An Ancient Frenemy

Abstract

Humans have been using fire for cooking and warmth since time immemorial. Today, open fires that burn solid fuels such as wood, coal or dung remain widespread in developing countries. While many people noticed this practice, it was one man, quite belatedly, who thought about the possible health consequences of exposure to the particulate matter in the resulting smoke. Kirk Smith spent most of his career researching the health risks to women and children of breathing smoke from these fires and evaluating approaches to reduce exposure and limit health consequences. In the last decade his work has led to widespread programs in India, where indoor fires may cause about one million deaths each year, to incentivize replacing solid fuel combustion with liquid petroleum gas. Using lpg greatly reduces exposure to particulate matter and is likely to reduce adverse health outcomes. The story of how hard it was to begin to address this issue and how long it took is instructive for anyone considering addressing major public health problems today.