Department of Industrial Management, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka.
Department of Public Administration, University of Sri Jayewardenepura, Gangodawila-Nugegoda, Sri Lanka.
Int J Health Plann Manage. 2022 Jan;37(1):465-485. doi: 10.1002/hpm.3350. Epub 2021 Oct 15.
Despite escalating income levels of Sri Lankan households, 70.3% of them still depend on firewood for cooking. This might lead to bad respiratory health and thereby, increased healthcare utilisation. With this backdrop, this paper examines how firewood burning for cooking influences respiratory health and healthcare utilisation of Sri Lankans. The study proposes a theoretical model to explain effects of firewood burning on respiratory health and healthcare utilisation and empirically tests it using nation-wide micro-data of 79,170 individuals belonging to 21,748 households. The data are drawn from the most recent wave of Sri Lankan household income and expenditure survey. After addressing potential endogeneity by applying instrumental variable regression models, the study finds that firewood burning increases households' probability of asthma prevalence by 10.9 percentage points (P < 0.001), out-patient care utilisation by 33.1 percentage points (P < 0.001), and in-patient care utilisation by 17.5 percentage points (P < 0.001), on average. Our individual level analysis demonstrates that females are more vulnerable to bad respiratory health induced by firewood burning (β = 0.055, P < 0.001) compared to males (β = 0.008, P > 0.1). The results imply policies on promoting improved-cooking stoves, separated-kitchen designs, and switching more towards cleaner energy sources, including LP gas and solar power.
尽管斯里兰卡家庭的收入水平不断提高，但仍有 70.3%的家庭依赖薪柴做饭。这可能会导致呼吸健康状况不佳，并因此增加医疗保健的使用。在此背景下，本文探讨了薪柴燃烧做饭对斯里兰卡人的呼吸健康和医疗保健使用的影响。本研究提出了一个理论模型来解释薪柴燃烧对呼吸健康和医疗保健使用的影响，并使用属于 21748 户家庭的 79170 个人的全国微观数据对其进行了实证检验。这些数据来自斯里兰卡家庭收入和支出调查的最新一波数据。在通过应用工具变量回归模型解决潜在的内生性问题后，该研究发现，薪柴燃烧使家庭患哮喘的概率平均增加了 10.9 个百分点（P<0.001），门诊护理利用率增加了 33.1 个百分点（P<0.001），住院护理利用率增加了 17.5 个百分点（P<0.001）。我们的个人层面分析表明，与男性（β=0.008，P>0.1）相比，女性更容易受到薪柴燃烧引起的呼吸健康问题的影响（β=0.055，P<0.001）。这些结果意味着需要制定政策，推广改良炉灶、分离式厨房设计，并更多地转向更清洁的能源，包括液化石油气和太阳能。
