Children & Health

Woodsmoke & Health
Tobacco smokers have higher death rates from lung diseases, cancers, heart attacks, strokes. Yet vested interests such as the tobacco industry tried for decades to tell us there was no direct causal evidence.  Similar tactics have been used by the asbestos and coal industries.

The research cited below shows the same is true for woodsmoke pollution. Dr Ben Ewald, GP & Senior Lecturer in Epidemiology, Newcastle University, told a 2013 Senate Inquiry into air pollution and health that exposure at the current National Standard of 25 ug/m3 has equivalent mortality risks to actively smoking 3 cigarettes a day. Tasmanian researchers found that hospital admissions for heart failure (HF, the leading cause of hospitalisation for adults aged over 65 years) started to increase as soon as PM2.5 exceeded 4 ug/m3, a tiny fraction of the current Australian PM2.5 standard. The researchers noted that the main cause of elevated PM2.5 in Tassie is biomass smoke from wood heaters during winter and from bushfires and planned burns at other times of the year, and also that there are more HF incidences and readmissions occurred in winter than in other seasons. Another Tasmanian researcher, Dr Fay Johnston previously described woodsmoke particles as worse than car exhausts.  Canadian research found that when most of the pollution came from wood burning a 5 ug/m3 increase in PM2.5 pollution was associated with a 19% increase in the risk of heart attacks for people aged 65 and older, noting "the association was stronger when more of the air pollution came from wood burning."  See also the news report: 2 min video, Canadian BC News, Feb. 27, 2017: Study links wood smoke to senior heart attacks.  

Most of us would be concerned about the health effects of children, pregnant ladies and the elderly smoking even one cigarette a day. New technology has created affordable, non-polluting, climate and environmentally-friendly heating options.  We need to read and understand the evidence so that informed decisions can be made about what is best for our city, our communities.

NSW Chief Medical Officer & other health professionals recommend
The NSW Asthma Foundation warned that wood smoke emissions in winter pose a bigger immediate health danger in built up urban areas than cars or cigarettes. The evidence convinced the NSW Chief medical officer, who said "wood heaters are so detrimental to health she supports banning and phasing them out in built-up urban areas". Similarly strong statements were made by the Australian Lung Foundation (who added: “real-life emissions from new wood-heaters have little relationship to measurements from a perfectly operated test model under laboratory conditions), the Canadian Lung Association (“don’t burn wood in a residential setting”) the American Lung Association (“avoid burning wood”) and the American Lung Association of California who urges the public to avoid wood burning and to consider cleaner heating alternatives. Burning wood emits harmful toxins and fine particles into the air that can worsen asthma and chronic obstructive pulmonary disease (COPD).

How wood burning affects children
3-minute UNICEF video: What does Air Pollution PM 2.5 do inside children's body and brainExplains how PM2.5 pollution causes problems for all critical organs in the children's bodies and brains.

Dr. Eric Zee, pulmonary medicine specialist at Stanford Children’s Health, explains how wood burning affects children. "The fine particles in woodsmoke are around 2.5 micrometers in size or smaller. That’s a size 30 times smaller than the size of a human hair and the smaller particles are so small several thousand of them could fit on the tip of a needle.  These particles are called PM2.5 and are small enough to bypass the nose and throat’s natural filtering systems, enter our lungs and pass into blood and to every organ in the body.”

    Dr Zee says fine particle pollution from woodsmoke is especially harmful to children, the elderly and those with respiratory conditions such as asthma and bronchitis. Children breathe at a faster rate and have developing respiratory systems … “Woodsmoke causes other problems in the body outside the lungs. Inflammation, while generated in the lungs, can be felt throughout the body … these higher inflammatory mediators running round our bloodstream can affect the way our brains work, can affect the health of our heart, and can affect our risk of stroke.” Keeping these health effects in mind, Dr Zee says it’s vital to reconsider burning wood.

   Woodsmoke is the number 1 child killer in developing countries.  According to UNICEF:  "Every year, nearly 600,000 children under the age of five die from diseases caused or exacerbated by the effects of indoor and outdoor air pollution" ..In Bangladesh, "more than 8,500 children per year die from diseases caused by household air pollution (HAP) and 89 per cent of households use solid fuels – mostly wood, agricultural waste and cow dung – for cooking and space heating" ...In Zimbabwe in 2010  "more than 3,000 child deaths from 0–4 years were caused by acute lower respiratory infections (ALRI). Research also shows that children in Zimbabwean households using wood, dung or straw for cooking were more than twice as likely to have suffered from ALRI than children from households using Liquefied Petroleum Gas (LPG), natural gas or electricity."  A comprehensive study published in 2018 in Nature Research covering 30 African countries found that a 10 μg m−3 increase in PM2.5 concentration was associated with a 9% rise in infant mortality. The new study used satellite data to provide accurate estimates of PM2.5 exposure and therefore more accurate estimates of the effect. The total of 449,000 additional deaths (22% of all infant deaths) in 2015 is more than three times higher than existing estimates that attribute death of infants to poor air quality for these countries.

