Northwestern University Feinberg School of Medicine

Program in Public Health

Can Public Health be Improved with Energy Access?

Kate Lamy, 2014

“The availability of energy is correlated to improved public health.” 

Image by Kate Lamy

This statement probably sounds like a reasonable assertion. Indeed, in informal polls it is difficult to find anyone who would disagree. However, it is equally challenging, for both experts and laypeople, to explain exactly why this intuitive statement holds true, a problem that may stem in part from the fact that it touches many disciplines. Here, Dr. Halley Aelion, PhD in Environmental Policy, and Dr. Amul Tevar, MPH and PhD in Materials Science and Engineering, teamed up to write an article probing the intersection of energy and public health. Honoring their different fields, they explore the links between energy and public health through personal and professional experience and empirical observations; then address its practical implications through the lenses of policy and technology. Writing this article led them to many unexpected technological- and policy-related topics, including the corporate social responsibility (CSR) theory and water sanitation methods. Simply put: energy access appears central to improving public health, indicating that a better understanding of this link is vital to achieve future global health successes. 

Personal and Professional Experience: Dr. Tevar 

My first tangible exposure to this link between energy and public health was during a visit to rural Haiti. I was at a remote health clinic that dealt with direct competition between their public health services and energy needs. As fuel costs increased and expenses were further raised due to the long and tortuous truck rides needed to reach the remote site, existing or planned public health programs had to be reduced or delayed because less money was available from the already small NGO budgets. Given such a scenario, it is difficult to say which is the priority: energy or public health. 

Many of my colleagues and I are convinced that better energy generation and management is the key to improving public health. However, the nature of the association remains unclear, leaving interested technology developers unsure of how best to affect the greatest improvement in global public health. 

Personal and Professional Experience: Dr. Aelion 

The tangible link between quality of energy access and quality of life first became apparent to me in 2007 when I worked for the World Food Programme (WFP). My primary focus was on a survey exercise evaluating the impact of WFP aid on orphaned and vulnerable children (OVC) in rural Namibia [1]. 

Similar to many Americans seeing a developing country for the first time, I was shocked at the basic ‘necessities’ of life these rural communities lacked. Clean water, electricity, and basic sanitation systems were all non-existent. Moreover, these are resources that cannot exist without a reliable energy source and good energy management. 

My most vivid memory during this experience was of an interview I did with a young boy who had been adopted by his aunt. The three-year-old boy had a serious wound on his face. When I asked what had happened, the aunt explained that the child had burned himself on the household fire. This fire, a dangerous hazard for a rambunctious toddler, was also the family’s essential energy source—their capacity to cook, to clean, and to wash. The child’s injury burned the reality into my mind that people still depend on fire—dangerous and primitive as it is—as their most reliable and accessible source of energy. 

The absolute necessity of this family’s fire, despite its danger, illustrates much of the intuition that we draw on when we agree that energy availability is essential for public health. Yet, how can we illustrate in a systematic and scientific way, the importance of the connection between resourceful, efficient energy management and enhanced public health? 

Rochelle Ku, 2014

Global Statistics and Current Approaches 

Image by Rochelle Ku

To shed light on the issue, the following trend is most telling: having >2,500 kWh/person-year of electricity appears correlated to an increased quality of life [2]. This correlation stands out because it presents an aggregate measure of benefit to a distinct measure of energy delivered. For reference, a single gallon of gasoline has about 34 kWh of energy [3] and ~3,334 Google searches uses about 1 kWh of energy [4]. Determining how best to satisfy this quota would help technologists design novel tools that will give the biggest public health return based on a quantitative measure, rather than on a broad and unsubstantiated assertion. 

Given this possible correlation, experts in public health are uniquely well-positioned to offer guidance to engineers and other technologists who are looking to develop new energy generation systems that would provide the threshold of energy that leads to an improvement in life quality. A great illustration of this type of public health focused technology effort is the Gates Foundation Toilet, which specifically focuses the efforts of seemingly unrelated fields to create a self-powered sanitation system that costs less than $0.05/day. 

Many other current projects focus on the immediate issues with existing energy sources to create cleaner, lower-particulate energy. This work is usually focused on cookstoves that are commonly used in rural developing areas [5,6]. Additionally, small, independent microgrids (small-scale versions of the centralized electricity system) and renewable projects to improve energy access are popular. These projects usually focus on a specific case study for a small community with limited follow-up [7], a situation that presents drawbacks but does provide short-term benefits both for the community and for the project developers. 

