China is already home to 16 of the planet’s 20 most heavily polluted cities -- a noxious consequence of its double-digit economic growth. Now researchers have worse news for the nation’s beleaguered lower classes: The air inside their homes is up to 10 times worse than the prevailing gloom outside.

Seven of 10 homes still burn coal and wood for heat, and half of Chinese men smoke -- a toxic combination of indoor pollution that raises dire questions about the fate of this industrial giant’s long-term public health.

Over the next quarter-century, 83 million Chinese -- a number equaling nearly a third of the total U.S. population -- will die of lung cancer and respiratory ailments unless cigarette smoking and indoor fuel-burning are reduced, a new study by Harvard’s School of Public Health warns.

“In many places in rural China, the roads are good, people now have cellphones and electricity, but residents are still cooking and heating with the same fuel they have used for centuries,” said Majid Ezzati, an associate professor of international health and senior author of the study. “And as a result, people are dying.”


In an article published this month in the Lancet medical journal, the Harvard team also concludes that programs to reduce smoking and household use of coal and biomass fuels such as wood for cooking and heating could significantly reduce the deaths.

The question, researchers say, is whether the Chinese government has the political willpower to enact sound public health policy.

“This analysis shows that smoking and fuel use, which affects hundreds of millions of people in China, will be a defining feature of future health in that country,” said Hsien-Ho Lin, a graduate student in the department of epidemiology at Harvard’s School of Public Health and the lead author of the study.

Ezzati said he was working a few years ago in central China when his team noticed the high number of deaths, which residents did not seem to attribute to their household habits.


“People may know when they are in the house and it’s very smoky . . . that it’s making them cough -- their chest may hurt and their eyes burn. They talk about symptoms and discomfort,” he said.

“They know there is something that’s not good from their living conditions. But neither in China nor in other parts of the world do these people say: ‘This is making me die early.’ ”

The World Health Organization in China calls the addiction of the nation’s 250 million smokers devastating to public health. “The human suffering, productivity loss on a massive scale and the billions in health costs is an epidemic,” said Sarah England, technical officer for the WHO’s Tobacco Free Initiative.

“The new Harvard study is a wake-up call, but they only looked at some of the ways smoking kills in China. Cigarettes kill a million a year there. That’s the highest death toll in the world by far.”


But China’s staggering rate of smoking among adult men brings a financial windfall for the government.

“The Chinese government is the largest manufacturer of tobacco in the entire world -- larger than all of U.S. tobacco,” Ezzati said. “There’s a huge economic incentive to continue making cigarettes.”

Though respiratory illnesses account for three of the top 10 causes of death in China, anti-smoking laws in public places are often not enforced.

Using mathematical models, the researchers determined that the gradual elimination of smoking and biomass fuel burning would prevent 26 million respiratory-related deaths and 6.3 million deaths from lung cancer by 2033.


But experts in China agree that the government has not publicized the extent of the danger. Indoor pollution is worse in rural areas and smaller cities, but even in modern Beijing, once the weather cools, men on bicycle carts wheel stacks of coal bricks for home delivery, peddling alongside European sports cars.

“Awareness needs to be raised. It is important to provide proper education on the subject to the civilians,” said Yang Xudong, a professor in the Department of Building Science at Qinghua University in Beijing who specializes in indoor air quality and pollution control research. “There’s not enough recognition on the subject, and the government’s support is essential.”

Ezzati said the solution must involve cooperation from China’s powerful economic and energy sectors.

“The nation’s public health sector realizes the problem,” he said. “But those who can influence a solution and those who care about it happen to be different people.”


Chinese officials have recently become more sensitive to the environmental cost of the country’s economic boom after a series of high-profile pollution accidents and worldwide reports before the Summer Olympics about its severe air pollution.

Beijing officials announced last week that they would ban half of the city’s 3.4 million cars from the roads during periods of very heavy pollution. On the same day, the state-run press reported that hundreds of villagers had been poisoned by contaminated water in southern China.

Ezzati said China has the resources to make changes.

“In a country managing such fantastic growth, they can do something about this pollution once its gets on their radar screen. The question is whether the government cares about the poorest of the poor as they do in continuing to fuel their economic boom.”


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john.glionna@latimes.com