Smoke-Filled Lungs in Exchange for a Meal: (Rural) Women and Children’s Health at Risk from Household Air Pollution and the Lack of Regulation in Tanzania

By Sally Duinmaijer, LLM Student International Human Rights Law, University of Groningen, s.duinmaijer@student.rug.nl

Picture a small, poorly ventilated, smoke-filled room with a woman, with a child strapped to her back, bent over the cookstove as she prepares a meal for her family atop a three-stone fireplace. This circumstance is one I often witnessed when I lived in the United Republic of Tanzania (Tanzania), particularly in its rural areas. Without enhanced policy action or legislative implementation to tackle the issue of household air pollution, the health of women and children continues to be at risk as the custom persists.

Domestic cooking using inefficient and polluting fuels and technologies produces high levels of household air pollution (HAP) and is a widespread practice in Tanzania. ¹ The problem is aggravated by poor housing conditions, with limited ventilation. ² Accordingly, numerous women and their children who remain close by are exposed to health-damaging pollutants almost daily. ³ While Tanzania has generally implemented policies and standards to address environmental and health issues, the state lacks concrete action regarding its approach to HAP, especially in rural areas. ⁴

The country has ratified various international treaties that assure the protection of the right to health for all. By ratifying, among others, the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of the Child (CRC), the state accepted a positive obligation to realise, without discrimination, the right to health progressively. ⁵ Nevertheless, Tanzania is falling behind concerning its regulation of factors contributing to the adverse effects of HAP on its citizens’ health.

Tanzania’s Insufficient Regulation of Indoor Air Pollution

Claiming that Tanzania has not addressed indoor air pollution in any way would be false. Nonetheless, its regulation of HAP is insufficient. ⁶ On the one hand, the Tanzanian government has advocated for the adoption of cleaner energy for household cooking to reduce the use of smoke-producing fuels, namely through its 2015 National Energy Policy. ⁷ In this regard, Tanzania has acknowledged an intent to improve the availability, accessibility and affordability of alternative fuels to biomass to “improve quality of life”. ⁸ This effort, however, is more centred on the urban areas, where household cooking fuels are commonly purchased. ⁹ Notably, the distribution of improved cook stoves is largely privatised, thus influencing the cost of cleaner fuels and technologies. ¹⁰ Accordingly, the disadvantaged population in rural areas do not similarly benefit from these efforts; instead, they favour cheap, easily accessible fuel sources. ¹¹ The regulation's drawback is thus that it overlooks the areas where costly modern household cooking fuel consumption is limited, namely where most smoke-producing fuels are used - resulting in the continuance of the harmful practice. Otherwise, in 2019, Tanzania developed a Health and Pollution Action Plan. ¹² The Action Plan helps prioritise challenges related to HAP and provides recommendations to reduce the impacts on public health. ¹³ Nevertheless, further action has yet to be taken to bring this Action Plan to fruition, and the Plan has yet to be reviewed.

On the other hand, the Tanzanian government has done little to regulate the adequacy of housing with respect to ventilation. ¹⁴ Although the 2004 Environmental Management Act briefly mentions this requirement, ¹⁵ there is scant evidence that the state has since followed up on or stressed the importance of this housing standard in future measures. ¹⁶ It is, therefore, no surprise that inefficient ventilation continues to be a factor exacerbating the HAP issue in Tanzania. ¹⁷ It follows that in the regulatory effort to address HAP, the Tanzanian government needs to consider both the promotion of alternative fuels and ventilation standards, among other things, to protect its citizens’ health. The next section will highlight why both dimensions matter for the fulfilment of the state’s international human rights law obligations.