Looking ahead, the main challenges lie in the significant variation in local needs in terms of energy source (biomass, solar, diesel), the cultural approach to energy (individual, village, centralized) and what to power with the energy (lighting, cell phones, water, sanitation, agriculture etc.). One of the key difficulties in determining both an energy/public health association and the best way to reach the 2,500 kWh/person threshold is that many areas new to receiving power are following a very different blueprint for energy than those more established countries that have met the 2,500 kWh/person. When the grid was created in developed countries, there were few options beyond centralized power systems; however, the Bell Labs solar panel, a novel invention 60 years ago, is now a commodity product. Due to massive technological change and economies of scale, novel power sources, often running on decentralized systems, are now widely available. This new option, a mix of centralized and decentralized, has completely changed the blueprint for what energy access can look like, and it allows rapid deployment in areas of high need or adaptability to local opportunities. This changes the implications of the kWh/person standard. Specifically, it raises questions such as: how do we deliver this energy in today’s decentralized energy world? What metrics should guide the focus for improving public health with today’s energy technologies? 

How Could Policy help? 

From a policy perspective, these statistics and advances lead to an interesting, two-fold implication: if policy-makers want to enhance social welfare, they will have to do so using macro-data but micro-strategies. In other words, although the policy goal of providing >2,500 kWh/person is captured by a global trend that can be described through global statistical analysis, the policy strategy must be sensitive to local needs and cultural nuances. 

One of the best ways forward, given this situation, is to craft incentives for corporations to get involved in the energy and public health game. Although multi-national corporations (MNCs) may not be traditional “good neighbors” where social welfare is concerned, they are arguably the best suited actors. Consider the following scenario: 

1) Corporation wants access to resources/market in an underserved community 

2) Community needs better access to more reliable energy sources which can be best provided by MNCs’ resources and technology 

3) Local policy-makers want to encourage a robust economy and gain community favor 

In summary: each actor’s happiness lies in the goodwill of the other two. With all three parties interested in pleasing the other two, what is the best-case scenario to realize this mutual goal? 

Imagine the following scenario: 

1) The policy-maker, after speaking with the community, identifies the localized need for better energy access. 

2) The policy-maker uses legal incentives such as tax breaks for installing subsidized solar panels to encourage corporations to act in a way that responds to that need 

3) The promise of gaining political and community good-will drives the corporation to allocate resources to address the energy deprivation, with the goal that this good-will will lead to continued and perhaps enhanced access to resources and market success 

The end result is that the community’s access to energy increases, enhancing general welfare and health. Additionally, the corporation is viewed as a good neighbor, thus benefiting from legal and public favor. The policy-maker, proving him- or her-self attentive to the community needs, is re-elected. Win-win-win. 

Can this happen? Although it may seem an overly-idealized scenario, examples of this in real-life do exist and, encouragingly, are becoming increasingly common [8]. An excellent real-life model comes from Rahimafrooz, an MNC based out of Bangladesh. Rahimafrooz is the clear leader of emergency power products in Bangladesh but the group is known not only as a dominant market force but also a good neighbor because of its corporate social responsibility (CSR) initiatives educating local communities on the construction, installation, and management of solar panels [9]. 

In addition, polls of the modern workforce show that employees in diverse industries view CSR activities and corporate-led volunteer opportunities as a desirable mingling of personal and professional growth. When respondents were asked specifically about their view of the most desirable prioritization of CSR goals, environmental sustainability, including improving renewable energy and democratizing sustainable energy sources, ranked at the top of the poll [10]. 

What is the end result of MNC resources allocated to enhancing CSR and employee volunteer contributions? It is better energy access, a stronger economy, and a happier community. 

How could technology help? 

The two areas that come to mind with compelling potential to maximize the effect of energy to improve public health are water treatment, a direct intervention, and cell phone functionality, an indirect intervention. 

Let’s first consider the impact of energy accessibility on clean water availability. Implicit in having enough energy per person is having enough energy for wastewater treatment, and it has been said that more lives have been saved through clean water engineering than by physician treatment [11]. The energy requirements for wastewater in areas with established infrastructure are well understood, and domestically ~1 Quad of total US energy is being used to pump and treat wastewater. As referenced, annual domestic use of all energy, including transport and industry, is about 100 Quads [12]. The energy use is for treatment steps that inactivate or remove biological contaminants and isolate dissolved solutes. The average US energy use per person for daily water decontamination is about 0.128 – 0.275 kWh/person-day, depending on the level of assumed use [13]. This amount of energy is easily supplied and well within the suggested kWh per person threshold. It is remarkably energy efficient given its sheer scale and distribution. However, translating this success of wastewater treatment for public health improvement globally has been very difficult due to the consistent energy needed per person, the need to establish a centralized infrastructure and the upfront capital cost of community water treatment systems. Without the supporting infrastructure, there are few water treatment systems that can cost-effectively treat large volumes of water in an affordable manner for the developing world. 

