Over half of the world's population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use
coal for household heating and cooking. This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household
coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of
lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the
lung cancer risk in this population and the factors associated with it. We found
lung cancer risk to vary substantially between different
coal types, with a higher risk associated with smoky (i.e.,
bituminous) coal use compared to
smokeless (i.e.,
anthracite)
coal use. The installation of a chimney in homes resulted in a substantial reduction in
lung cancer incidence and mortality. Overall, our research underscores the need among existing
coal users to improve ventilation, use the least toxic fuel, and eventually move toward the use of cleaner fuels, such as gas and electricity.