Tanzania’s Insufficient HAP Regulation vs Its International Human Rights Law Obligations

As mentioned earlier, Tanzania is a party to international human rights treaties, such as the ICESCR and CRC, that aim to promote and protect, among other things, the right to health. Namely, Article 12 ICESCR fundamentally places a positive obligation on States Parties to take the necessary steps for, inter alia, the prevention of diseases to ensure the full realisation of the right to health. ¹⁸ General Comment 14 of the Committee on Economic, Social and Cultural Rights (CESCR) further clarifies that this obligation requires States to respect, protect, and fulfil the right to health. ¹⁹ That is to say, States cannot violate the right themselves (respect), they must prevent the violation of the right by third parties (protect), and they must take proactive measures to ensure the enjoyment of the right (fulfil). ²⁰ In this sense, Article 12 calls on States Parties to ensure the availability, accessibility, acceptability and quality of, for instance, alternatives to smoke-producing fuels to meet their obligations regarding the right to health and HAP. Indeed, HAP falls within the scope of this right, as it is a cause of various non-communicable diseases (NCDs), including stroke, ischaemic heart disease, chronic obstructive pulmonary disease, and lung cancer. ²¹ It is further worth noting that regarding the obligation to fulfil, General Comment 14 specifically highlights the need for the States Parties to ‘implement national policies aimed at reducing and eliminating pollution of air (...)’. ²²  

Based on this, while Tanzania has tried to promote alternatives to smoke-producing fuels and developed a relevant action plan, there are shortcomings in its fulfilment of the right to health concerning HAP. Firstly, the state has seemingly failed to ensure that access to such alternatives is equally available, accessible and affordable for the rural, disadvantaged population, which contradicts the principle of non-discrimination. ²³ Secondly, the lack of policy action and strategy in terms of addressing ventilation improvement as a component of housing standards suggests a failure to fulfil its citizens’ right to health - through the lack of initiative in this regard. ²⁴

The obligation to protect children’s right to health is otherwise emphasised under Article 24(2) CRC, which more specifically requires States to ensure, inter alia, ‘adequate housing that includes non-dangerous cooking facilities, a smoke-free environment, [and] appropriate ventilation, (...)’. ²⁵ It follows that this requirement recognises the particular vulnerability of children in this sense. Indeed, various studies have shown that HAP affects small children (and women) ‘far more than any other people in the society’. ²⁶ Accordingly, the Tanzanian government’s lack of action in modernising housing standards may be considered a violation of their obligations under the CRC - whereby the state is not meeting the minimum requirements for protecting vulnerable children from HAP.

Future Direction

As Lim et al. stated, ‘[n]ow is the time to recognise access to clean air as a crucial component of access to health, and as a human right that is well within governments’ mandate to fulfil’. ²⁷ As such, the state needs to ensure that up-to-date measures are in place to mitigate the effect of HAP on its citizens’ health. Namely, Tanzania should set clear targets to improve access to cleaner energy and technologies for all and monitor its progress so that it is held accountable for realising this right. ²⁸ Furthermore, it is of particular importance that the state places greater emphasis on regulating ventilation standards, making sure to include it in its policy agenda. By addressing both fuel alternatives and ventilation standards, Tanzania can effectively protect its citizens’ health from the harm caused by HAP. While factors such as cultural acceptability of, or rather opposition to, change in practice may hinder enforcement, this does not undermine the need for progressive improvement, especially for the marginalised populations whose very lives are threatened by indoor smoke. ²⁹

Endnotes

1.  United Nations Industrial Development Organisation (UNIDO), ‘Health and Pollution Action Plan: United Republic of Tanzania’ (February 2019) <https://www.unido.org/sites/default/files/files/2019-10/Tanzania%20HPAP.English_2.pdf> 41.

2.  ibid.

3.  Fanuel M. Bickton et al, ‘Household Air Pollution and Under-Five Mortality in Sub-Saharan Africa: An Analysis of 14 Demographic and Health Surveys’ (2020) EHPM 1;
World Health Organisation (WHO), ‘Household Air Pollution’ (WHO.int, 15 December 2023) <https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health?gclid=EAIaIQobChMI973cq_uEgwMVnJKDBx0rtA54EAAYASAAEgIDnPD_BwE> accessed 20 December 2023; Notably, ‘women and children are disproportionately exposed in and around the home due to gender-based domestic roles associated with time spent indoors’.

4.  Editha M. Ndunguru, ‘Increasing Access to Clean Cooking: The Practicality of Pay-Go in Promising Adoption Adoption of Bottled Gas in Kinondoni, Dar Es Salaam, Tanzania’ (2021) IJCCE 42; See also Festo S. and Deogratius Bintabara, ‘Household Air Pollution from Cooking Fuels Increases the Risk of Under-Fives Acute Respiratory Infection: Evidence from Population-Based Cross-Sectional Surveys in Tanzania’ (2022) 88(1) Annals of Global Health 1, 2.

