Health Research Program
Helen Petach, Senior Science Advisor
Office of Maternal and Child Health and Nutrition, USAID

Air pollution, both indoor and outdoor, leads to over 4 million premature deaths annually1 and additional, long-term health impacts, particularly for pregnant women and children.  These impacts include a disproportionate number of deaths in lower- and middle-income countries (LMICs). However, since we do not see the immediate impacts from a high air pollution day, nor can we readily quantify our ongoing exposure to air pollution, we tend to overlook the hazards of poor air quality more than other health threats such as infectious diseases or contaminated water. Given this backdrop, one practical approach for improving air quality is to build a deeper understanding of this health threat along with the recognition of sources and solutions that impact air quality.

 Global estimates suggest that nearly 1 in 10 deaths among children are linked to air pollution, and the majority of these deaths take place in LMICs. Prenatal and childhood health effects of air pollution impact health and productivity across the life course. UNICEF reports that over 300 million children are exposed to health-damaging levels of outdoor air pollution, as well as daily household air pollution.

Source: LMIC Urban Air Pollution Solutions Technical Document (2019)

Communication and campaigns that share air pollution levels and their health impact are a vital step forward, and this information is increasingly becoming more readily available and easier to understand. Several agencies now provide real-time air pollution data on public platforms including OpenAq, the United States Environmental Protection Agency’s  AirNow, and Breathe Life, the World Health Organization’s (WHO) global campaign for clean air,. Data visualization available on these websites help us appreciate the reality of air pollution.

The sources of air pollution, especially in LMICs, can be varied and surprising. Although the transportation and power sectors are often considered the largest contributors to air pollution, this is not always the case. For example, in India the largest contributor to air pollution is household burning, mostly for cooking, that creates air pollution within the home and also contributes up to 30% of the ambient air particulate matter across India (Chowdhury et al, 2019). Similarly, in Ghana household burning of solid fuels may account for up to 65% of the total particulate matter emissions (HEI, 2019). The high proportion of air pollution from household burning suggests that in these locations, the transition to burning clean household fuels is particularly important. Understanding the dominant sources of air pollution is critical before identifying potential solutions.

Photo credit: Abid Omar, Pakistan Air Quality Initiative

Certainly, clean cooking alone will not create global clean air, but it is an important contributor and deserves special attention since this solution may be less well known than others. USAID’s Health Research Program supported studies found that key drivers to household adoption of clean cooking included the availability and affordability of clean fuels and technologies. These studies also revealed that it is probably unreasonable to expect a single cooking technology to meet the varied cooking needs of a household. Given these results and the potential impact on maternal and child health outcomes, the transition to clean fuels (liquefied petroleum gas, biogas, ethanol, pellets and electricity) will need to be creative and incorporate human-centered design.

Photo credit: Micaela Arthur, USAID

Other sources of air pollution in LMIC cities arise from vehicle exhaust, industrial systems such as brick kilns, agricultural burning, trash incineration, and biomass- or coal-fired power generation. Some of the technical solutions that will reduce air pollution from these sources are known, but LMICs may be able to leap beyond those well-known solutions to new innovations.

The first WHO Air Pollution and Health Conference in October 2018 highlighted the importance of the health sector in communicating the health impacts of air pollution. Following the Conference, interested stakeholders continued to expand on this message with the release of Hazy Perceptions from Vital Strategies, State of Global Air from the Health Effects Institute, and Air Pollution and Child Health advance copy from WHO. In July, USAID released a report that focused on health-relevant solutions to air pollution, LMIC Urban Air Pollution Solutions, available here.

The word is out!


  1. Global Burden of Disease (GBD). (2018, December 17). Retrieved from
  2. Chowdhury et al. 2019. PNAS, 116(22):10711. (
  3. Health Effects Institute. 2019. State of Global Air. Special Report. Boston, MA (
About the Author

Helen Petach is a Senior Science Advisor in the Bureau of Global Health’s Office of Maternal and Child Health and Nutrition, Division of Research and Policy at USAID. She is responsible for leading the household air pollution programs and more broadly developing strategies and programs to address the maternal and child health challenges, with a focus on health commodities. Previously, Helen was the Senior Director of Scientific Affairs at SomaLogic, a clinical diagnostics company, and a Senior Technical Manager at Hewlett-Packard leading the mobile technology data analytics team. Helen obtained her PhD in Chemistry from Cornell University.