
Air pollution is a big killer. Air pollution of all kinds helped kill 4.2 million people globally in 2019, according to the World Health Organization.
It can damage nearly every organ in the body, worsening asthma and leading to cancer and heart disease. It especially affects pregnant women and can damage a growing fetus.
Air pollution also has more insidious effects.
Dr. Álvaro Hofflinger of Arizona State University and colleagues studied school children in a part of Chile where many people still rely on wood-burning stoves. They found the more air pollution children were exposed to, the lower their grades. It’s another piece of evidence that can help parents, policymakers, officials, and health experts make decisions about where to focus their efforts in reducing pollution.
In this episode of One World, One Health, host Maggie Fox chats with Dr. Hofflinger about what his team found, about the factors that cause this type of pollution, and what people might be able to do about it.
They found it’s not going to be such an easy problem to solve. Wood is cheap or free for many in parts of Chile, and electricity isn’t. Old habits are hard to break. And clean energy is not always an uncomplicated choice for governments.
Give it a listen and check out some of our other episodes on air pollution and health.
Learn from Dr. Sarah Chambliss about how people of color and in low resource neighborhoods are disproportionately affected by poor health due to pollution.
Find out about the association between air pollution, depression, and pregnancy in our episode with Dr. Jun Wu.
Maggie Fox 00:01
Hello and welcome to One World, One Health, where we chat with people working to solve the biggest problems facing our world. I am Maggie Fox. This podcast is brought to you by the One Health Trust with bite-sized insights into ways to help address challenges, such as infectious diseases, climate change, and pollution. We take a One Health approach that recognizes that we are all in this together and everything on this planet — the animals, plants, and people, and the climate and environment — are all linked.
One pretty obvious link between climate and health comes when you look at pollution. It’s clear that air pollution is bad for everyone, but it’s especially bad for kids. It’s also important to demonstrate how bad it is and just what damage it does, so that people can start to do something about it.
Álvaro Hofflinger is trying to do just that. He’s an assistant professor in the School of Public Affairs at Arizona State University, and he’s just finished a study on the effects of air pollution on students in Chile.
Air pollution had clear effects on kids’ grades. Hofflinger and his colleagues found the effects were worse in less advantaged kids. They’re calling for urgent action, maybe installing air filters, which might offer a range of benefits, or moving classes to times when there’s less air pollution. The bigger problem, however, is how to get people to stop burning wood in stoves in the first place.
In this episode of One World, One Health, we’re chatting with Álvaro about what he’s found, what it means, and what people can do about it.
Álvaro, thanks for joining us.
Álvaro Hofflinger 01:39
Thank you for having me.
Maggie Fox 01:41
So, you found some links between air pollution and learning. Can you tell us a little bit about what you found?
Álvaro Hofflinger 01:47
Yeah, we found a significant association between the exposure to air pollution, in particular to exposure to the most dangerous pollutants in the air and especially its relationship with grade point average (GPA).
Maggie Fox 02:00
GPA is grade point average. It’s their grades?
Álvaro Hofflinger 02:04
Yes. So, we created a panel dataset to track students and estimated their exposure to fine particulate matter that is 2.5 micrometer or less (PM2.5) from first grade in elementary school until they finish through eighth grade in middle school.
So, we followed this, and we tracked the exposures in the whole school year, and we also collected the information about their grades. We were able to collect different variables such as family income, education of the parents and different characteristics of the family, and we were able to track these students over time. We saw that students that were more exported to air pollution had a lower grade at the end of their middle school.
Maggie Fox 02:37
And what’s causing these effects, Alvaro?
Álvaro Hofflinger 02:42
The main source of air pollution in Southern Chile is the use of wood-burning stoves. It’s different in big cities, right? So, for example, here in the United States and Europe.
But in Chile, people still use this kind of heater system from the last 100 years. People are still using that, mainly because traditionally it has been a more rural area, this area in Chile and Patagonia and southern Chile, wood is used as fuel to cook and heat, mainly because it’s cheaper, easier to access. It’s way cheaper than electricity, gas, or other more eco-friendly sources.
So, people keep using that. This is bad, especially in the winter, because it is related to the school year. After all, in Chile, the school year, starts in March and ends in December, and our winter is in June and July. So, June and July are the worst parts of the year, and this is the time when a student and the school have a lot of exposure to air pollution.
Maggie Fox 03:32
And just to be clear, this is in the neighborhoods, the homes around the schools. This isn’t like the schools using a wood-burning stove.
Álvaro Hofflinger 03:39
Right! It’s in the homes. So, we tracked students through an air quality monitoring station in Chile. We measured different distances, for example, one student lived one kilometer from the school, two, three. We know for sure their exposure to this because we measure that.
So, at school for the heating system, they must use gas or electricity. But in the house, mostly low-income people, they use wood burning stuff because it’s cheaper. As I say, I mean, high-income families have a variety of different options for heating systems.