5.  International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 993 UNTS 3 (ICESCR) Art 12; Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) 1577 UNTS 3 (CRC) Art 24; Tanzania acceded to the ICESCR on June 11th, 1976, and ratified the CRC on June 10th, 1991.

6.  UNIDO (n 1) 43.

7.  Ndunguru (n 4); National Energy Policy 2015, 21-22; The associated policy statements in the National Energy Policy state that the government will (i) enhance fuel switch from wood-fuel to modern energy and (ii) facilitate the adoption of appropriate cooking appliances to promote alternatives to wood-fuel.

8.  National Energy Policy 2015, 22.

9.  Ndunguru (n 4) 45.

10.  J. Leary et al, ‘Policy & National Markets Review for eCook in Tanzania’ (mess.org.uk, October 2019) <https://mecs.org.uk/wp-content/uploads/2020/12/TANZANIA-Policy-Review-JL-4-10-19-2-COMPRESSED.pdf> accessed 20 December 2023 26. 

11.  Mazbahul G. Ahmad et al, ‘Household Smoke-Exposure Risks Associated with Cooking Fuels and Cooking Places in Tanzania: A Cross-Sectional Analysis of Demographic and Health Survey Data’ (2021) 18 IJERPH 1, 8.

12.  UNIDO (n 1).

13.  United Nations Environment Programme (UNEP), ‘Pollution’ (diff.unepgrid.ch) <https://dicf.unepgrid.ch/united-republic-tanzania/pollution> accessed 20 December 2023.

14.  UNIDO (n 1) 6; It should be noted that Tanzania has policies in place regarding general housing standards, namely the 1997 National Land Policy and the 2002 National Human Settlements Development Policy; however, these policies are not particularly concerned with efficient ventilation and guaranteeing a smoke-free environment.

15.  The Environmental Management Act 2004, Sec 130(a).   

16.  Notably, ventilation standards are mentioned in the 2019 Action Plan, but further regulation is lacking; See UNIDO (n 1) 99.

17.  UNEP (n 13).

18.  ICESCR (n 5) Art 12(2)(c).

19.  UN Committee on Economic Social and Cultural Rights (CESCR) ‘General Comment 14: The Right to the Highest Attainable Standard of Health (Art. 12)’ 11 August 2000, UN Doc E/C.12/2000/4, para 33; It is important to note that the General Comment of the Committee is not binding on States; however, it is authoritative.

20.  ibid para 34-36.

21.  WHO (n 3); Ahmad et al (n 10) 2; United Nations Environment Programme, ‘Pollution Action Note: Data You Need to Know’ (unep.org, 7 September 2021) <https://www.unep.org/interactives/air-pollution-note/> accessed 20 December 2023.

22.  CESCR (n 19) para 36.

23.  CESCR (n 19) para 18; See also ICESCR (n 4) Art 2(2).

24.  ibid, para 36; UNIDO (n 1) 43.

25.  UN Committee on the Rights of the Child, ‘General Comment 15: The Right of the Child to the Enjoyment of the Highest Attainable Standard of Health (Art. 24)’ 17 April 2023, UN Doc CRC/C/GC/15, para 49.

26.  Leary et al (n 10) 34; Further information on this matter can be found here: UNICEF, ‘Clean the Air for Children’ (unicef, October 2016) <https://www.unicef.org/media/60106/file> accessed 20 December 2023 40; UNICEF, ‘Silent Suffocation in Africa: Air Pollution is a Growing Menace, Affecting the Poorest Children the Most’ (unicef, June 2019) <https://www.unicef.org/media/55081/file/Silent_suffocation_in_africa_air_pollution_2019.pdf> accessed 20 December 2023 5; Bickton et al (n 3) 2.

27.  Jamie Lim et al, ‘A Rights-Based Approach to Indoor Air Pollution’ (2013) 15(2) HHRJ <https://www.hhrjournal.org/2013/12/a-rights-based-approach-to-indoor-air-pollution/> accessed 20 December 2023.

28.  ibid. 

29.  ibid.