Global access to clean energy is an under-recognized determinant of health

Despite decades of work on clean energy, between two and three billion people still lack electricity and must rely on dirty biomass fuels such as wood, dung, coal, charcoal, and agricultural residues for cooking and heating.

These fuels pollute their homes and neighborhoods—with devastating impacts on health—contributing to roughly 3 million premature deaths per year, according to the 2023 Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Women and children, who spend the most time near these sources of pollution, bear the greatest health burden.

The new Lancet Global Health Series on Energy and Health, which features research from three UC Berkeley School of Public Health faculty, has pulled together the strong but previously fragmented evidence of the health hazards caused by biomass fuels, and clarified priorities for action at the intersection of energy, health and equity.

The series’ five research papers show that access to clean, reliable energy is a fundamental but under-recognized determinant of health, shaping everything from household air pollution exposures to the quality of care in health facilities. It highlights that persistent gaps in energy access and reliability are a major driver of global health inequities.

A previous Lancet series in 2007 focused on energy access, including power generation, the built environment, food, and transportation. The new series moves beyond the notion of access to show that reliability, affordability and sustained use—not just access—determine health benefits.

The series highlights global inequity in energy access, the impact of limited energy access on human health and well-being, and the adverse impact on human health of climate change caused by burning fossil fuels for energy. It also focuses on characterizing actual energy use, compared to energy access and potential for cleaner cookstoves; and offers recommendations to advance electrification of healthcare facilities, as well as other areas of research and policy action.

“My hope is that the series helps global health researchers and professionals think about electricity not as a constraint to what types of interventions we can roll out but rather that electricity, particularly electricity generated from decentralized, renewable resources, can be part of interventions,” said Laura (Layla) H. Kwong, assistant professor of environmental health sciences at UC Berkeley School of Public Health and a co-author of the series. “A whole new approach to addressing global health issues is unlocked by incorporating electricity, and the appliances, opportunities, and income that electricity can power.”

Kwong’s work in the Rohingya refugee camps of Bangladesh demonstrates that there can be near exclusive use of clean fuel among people who previously used biomass when clean fuel is free and biomass is costly. Unfortunately, in most situations, it is cheaper to burn biomass in a traditional stove than to pay for an improved stove or cleaner fuels.

Kwong is particularly concerned about the lack of electricity in hospitals.

“It is truly shocking that 1 billion people are served by healthcare facilities with no electricity or unreliable electricity,” Kwong said. “Can you imagine going to the hospital with a young child that has a high fever and not having any electricity to run the diagnostic tests required to figure out what the child needs? Can you imagine needing a C-section and not having the anesthesia required to perform the operation? I hope that this new knowledge encourages readers to reset their frame of inequity and prompts governments and NGOs to take seriously the harms caused by insufficient and unreliable electricity. We have the tools to address this lack of electricity and improve public health. It is past time to put these tools into action.”

Misbath Daouda is an assistant professor of environmental health sciences at UC Berkeley Public Health and was also series co-author. Her interdisciplinary research focuses on the health equity implications of climate mitigation strategies in the United States and West Africa.

Daouda would like to see changes in field research, so that investigators develop a more granular understanding of access and use of clean energy. For example, Daouda said, researchers need to understand whether people use clean energy exclusively or not, because that is when the health benefits start to kick in.

“What surprises me is that we know as a scientific community that understanding energy use and access is a complex problem, but it is still oversimplified,” she said.

“We hope this work informs policies that prioritize equitable access to clean, reliable energy, such as targeted subsidies, investments in health facility electrification, and integrated energy-health programs, so that energy transitions deliver measurable health gains and reduce disparities,” Daouda said. “We also hope it helps shape the research agendas of trainees and early-career scholars by identifying key evidence gaps and framing energy as a central, actionable determinant of global health.”

Ajay Pillarisetti, a UC Berkeley assistant professor of environmental health sciences who also served as an investigator and writer on the series, said it will continue to be difficult to reduce the large health impact associated with the relatively mundane daily activity of cooking that is essential for everyone.

“We still don’t know exactly how best to enable households to switch to cleaner fuels and technologies for cooking, heating and lighting,” Pillarisetti said. “We think that the biggest driver is affordability—that is, is the fuel affordable, available, and easy to get? Cooking with gas, for example, could be relatively cheap, but if you have to travel an hour or two to get a refill, and it’s costly, yes, you’re less inclined to use it.

“And figuring out how to convince governments and industry to reach out to rural communities and make sure they have an affordable, reliable and accessible source of fuel is an ongoing challenge.”