Review on Health Impacts from Domestic Coal Burning: Emphasis on Endemic Fluorosis in Guizhou Province, Southwest China.

Endemic fluorosis in Guizhou Province, Southwest China was firstly reported by Lyth in 1946 and was extensively concerned since the early 1980s. Initially, the pathological cause of endemic fluorosis in Guizhou Province was instinctively ascribed to the drinking water. However, increasing evidences pointed that the major exposure route of fluorine for the local residents is via the roasted foodstuffs, especially the roasted pepper and corn. Source of fluorine in roasted foodstuffs was once blamed on the local coal and subsequently imputed to clay mixed in the coal. In fact, both are probably the source. Geogenic fluorine concentration in soil and clay is indeed high in Guizhou Province, but is not likely to be the direct cause for endemic fluorosis. The real culprit for endemic fluorosis in Guizhou Province is the unhealthy lifestyle of the local residents, who usually roasted their foodstuffs using local coal or briquettes (a mixture of coal and clay), resulting in the elevated fluorine in roasted foodstuffs. Nowadays, endemic fluorosis in Guizhou Province has substantially mitigated. Nevertheless, millions of confirmed cases of dental fluorosis remain left. In addition to endemic fluorosis, other health problems associated with domestic coal burning may also exist, because of the enrichment of toxic/harmful elements in the local coal. It is necessary to determine how serious the situation is and find out the possible solution. As people in other developing countries may suffer from similar health issues, same health issues around the world deserve more attention.