One technology target would be process-intensification research to create low capital cost, low-energy household treatment systems that would approach the energy efficiencies at a smaller scale. New technologies, such as the Lifestraw or the self-powered Gate’s Foundation Toilet, are successful and can provide drinking water or wastewater treatment through zero end-point energy use. There is some controversy with these types of technologies because it is not clear if they will be affordable in areas of greatest need. However, approaching the thermodynamic limits to separate water from solutes becomes more difficult in smaller systems, especially when it includes biological and particle treatment or in a system that isn’t disposable. A metric for public health experts would be to define what would need to be removed, and what the characteristics onsite are. For example, a public health worker involved with the Haitian cholera outbreak could identify that the distribution chain needs self-powered refrigeration points for Dukoral vaccine along known endemic areas. However a family-sized system capable of inactivating pathogens for 2L/day with a lifetime of 1 year and costing no more than $25 would be a tremendous win that better fits within the social and economic structure. In our opinion, there are many technologies and researchers with potential solutions for the tremendous and varying water issues, but they lack guidance from public health experts as to what specific metrics they must engineer to. 

Another technological approach to improve public health that would require much less energy per person would be to build on the success of the cellular phone, as “more people now have cellular phones than clean water” [14]. The global deployment of these systems is remarkable, given that each phone represents an incredible advance in technology itself but also the ability to communicate without the need for static infrastructure. Systems for public health can benefit by building on the cell phone’s wide deployment and convenience [15]. There already are public health technologies that build on the cell phone to deter drug counterfeiting [16] or phone attachments that act as remote medical diagnostic equipment [17]. The unprecedented success of its global deployment, combined with public health applications, should be recognized for the convenience and instant, global information exchange it can allow. The next iteration of using the cell phone could be attachments that allow remote monitoring tools or assays combined with a simple query system to allow remote diagnoses. 

This would essentially allow a hospital-on-a-phone and when combined with cloud data, would recreate John Snow’s dot map incidence (London cholera, 1854) by location in real-time. The direct link to energy here would be simple: make charging cell phones and using additional energy for attachments trivial, as it currently is not a simple event. This could allow the cell phone to become a reliable base for building a distributed health network. In the same way that the future electricity grid in developing countries will hopefully not look like existing ones, the availability of a mobile computing device could change the way that public health is improved in these countries as well. This may not be the ideal solution, as it is reacting to events rather than preventing them. But it is a possible solution that doesn’t require costly infrastructure, that can be completely overhauled with a software update, and whose major innovation/capital cost already is in the pocket of most people across the world. 

Xochitl Vinaja, 2014

Conclusion 

Image by Xochitl Vinaja

Here we have discussed the connection between public health and energy availability from two perspectives. There appears to be value in providing decentralized energy to create critical systems such as water treatment and the enablement of new ones, such as mobile diagnoses. This avoids the prohibitive cost of providing large infrastructure and using less expensive devices as the point of care. These approaches can be considered complementary, because a treatment system such as the self-powered Gates Foundation Toilet can have significant immediate improvement, but also requires a centralized collective will to purchase and maintain the public health benefit [18]. The cell phone add-on is decentralized, individual, and possibly more easily palatable for impoverished people that are remarkably savvy with their investments [19], but cell phones still rely on an external, consistent energy source. There is likely not a silver bullet, but there are significant benefits to better understanding how and why better energy management impacts public health. 

By offering a mix of individual anecdotes and global statistics, we have demonstrated why safe and reliable energy sources are important to public health, and offered concrete examples of past successes and lessons learned in the interaction of the two fields. Looking to the future, we also identify hypothetical policy and technology triggers to enhance and leverage this symbiotic relationship going forward. We hope this interdisciplinary call to action has helped illustrate that the link between energy access and public health is central to future global health successes, and that these advances can be made possible with the contributions of strategic CSR funds and activities. Ultimately, with enhanced and focused conversations and collaboration between public health, policy, and technology experts as well as with CSR leaders in the private sector, we have confidence that public health will improve exponentially into the next century. These diverse fields currently interact in ad-hoc ways, but consistent, sustained and focused cooperation between them is essential to enhance the global quality of life through better energy management. 

