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Environmental Health: A Fifty-Year Perspective*

Jeffrey Koplan

During the past 50 years, substantial progress has been made on environmental health issues. We have progressed from a time when the environment was taken for granted with no thought of its degradation, to a period in which recognition of environmental issues spurred many historic laws, to the present era where we have begun to think about the environment in a much broader interdisciplinary context. This trend might best be illustrated by comparing experiences in two cities, Boston and Atlanta, 50 years ago and today. Boston typifies an older American city—one that experienced most of its suburban growth in the pre-automobile era—and Atlanta exemplifies a modern American city—one that had its greatest suburban expansion in the post-automobile era. In these 50 years, what has changed and what has remained unchanged? What has improved and what has deteriorated?

THE 1950s IN BOSTON

In the 1950s in suburban Boston, clean air was the rule. Air pollution was not a feature of life or even talked about. The water was not fluoridated. Boston was one of the last cities in the country to fluoridate its water, to the detriment of its citizens. In the 1950s, all children in Boston walked to school. The elementary school was about a half a mile away, and the junior high school was a little over a mile away. Many schools had no school buses, and there was no concept of car pooling children to school. There were sidewalks on both sides of every road, and they were considered a necessary part of every community. Tobacco smoke was a feature of life up through the 1970s. Many homes were filled with smoke most of the time. Many parents smoked, and social events were marked by smoke, food, and drink. Smoke was everywhere, in restau-

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This chapter is an edited transcript of Dr. Jeffrey Koplan’s remarks at the workshop.



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Health and the Environment in the Southeastern United States 3 Environmental Health: A Fifty-Year Perspective* Jeffrey Koplan During the past 50 years, substantial progress has been made on environmental health issues. We have progressed from a time when the environment was taken for granted with no thought of its degradation, to a period in which recognition of environmental issues spurred many historic laws, to the present era where we have begun to think about the environment in a much broader interdisciplinary context. This trend might best be illustrated by comparing experiences in two cities, Boston and Atlanta, 50 years ago and today. Boston typifies an older American city—one that experienced most of its suburban growth in the pre-automobile era—and Atlanta exemplifies a modern American city—one that had its greatest suburban expansion in the post-automobile era. In these 50 years, what has changed and what has remained unchanged? What has improved and what has deteriorated? THE 1950s IN BOSTON In the 1950s in suburban Boston, clean air was the rule. Air pollution was not a feature of life or even talked about. The water was not fluoridated. Boston was one of the last cities in the country to fluoridate its water, to the detriment of its citizens. In the 1950s, all children in Boston walked to school. The elementary school was about a half a mile away, and the junior high school was a little over a mile away. Many schools had no school buses, and there was no concept of car pooling children to school. There were sidewalks on both sides of every road, and they were considered a necessary part of every community. Tobacco smoke was a feature of life up through the 1970s. Many homes were filled with smoke most of the time. Many parents smoked, and social events were marked by smoke, food, and drink. Smoke was everywhere, in restau- *   This chapter is an edited transcript of Dr. Jeffrey Koplan’s remarks at the workshop.

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Health and the Environment in the Southeastern United States rants, in offices, in sports facilities, and even in hospitals. People smoked at the nurses’ stations. Following patient rounds, doctors retired to a conference room and everyone pulled out a pipe or a cigar. In that room you could cut the smoke with a knife! When the doctors left the room, a wall of smoke would roll out into the patients’ corridor. There was no concept of auto safety. Cars had no seat belts. Cars were for speed, looks, prestige, and transport; safety was rarely considered. These were the features of the environment in the 1950s, 1960s, and even the 1970s, not only in Boston, but in many similar cities throughout the United States. 2001 IN ATLANTA How have these things changed in a modern city of today—suburban Atlanta? The air quality in Atlanta has deteriorated noticeably from the early 1970s to the present. Haze and pollution are now common features of the city’s environment. The water is fluoridated. In fact, cities that do not fluoridate water supplies are now hard to find, and the current threat is the explosive growth of the bottled (unfluoridated) water industry and the concern that children are no longer getting adequate levels of fluoride. Walking is difficult in Atlanta today. Sidewalks are not a feature of most Atlanta communities that were built in the last 30 years. Biking is unsafe in many places because of the explosion of automobile traffic and the absence of bike paths and bike lanes. The lack of physical exercise has resulted in an epidemic of obesity and its sequelae. Most of life is smoke-free, and people are rarely exposed to a smoky environment. Auto safety is now firmly entrenched in the public mind, and lives are being saved as a result. Roads are safer, and cars are safer. Our concept of occupational and environmental safety has matured tremendously. A new aspect of today’s life is that workplace stresses follow us around all day. We have difficulty separating work from other parts of our lives because we are constantly accessible by pages, e-mails, faxes, and cell phone calls. This trend is an environmental stressor that is probably not healthy. If we consider the two locales in the two eras, we see pluses and minuses in each one. For example, although we have become more dependent on cars, we have enhanced auto safety. Although our air has become more polluted, we have reduced our use of tobacco. It is clear that one time period or one city does not represent the ideal. As we improve in some areas of environmental health, we stumble across new hazards that keep us from living healthier lives. As recently as 25 years ago, issues linking the environment with social injustice, a range of health conditions, or genetic and behavioral factors would not have been discussed. Today we understand that the environment intersects with every element of public health—from combating infectious diseases, to dealing with problems of climate and terrain, to preserving biodiversity. Public health now addresses a wide range of interrelated environmental issues, such as

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Health and the Environment in the Southeastern United States injury control and prevention, toxic exposure, maternal and child health, genetics, physical activity, and obesity. Environment has always been a key factor in public health. It is likely that our appreciation of its importance to public health will continue to grow and that our efforts will improve the environment and health in Atlanta, in Georgia, in the Southeast, and throughout the United States.