Just because developed countries aren't as polluted doesn't mean there's no risk. The “Growing up in New Zealand” study found that every additional modern woodstove per hectare increased by 7% the risk children under 3 would need hospital emergency treatmentWith some residential areas of Armidale averaging over 20 ug/m3 all winter, if the same effect holds in Armidale, it represents a substantial risk to health.

Increased mortality in developed countries
  Developed countries have less woodsmoke pollution, but the risk is still significant. In Utah, where a high proportion of wintertime pollution is woodsmoke: "we are really sure that the air pollution contributes to let’s say low birth weight - or increased mortality." said Dr Blagev, director of the Schmidt Chest Clinic at Intermountain Medical Center.  "Multiple studies point to a connection between bad air days and lifelong health problems for babies conceived and or born during periods of pollution.   Blagev explains that “even if you feel fine on a bad-air day the pollution is still bad for you.  Particulates in the air enter your lungs and ultimately your bloodstream causing inflammation which can make you feel sick. More importantly that inflammation can alter the growth of a baby in utero."

 Another Utah study found: "Even the briefest increase in airborne fine particulate matter PM2.5, pollution-causing particles that are about 3 percent of the diameter of human hair, is associated with the development of acute lower respiratory infection (ALRI) in young children, according to newly published research ... In an analysis of death rates among the study population, 17 children ages 0-2, nine children ages 3-17 and 81 adults (18+) died within 30 days of diagnosis with ALRI."  

 In California, where programs such as 'Spare the Air' inform residents of the dangers of woodsmoke, and wood stove use is banned on high pollution days, a 10 ug/m3 increase in PM2.5 pollution was found to double the rate of respiratory-related postneonatal mortality.

 The effect of PM2.5 pollution on cot deaths has been difficult to interpret, because other factors such as sleeping position are also important. In the UK, where this was addressed by the 'back to sleep' program, an increase of 12.5 ug/m3 in PM10 (PM2.5 measurements weren't available) was associated with a 16% increase in SIDS.

Can’t keep PM2.5 out of our homes

Because of their small size PM2.5 behave like gases and enter our homes even when all windows and doors are shut, just like the air we need to breathe. High levels of outdoor PM2.5 pollution in Armidale have been shown to create high indoor PM2.5 pollution - see Fig 7 of the peer-reviewed research 'What makes a Successful Woodsmoke-Reduction Program? 

Still births and brain abnormalities
In Ohio, exposure to high PM2.5 pollution (over 16.2 ug/m3) during the 3rd trimester increased stillbirths by 42%. Armidale's PM2.5 pollution is now worse than 1999, when East Armidale averaged 31.8 ug/m3.  Residential areas are exposed to much higher PM2.5 pollution than the CBD as demonstrated by the map of pollution exposure from the UNE Air quality research group and the 2017 Purple Air measurements.  If exposure to more than 16.2 ug/m3 during the 3rd trimester results in a 42% increase, just think of the impact of over 30 ug/m3.  Purple Air measurements show that, compared with the rest of Australia, we often have unhealthy or very unhealthy levels of pollution in some residential areas.

 Residential air pollution in the Netherlands during fetal life was linked to brain abnormalities that may contribute to impaired cognitive function in school-age children.  These brain abnormalities contribute in part to difficulty with inhibitory control—the ability to regulate self-control over temptations and impulsive behavior—which is related to mental health problems such as addictive behavior and attention-deficit/hyperactivity disorder. 

 Stanford researchers have found that wood smoke is also bad for the brain, even in young people … "We're finding in young adults that there may be an increased risk of psychiatric problems like depression," said Stanford pediatrics professor Eric Zee. And in kids and teens, "it also affects grades and test scores …" Zee said the tiny particles from smoke can inflame the lungs, and in turn cause inflammation all over the body, including in the brain. The study found regular exposure to smoke can speed up the brain's aging process, even in kids.

Witch’s brew of carcinogens

Woodsmoke has been called a "witch's brew of carcinogens" because of all the toxic chemicals including PAH (polycyclic aromatic hydrocarbons) it contains. Domestic solid fuel burning is the major source of PAH emissions in Australia. In the USA, PAH exposure during pregnancy resulted in genetic damage in babies (measured in umbilical cord blood), behavioural problems, reduced IQ on starting school, and reduced white matter in the brains of 8 year olds.  A review of published research stated: "We encountered … evidence of detrimental effects of pre- or postnatal exposure to PAH on global intelligence quotient.”