Maggie Fox 04:11
So, pollution and learning wouldn’t necessarily put those two things together. So how does pollution biologically affect how a child is doing in school.
Álvaro Hofflinger 04:22
The research found two different mechanisms to explain the relationship between air pollution and student achievement.
The first one is that air pollution can affect students’ cognitive abilities.
So, when a child or a baby is exposed to air pollution, it can have an effect on their cognitive development later on. So, there’s a group of studies focused on that.
The second mechanism could be that they keep falling sick because of their exposure to the air quality. So, if they develop asthma, for example, they miss class, which decreases their attendance at school. We found that students with more exposure to air pollution have lower attendance in school.
So, if you don’t go to school, you’re going to learn less, right? And therefore, their GPA is going to be lower at the end of the day. So, these two kinds of mechanisms can explain why air pollution can be connected to an achievement.
Maggie Fox 05:14
Could it also be that poorer kids are just more likely to live in the polluted areas? And so, there’s a whole lot of other factors involved too.
Álvaro Hofflinger 05:24
Yeah, the picture as you say, is a little bit more complex. So, we also must research about that to understand the distribution of air pollution. Because, we think, “Okay, this city is polluted,” right?
But we assume the distribution of the air quality is similar across the neighborhood, but it’s not the case.
We have found that in low-income families or low-income neighborhood, the quality of air is bad, because, as I explained, the case of Chile, and especially southern Chile, people use wood burning stove as a heating system, also for cooking or even to dry clothes, because the winters can be humid.
But if you live in a neighborhood, an upper middle-class neighborhood, they have access to different kinds of heating systems, as I said electricity, gas. So, the government tried to push a little bit to reduce the use of wood-burning stoves, especially in poor areas.
What happened with these children who lived in this kind of neighborhood is that they were more exposed to air pollution. We saw in the research that they have a lower grade at the end of middle school. And with this longitudinal data set, we were able to follow the students. So, in some ways, you accumulated this effect over time. So, you start in third grade, right? It’s a little bit effective, but it starts to grow, so it’s going to accumulate over time.
Maggie Fox 06:40
So, you mentioned briefly, the government is sometimes pushing for less use of wood burning stoves. How do they even do that?
Álvaro Hofflinger 06:48
Well, they have different policies that have been implemented. One is the main policy is to replace the wood-burning stove with more eco-friendly heating systems, especially the use of electricity. It could be gas or a kind of cleaner energy, and has been successful in some ways, but also, it’s very hard. I mean, you are, you’re gonna go to a poor neighborhood and then tell people, “Okay, now you need to start to use electricity,” and electricity is kind of expensive.
There they have access to wood, right? I mean, that the entire area has a lot of forests, and people have connections with rural areas. So wood is way cheaper, and sometimes it’s free. For example, they have a relative who lives on a farm, and they go to the farm, they have access to wood, and they bring it to the city.
The first thing the government tried to do was replace. Also, they have been pushing for an increase in the installation of electric and gas stoves in houses, because we know indoor pollution is worse than outdoor pollution. So, they say, well, maybe if you replace your window, you get money to seal your door. There are different kinds of things that they are doing. Also, they are changing the regulations for the new houses now, and so they need to have certain standards to prevent outdoor pollution from coming inside the house. These are the two main policies that they are trying to implement.
Maggie Fox 07:59
This doesn’t sound like it’s going to work well. This is a lot of governments telling people what to do and not necessarily helping them to do it
Álvaro Hofflinger 08:07
Right! And, they have some regulations. For example, if their pollution is really bad one day, they call it an emergency. There’s a restriction on using your wood-burning stove, otherwise, you get a ticket from the government.
But it is almost impossible to regulate that, because everybody’s doing the same thing. How are you going to go to New York and tell them, okay, now you need to stop using your wood-burning stove? There could be elderly is living there, or they have a little kid. I mean, it’s a lot of issues there, right?
So, the government has not been very successful in implementing this kind of strange regulation about the use of preparing stuff. They tell you to do it, but people don’t follow the rules.
Maggie Fox 08:44
So, what about on the other hand, how about making the air cleaner in the schools? Is there some way to do that?
Álvaro Hofflinger 08:52
What they are doing is, as I say, the new school in the new building, and they are building it, so they need to follow certain regulations. They need to use clean energy to pass this new regulation.
But what happens with all the (existing) schools, right? I grew up in a rural area, and the heating system in my school was a burning stove. It’s less now! It’s way less now, because the government is pushing them to use the most electric system. Still, in some cases, they use a wood-burning stove.
Maggie Fox 09:19
What about air cleaners? Something like that, an air filter?
Álvaro Hofflinger 09:23
Yeah, that could be another solution. But now most of the effort the government is trying to make is to focus on and reduce the emission of air pollution based on households. They are not that focused on the school. It’s kind of a new discussion.
