Where there is smoke: Solid fuel externalities, gender, and adult respiratory health in India

Chronic respiratory conditions are a leading cause of death in the world. Using data on lung obstruction from the WHO Survey of Global AGEing and Adult Health (WHO-SAGE 2007-08), this paper studies the determinants of respiratory health in India, home to a third of all deaths from Chronic Obstructive Pulmonary Disease. First, we find that smokers and members of households that use solid fuels (wood, biomass, coal or dung) for cooking have higher lung obstruction. Second, even if a respondent's household uses clean fuels, their lung obstruction is higher if their neighbors use solid fuels. In neighborhoods with high solid fuel use, the lungs of members of households that use clean fuels can be as obstructed as lungs of members of households that use solid fuels. These negative externalities of solid fuel use are robust to additional controls for neighborhood socioeconomic status, falsification tests, tests with placebo measures, and tests using alternative measures of respiratory health as outcomes. Third, the influence of the determinants is patterned by gender. Smoking tobacco is an important influence on lung obstruction among men. Confirming non-linear dose-response relationships, we find that women from households that use solid fuels are the only group not further harmed by neighborhood solid fuel smoke, possibly because of high exposure to pollutants while cooking. The study improves our understanding of behavioral, social, and environmental determinants of respiratory health in India. Importantly, it makes a case for greater public investments to promote the adoption and use of cleaner fuels.