 Tests on bacteria and mice show that woodsmoke causes 12 to 30 times as many mutations and tumours as the same amount of cigarette smoke.  Benzo[a]pyrene (B[a]P, a known human carcinogen), is the most well known PAH in cigarette smoke.  Burning 10 kg of wood in a correctly-operated Australian heater emits as much BaP as in the smoke from 270,000 cigarettes.

Six studies link PM2.5 pollution to increased autism

"Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air" says a Scientific American article.  In 2014, Prof Frank Kelly, director of the environmental research group at King's College London, discussed the links between PM2.5 pollution and autism: "I think if it was this study by itself I wouldn't take much notice, but it's now the fifth that has come to the same conclusion." A sixth study, Fine Particulate Air Pollution Associated with Increased Risk of Childhood Autism was published a few months later.

 "There are a range of studies now that have shown that even a short amount of exposure to modest levels of pollution in utero and the first year of life leads to demonstrable impacts on intellectual performance on standardized tests in middle school, in high school," said Dr. Joshua Graff Zivin, a professor of economics at the University of California San Diego . "We also find from other studies that we even see the imprints of that exposure 30 years later on the earnings of workers."  "Those same impacts at more subtle levels simply impair our ability to do every day tasks."  This might lead to increases in injuries and deaths from apparently unrelated causes such as accidents at work and on the road.  In Australia, poverty and low school achievement are also linked to higher child death rates.

Armidale doctors and health professionals have spoken out

Armidale doctors and health professionals have spoken out about the health problems. UNE research found that, about 38% of visits to Armidale GPs for respiratory complaints in winter were due to woodsmoke pollution. Armidale Lung Specialist Dr Gary Baker, “We need to eliminate or minimise the need for heating by design.  Wherever possible, substitution with other non-polluting technologies is the best."

 UNE Associate Professor and retired local GP John Nevin said  "Where people have had respiratory problems and have lived in the inversion hollow of central Armidale I have suggested that they move to the heights or out of town."  “It’s not in their best interests to be exposed to the dangerous levels of woodsmoke.”  ...  "on really bad mornings when the inversion layer comes into affect over Armidale - you can nearly cut the air with a knife, like you are in Beijing."  More than 30 years ago, Dr Nevin heeded his own advice: he moved out of town. “Although I don’t have lung trouble, I don’t want to be exposed to the risk of lung cancer, chronic bronchitis and emphysema”.

Woodsmoke reduces the ability of the lungs to fight infection

People think they get colds in winter - they don't realise that woodsmoke reduces the ability of the lungs to fight infection, a fact demonstrated in animals.  When mice were forced to breath woodsmoke for 6 hours at levels not much higher than we get in Armidale and then challenged with a respiratory bug, 21% were dead 2 weeks later compared to only 5% that breathed oil furnace fumes for the same period of time or clean air.

The “Growing up in New Zealand” study found that every additional modern woodstove per hectare increased by 7% the risk children under 3 would need hospital emergency treatment.  Thankfully, most will recover, but as demonstrated by the Utah study, 26 children died of acute lower respiratory infections. 

 The NSW Asthma Foundation warned that: wood smoke emissions in winter pose a bigger immediate health danger in built up urban areas than cars or cigarettes.

Example of Armidale residents who did not know that woodsmoke was affecting their children's health until they moved house.

A submission on Armidale's Air Quality Policy, April 2010, states:  We lived for fifteen years in xxx St, between xxx and xxx. From two years of age my daughter suffered respiratory illness every year. It started in early May each year approximately two weeks after wood fires were lit, and continued until the end of winter when the fires stopped.  This occurred until my daughter was twelve years old, which is when we moved to a house above the smoke line on South Hill. Since then she has not suffered from the same respiratory illness. It just stopped! We did not have to go to the Doctor or buy any more medication .During the same time my son suffered from a persistent cough during winters, this also stopped when we moved house.

   Note our previous house was heated by a wood fire our new house is not. Otherwise nothing changed. We have always had a good diet and our children participated in several sports. The only thing that changed was our moving out of a house that had a wood heater in an area that was in a heavy smoke zone into a non-wood heated house out of the smoke zone.  Our decision to move house was not driven to get out of the smoke, but we were surprised in the dramatic change in our children’s health when we did. 