Related article:  "A Smartphone Test for HIV and Syphillis Costs Pennies," MIT Technology Review, 2015.

References 

[1] Prout, J et al. Namibia Community and Household Surveillance: Round 2, 2007. 

[2] Majumdar, Arun. Harvard Business Review, “The HBR List of Audacious Ideas.” 2012. Accessed March 2014. 

[3] Alternative Fuels Data Center: Fuel Properties Comparison, 10/29/2014. http://www.afdc.energy.gov/fuels/fuel_comparison_chart.pdf 

[4] “Powering a Google Search.” 1/11/2009. http://googleblog.blogspot.com/2009/01/powering-google-search.html 

[5] Demirbas et al. Energy Conversion and Management, “Biodiesel from sunflower oil in supercritical methanol with calcium oxide.” 2007. Accessed March 2014. 

[6] Smith, K. et al. Annu. Rev. Public Health “Energy and Human Health”, 2013. 

[7] Brass, J. et al. Annual Review of Environmental Resources,” Power for Development: A review of distributed generation projects in the developing world.” 2012. 

[8] Werner, W. JHPN, “Corporate Social Responsibility Initiatives Addressing Social Exclusion in Bangladesh” 2009. Accessed March 2014. http://www.jstor.org.proxy-um.researchport.umd.edu/stable/pdfplus/10.2307/23499643.pdf 

[9] Ruman A et al. Bangladesh Research Foundation Journal, “A Literature Review on Green Banking in Bangladesh: Policy Guidelines for Banking and Issues.” 2013. Accessed March 2014. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CCYQFjAB&url=http%3A%2F%2Fwww.researchfoundbd.org%2Fimages%2F3rdissue.pdf&ei=ZAsXVJj7NNa1yASR7oDQCw&usg=AFQjCNHk4OMKzsR9-fJRwNtQe3Q5bWEs9g&sig2=j-UxFrlN5RN7DsGadjsUkA&bvm=bv.75097201,d.aWw 

[10] Aelion. PhD Qualification Thesis. “Environmental Stewardship in the Private Sector,” 2013. Accessed March 2014. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCMQFjAA&url=http%3A%2F%2Fdrum.lib.umd.edu%2Fbitstream%2F1903%2F14281%2F1%2FAelion_umd_0117E_14170.pdf&ei=uwsXVOS-BZK3yAT7lYLwDQ&usg=AFQjCNHzVCa8xPb3lZlNbyOkSTF-w97Prg&sig2=mDc8q1jSN67ptoNtVd9VRA&bvm=bv.75097201,d.aWw 

[11] Cutler, D. Demography, “The Role of Public Health Improvements in Health Advances: The Twentieth-Century United States.” 2005. Accessed October 2014. 

[12] Department of Energy. Science of Energy Flow, 2014. 

[13] United States Geological Society. USGS Water Science School, 2014. 

[14] Worstall, T. Forbes, “More Peoples Have Mobile Phones than Toilets.” 2013. Accessed March 2014. http://www.forbes.com/sites/timworstall/2013/03/23/more-people-have-mobile-phones-than-toilets/ 

[15] Feldscher, K. Harvard School of Public Health, 2012. Accessed Sept 2014. http://www.hsph.harvard.edu/news/features/eagle-cell-phones-public-health/ 

[16] Sproxil.com. Counterfeit Protection, 2014. 

[17] MIT Technology Review. Innovators Under 35: Caroline Buckee, 2013. Accessed March 2014. http://www.technologyreview.com/lists/innovators-under-35/2013/humanitarian/caroline-buckee/ 

[18] Schnitzer, D et al. Microgrids for Rural Electrification, 2014. Accessed Sept 2014 http://wpweb2.tepper.cmu.edu/ceic/pdfs_other/Micro-grids_for_Rural_Electrification-A_critical_review_of_best_practices_based_on_seven_case_studies.pdf 

[19] Pooreconomics.com, 2014.

Dr. AelionDr. Aelion is a project manager at the Department of Energy’s Advanced Research Project Agency. She also serves as an adjunct professor at the University of Maryland’s R.H. Smith School of Business. Her areas of research focus are corporate social responsibility best practices and environmental policy.

Dr. TevarDr. Amul Tevar is currently a joint appointee between Ohio State University’s College of Engineering and Battelle Memorial Institutes Energy Health & Environment Division. He was previously an ARPA-E Fellow who worked in energy storage control systems, the energy-water nexus and other emerging energy areas.