Introduction
Energy transitions in developing economies lie at the intersection of social justice, public health, and climate action. Over 80% of the world’s 2.3 billion people without access to clean cooking solutions live in Sub-Saharan Africa, where continued reliance on traditional biomass fuels such as wood, charcoal, and agricultural residues contributes to more than 800,000 premature deaths annually, disproportionately affecting women and children. This study examines the relationship between energy transitions and health equity in developing economies, with particular attention to Bangladesh, South Asia, and Sub-Saharan Africa. It explores how the adoption of clean energy influences health outcomes, household medical costs, and gender equity. For low- and middle-income countries, transitioning from fossil-based and traditional biomass energy systems to renewable and clean energy sources presents both opportunities to reduce health disparities and challenges related to affordability, infrastructure, and policy implementation.
Methods
A systematic review methodology was employed, integrating qualitative assessments of policy interventions with quantitative analysis of empirical studies published between 2020 and 2025. Peer-reviewed literature focusing on household energy transitions in China, Bangladesh, Kenya, and broader Sub-Saharan African contexts was analyzed. Data sources included longitudinal household surveys, geospatial modeling studies, and difference-in-differences (DID) analyses. Key outcome measures were: (1) household medical expenditures before and after clean energy adoption; (2) health outcomes measured through respiratory disease incidence, mortality rates, and disability-adjusted life years; (3) gender-specific impacts on time use, income generation, and household decision-making; and (4) rural–urban disparities in energy access and health equity. Case studies were selected based on geographical diversity, empirical rigor, and representation of diverse clean energy technologies, including liquefied petroleum gas (LPG), solar home systems, biogas digesters, improved cookstoves, and micro-hydropower. The analysis also incorporated policy framework evaluations, infrastructure requirements, and cost–benefit considerations to identify scalable and context-specific solutions.
Results
The findings demonstrate that clean energy transitions yield significant health and economic benefits, with notable heterogeneity across populations. In China, household adoption of clean energy was associated with a 16.1% reduction in medical expenditures, with stronger effects observed among rural households, individuals with lower educational attainment, and medium-sized families. These reductions were mediated by improvements in income and health status. In Bangladesh, more than 6 million solar home systems had been installed by 2021, generating 489 MW of electricity and substantially expanding energy access. However, high upfront costs and infrastructure limitations constrained broader impacts, with renewables accounting for only 3.5% of total energy consumption.
Sub-Saharan Africa faces the most severe challenges: in 2022, approximately 990 million people lacked access to clean cooking, a figure increasing annually due to population growth outpacing infrastructure expansion. Geospatial analyses indicate that traditional biomass yields the lowest social net benefits, reflecting significant market failures. Gender impacts were particularly pronounced, as women in rural areas spend an average of 20 hours per week collecting firewood—time that could otherwise be allocated to education or income-generating activities. Clean cooking initiatives, such as biogas programs in East Africa, benefited approximately 0.5 million people and enabled participating women to save $150–$300 annually in fuel costs. Health gains extended beyond reductions in mortality to lower incidences of chronic obstructive pulmonary disease, lung cancer, and ischemic heart disease. Projections suggest that universal access to clean cooking could avert 2.5 million premature deaths globally by 2030.
Conclusion
Energy transitions in developing economies offer substantial potential to advance health equity, gender equality, and climate objectives, particularly for vulnerable populations such as women, low-income households, and rural communities. Clean energy adoption reduces household medical costs, improves health outcomes, and redistributes time and economic opportunities more equitably. Nonetheless, achieving universal access requires addressing persistent barriers, including inadequate infrastructure, affordability constraints, and limited financing mechanisms. The global annual financing gap of approximately $8 billion represents a small fraction of existing energy subsidies, underscoring that political commitment rather than resource scarcity remains the principal obstacle. Successful transitions demand gender-inclusive policies, innovative financing, strengthened local governance, and context-specific strategies grounded in energy justice. As climate change is projected to affect billions of people in coming decades, accelerating clean energy access constitutes essential infrastructure for sustainable development, public health protection, and social equity.