Summary article

A recent article, the Effects Of Air Pollution On Human Health states:  "Exposure to high levels of air pollution during pregnancy has been linked to miscarriages as well as premature birth, autism spectrum disorder and asthma in children.  Air pollution may damage children’s brain development.  Pneumonia, which kills almost 1 million children under the age of 5 every year, is associated with air pollution. Children who breathe in higher levels of pollutants also face a greater risk of short-term respiratory infections and lung damage."

What happened when Launceston residents understood what woodsmoke was doing to their health

When residents of Launceston understood what woodsmoke was doing to their health, a majority chose to switch to non-polluting heating. The community was rewarded by 28% fewer deaths in winter from respiratory disease and 20% fewer cardiovascular disease deaths.

 A similar level of understanding has not yet been achieved in Armidale, as demonstrated by the health professional who, as explained above, was surprised by the dramatic change in his children’s health on moving out of the area affected by woodsmoke.

Non-polluting heating - cheaper than buying firewood, better for the environment

Modern, efficient heat pumps have superseded wood stoves and natural gas as the most cost-effective heating.  They can deliver 5 or 6 times as much heat to the home as they use in electric power, are affordable (as cheap as buying a wood stove) and have lower running costs than buying firewood.  In addition they cause a lot less global warming, and don't damage our health, as explained in the New Scientist Review: log-burning stoves are harming our health and speeding up global warming

 For those who like snuggling up against a flaming fire, gas-logs are a healthy alternative, especially for pubs and restaurants.

 The evidence cited above shows beyond doubt that PM2.5 pollution in Utah, California, Europe and the UK increase the risk of both child and adult death rates.  It would be naive to think it's not also happening here. 

 With estimated health costs of thousands of dollars per wood heater per year (a significantly greater cost than switching to non-polluting heating), what would an informed community want? 

Ideally, all new homes should be energy efficient so they don't need wood stoves.  We should also heed the NSW chief medical officer's recommendation to improve the energy efficiency of existing homes and gradually phase out wood stoves in favour of non-polluting, climate friendly heating.

HEPA (High Efficiency Particle Air) Filters

HEPA filters can reduce the damage to our health.  Canadian researchers studied healthy adults living in a small community in British Columbia where wood burning stoves are the main sources of pollution. They found that HEPA filters reduced the amount of airborne particulate matter inside homes, resulting in improved blood vessel health and reductions in blood markers that are associated with an increased risk of cardiovascular disease

   In another experiment, mice were housed for 10 weeks in a outdoor location with high PM2.5 and PAH pollution.  Half were housed in enclosures with HEPA filters. They were then moved to clean air and mated 9 weeks later. Those that breathed filtered air had mutation rates 52 per cent lower than the mice exposed to full-strength pollution.

   Researchers from the Menzies Institute for Medical Research showed that that hospital admissions for heart failure (HF, the leading cause of hospitalisation for adults aged over 65 years) started to increase as soon as PM2.5 from woodsmoke exceeded 4 ug/m3. They are now investigating the role of HEPA filters in reducing the risk.

   Our residents might also wish to consider the health benefits of HEPA filters, given their role in protecting the offspring of mice from genetic damage and research showing HEPA filters reduce inflammation in healthy human volunteers.

Protecting children also protects adults

Woodsmoke and PM2.5 pollution also affects adults, damaging our lungs, hearts and brains.   “We have seen that people who live in areas where wood-fire stoves are common run a greater risk of being affected (by dementia), and that also goes for people who live next to someone who uses wood-fire stoves,” said Anna Oudin, a researcher in occupational and environmental medicine at Umea University’s department of public health and clinical medicine. "The risk for residents living in areas with the highest rate of smoke from wood fires to be hit by dementia, or dementia-related diseases, was 30% higher compared to other residents in the town of Umea. "In households that had their own wood-fire stoves the risk was 70% higher."  The abstract of the journal paper shows that exposure of just 1 ug/m3 of PM2.5 pollution increased the risk of dementia by 55%. In May/June 2018, Armidale's woodsmoke pollution at the new OEH monitoring station averaged 17 ug/m3, 17 times worse than the woodsmoke exposure found to increase dementia by 55%. In the USA, increased exposure of 10 ug/m3 PM2.5 increased the risk of dementia by 80%, Alzheimer's by 150% and the risk of Parkinson’s diseases by 80%  Increased exposure of 3.5 ug/m3 reduced the volume of white matter in the brain by 6.2 cubic centimeters. Exposure to PM2.5 pollution above the US EPA standard of 12 ug/m3 nearly doubles the risk of cognitive decline and all-cause dementia; exposure to this level of PM2.5 pollution quadrupled the risk for people with 2 copies of the APOE gene.