With this kind of research, we are trying to say, “Well, this is important too!” I mean, it’s not just housing that we focus on. We focus on individuals’ rights. “Oh, this family needs to replace their wood-burning stove with a different system.” Also, the school needs to be conscious of the exposure that the student has in the school. Because, as we know based on the research, indoor pollution is worse than outdoor pollution. But for now, the discussion is more about this kind of policy focus and the household.
Maggie Fox 10:02
So why do you feel it’s important to study these, these kinds of things in the Global South, in countries such as Chile instead of just in the richer countries, where it might be a little easier to study it?
Álvaro Hofflinger 10:12
Yeah, most of the research about the connection between air pollution and student achievement have been focused primarily on global north, by United States and Europe. There is less research in the global South, especially in Latin America and there are a couple of reasons for that. I think one of the main reasons is that access to data is hard.
In these places, having access to air quality is hard, and having access to even harder, right? I mean, in this case of Chile, we have good quality data. In this case, we have individual data, so that’s good. We were able to track these students over time, and that made this research very, very interesting. It’s important to do it, this connection with air pollution, because then we can push the agenda a little bit and say, “Well, our focus should not just be on replacing this wood burning stove or on families and households, but also schools, because the exposure of the student, they spend most of the time there, especially in the winter. They spend an entire day from 8 am to 4 or 6 pm. June and July are the worst times to be outside, and the students are there. I mean, even they have outside activities. So, if we are really focused on children, and we are considerate of both their learning, their development, we also need to discuss what is going on at school.
Maggie Fox 11:31
There was one thing I wanted to ask you. When you talked about replacing wood-burning stoves with electricity, there are a lot of areas where that’s not necessarily cleaner for the region, because the electricity is generated in, say, a coal-burning plant. So, what’s going on in these areas of Chile? Is electricity generated by clean methods?
Álvaro Hofflinger 11:54
In Chile we have most cases of clean energy, usually is generated by renewable sources. But also, this electric plant industry also has a problem, right?
For example, especially in southern Chile, where most of the indigenous people live, there is strong resistance to large-scale energy developments. These projects often alter the landscape and disrupt ecosystems. They feel that electricity from renewable sources interferes with their ecosystem.
So, they have a lot of pushback from private companies that generate electricity based on that, could be clean, but can also have an environmental impact.
Especially the indigenous community, I completely understand their point of view, the mining sectors can go there, sometimes leading to further disruption in these regions. Hydroelectric dams, for example, may seem like a viable solution, but they require extensive intervention in natural environments.
Also, there is a lot of ongoing debate about nuclear plants. But as you know, in Chile, we have a lot of earthquakes, so it’s not very good idea. You can create clean energy there for a couple of years, and then we have a big earthquake. Could be a big disaster, too.
So, the question is, how can we do that, right? How can we replace wood-burning stoves with cleaner energy?
So, one of the proposals has been this — the problem with using a wood-burning stove is that people use bad quality wood. If the quality of the wood is good, if it’s less humid, like five percent, then it’s not that bad, so maybe that could be a solution too.
But it’s really hard to change the habits of people, right? I mean, as I say, I grew up in a rural area. In my town, we have around 500 people, and everybody uses the burning stove, and it’s a very traditional way to live, and it’s very useful. I mean, it’s cheap, it’s a hidden system. Also, you can cook there, you can dry your clothes.
When we interview people, they say, “Well, yeah, you can give me an electric system, but it’s just not gonna be enough for me, because I need to cook, and I need to dry my clothes.” So, there are a lot of barriers to replacing this kind of old system. During the 90s, I remember when I was a student there, and the capital, Temuco, was way worse than it is now, and we can see the trend over time, and the air pollution has decreased significantly.
But the point is, it was too bad, right? It was really bad, and now you are getting just bad, but it still is about the threshold to the World Health Organization, or the standard that we have here in the United States. But this trend moved from really bad to just bad, it wasn’t that hard. I mean, it will take us 10 years, and now we need to move to the threshold to create a better quality of air. But it’s really hard because, as I say, we have an economic barrier, a cultural barrier, a kind of psychological barrier. And really, we need to understand the problem and push for a solution.
Maggie Fox 14:39
Alvaro, thank you so much for coming to the podcast.
Álvaro Hofflinger 14:42
Thank you so much, Maggie, for having me.
Maggie Fox 14:46
Listeners. If you enjoyed this podcast, please share it. You can learn more about this podcast and other important topics at onehealthtrust.org and let us know what else you would like to hear about at owoh@onehealthtrust.org. Thanks for joining us.
Guest

Credits
Hosted and written by Maggie Fox
Special guest: Álvaro Hofflinger
Produced and edited by Samantha Serrano
Music composed and sound edited by Raquel Krügel
Transcript edited by Namitha Prabhu