malaria prevention. Soc Sci Med 2006;62:2810–2825. |
Author disclosures are available with the text of this letter at www.atsjournals.org.