As well as harming the developing brains of children, evidence suggests exposure to air pollutants can cause inflammation in the brain, can damage brain and neural networks and influence behaviour - see air pollution increases crime in cities – here’s howLow level air pollution are also said to cost the economy billions of dollars in lost productivity  
"What we're learning is that, at severe levels, pollution clearly impacts respiratory and cardiovascular function," says Graff Zivin. "Those same impacts at more subtle levels simply impair our ability to do every day tasks."  

Like Armidale, the vast majority of PM2.5 pollution in Tasmania is woodsmoke.  Researchers found that hospital admissions for heart failure (HF, the leading cause of hospitalisation for adults aged over 65 years) started to increase as soon as PM2.5 from woodsmoke exceeded 4 ug/m3, a tiny fraction of the current Australian PM2.5 standard of 25 ug/m3.  An increase of 20 ug/m3 daily average PM2.5 was associated with a 58% increase in admissions for heart failure.  

 The good news is that a 40% reduction in woodsmoke pollution in Launceston reduced deaths in winter from respiratory disease by 28% and cardiovascular disease by 20%.  The cost was less than $21 per resident.

 Surely it would be a great investment to protect our health and boost our economic development by making Armidale a more attractive place to live.

What could Armidale do?

Local sustainability charity Starfish offered to help fix the problem by coordinating a demonstration project to show that non-polluting heating can be affordable and environmentally friendly. The cost would be less than the consultancy fees for the controversial designs and plans for traffic in the Armidale Mall that sparked outrage.

 If Armidale converted from wood stoves to heat pumps, we could expect to live longer, healthier lives with fewer heart attacks, strokes, lung diseases and cancers, as well as healthier children. The total costs would probably be less than building a rail trail from Black Mountain to Ben Lomond, but provide a much greater boost to our economy.

A 28% reduction in wintertime deaths from respiratory diseases and a 20% reduction in heart attacks and strokes would be a great investment for our economy.  Don't our current residents and potential new residents want to live longer, healthier lives?  

Current Purple Air Measurements in Armidale - it's often unhealthy at 8:30 in the morning (but clears soon afterwards allowing the pollution to blow away) (click images to enlarge)

and builds up to very unhealthy levels towards the end of the evening
How Armidale's pollution compared with Rozelle (Sydney CBD), Macquarie Park (Sydney), Muswellbrook and Singleton (Hunter Valley) in May/June 2018.
PM2.5 are so small they behave like gases and enter our home even when all doors and windows are shut, as demonstrated by CSIRO's measurements:a
and by measurements outside and inside an old weatherboard house in Armidale

World Health Organization Video Air pollution is an invisible killer that lurks all around us, preying on the young and old. Learn how it slips unnoticed past our body's defenses causing deaths from heart attack, strokes, lung disease and cancer. Help breathe life back into our cities and take action to protect our health and climate.

World Health Organization 90 sec air pollution video

New Scientist Report and Video: log-burning stoves are harming our health and speeding up global warming (Feb 2017)

NSW EPA 30-sec animation

Utah Physicians for a Healthy Environment - 30-sec video - essential viewing!

For your own health stop burning wood

Winter Spare
the Air 30-second video - also essential viewing!

SF Bay Area 'Spare the Air'

Woodsmoke Pollution and your health - video of woodsmoke pollution in Canberra and Armidale and advice from Dr Jim Markos, Australian Lung Foundation
CSIRO Study: Impacts of smoke from regeneration burning on air quality in the Huon Valley, Tasmania
   The study measured PM2.5 pollution in Grove, a rural area, exposed only to forestry burns and Geeveston, a small town with 277 houses, exposed to smoke from domestic wood heaters as well as forestry burns. The difference is shown in the graph below.  Although there is some pollution from forestry burns in Grove, the vast majority of the pollution in Geeveston is woodsmoke from domestic heating.
    The graph below compares the two - Grove (light green) has relatively low pollution.  The 277 houses in Geeveston create a massive, unhealthy pollution problem every winter.  The PM2.5 standard was exceeded in Geeveston on 99 occasions.
During the 20 month study wood heater emissions were responsible for 77% of the man-made PM pollution in Geeveston, compared to 11% from smoke plumes from forestry burns, 4% from waste combustion and 8% from other sources. 
    Because most people live in towns, people shop there children go to school there, people are exposed to high levels of toxic smoke pollution. As in Launceston, funds should be made available as a matter of urgency to replace wood heaters with gas or reverse cycle electric heating to protect residents' health.  

New Heater standards are ineffective, as shown by the graph below, in which average emissions of heaters rated 0.6, 0.8 and 0.9 grams/kg firewood were all higher than those rated 1.2 g/kg.