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He. Environmental Public Health
For several years, Denver, Colorado, has led the
Environmental Protection Agengy's (EPA) list of
cities with serious carbon monoxide air pollution
problems. At the state level, Colorado has the fourth
highest rate of death from chronic obstructive pul-
monary disease." Bradley Beckham of the Colorado
Department of Health says that researchers can
speculate that these two phenomena are related, but
no model based on reliable data exists to definitively
relate one to the other. (#469)
This situation is mirrored around the country with
many environmental concerns. The most common
observation of the 50 testifiers on environmental
health goals for the year 2000 is that for a wide range
of environmental problems, the data that might guide
public health policy are sorely deficient. Most of the
1990 environmental health objectives are unquantifi-
able. According to the majority of testifiers, research
and monitoring are needed to gauge how much of a
particular substance the population at large, or a
certain group, is exposed to and what health risk this
exposure induces.
Testimony reported in this chapter illustrates the
scientific and political problems involved in such
issues as toxic agents, hazardous waste, water pollu-
tion, air pollution, lead poisoning, food purity, electric
and magnetic fields, and noise pollution. Several
testifiers call for interdisciplinary research, whereas
others go further and identifier the kinds of private and
public action needed now.
One speaker, however, is very circumspect in
committing more public health resources to environ-
mental issues. Environmental health priorities should
be guided by better surveillance data and weighed
against priorities for known risks found in the occupa-
tional setting, argues Robert Spear of the University
of California, Berkeley. Most toxic agent or radiation
harm involves workers at specific sites. Thus, from a
quantitative or population-based perspective, public
health should devote more of its environmental efforts
toward high-risk populations and to surveillance of
the health outcomes of environmental conditions on
populations such as these. Conversely, public health
should not be expending as much of its limited funds,
Spear urges, on "programs whose health benefits are
difficult to Justin on the basis of procedures like
quantitative risk assessment, let alone on epidemi
148 Healthy People 2000: Citizens Chart the Course
ological grounds." (~275J
Although most witnesses addressed either the
immediate environment of the home and workplace or
the proximate physical environment in terms of land,
water, and air, Malcolm Watts of the University of
California, San Francisco pointed out that to help
ensure health for all people in the year 2000 and
beyond, attention also must be paid to longer-term
issues related to protecting our global environment.
If these problems are neglected in the next 10 years,
Watts says, they will be even more pressing-and
possibly overwhelmingly the year 2000. ¢#781)
TOXIC AGENTS
Much of the testimony on environmental health issues
involved toxic agents, hazardous wastes, and human
exposure to these substances through the water
supply.
"With the exponential growth of new technologies,
and the associated new, potentially toxic substances
used, what we do know continues to be far out-
weighed by what we do not know concerning all of
the effects produced by toxic agents," says George
Gaines of the Detroit Department of Health. (~210)
For example, Bernard Weinstein of Columbia Univer-
sity reports that although it is known that en~ron-
mental toxins and toxic chemicals contribute to
several kinds of cancer, as well as to a variety of
reproductive disorders, the mechanisms behind these
effects are less well understood. (#456}
Focusing on a particular health risk, Raymond
Singer of Mount Sinai School of Medicine is con-
cerned about how little is known of neurotoxicity.
Exposure to neurotoxic chemicals, which are present
in certain pesticides, solvents, herbicides, metals,
polychlorinated biphenyls (PCBs), and other sub-
stances found in consumer products, can cause per-
manent nerve and brain damage, according to Singer.
More than 850 chemicals are known to be neuro-
toxic,2 and the National Institute for Occupational
Safety and Health lists neurotoxicity as one of the 10
leading work-related diseases.3 However, "the effects
of low-level exposure to neurotoxic chemicals to
which most of us are exposed remains uncharted,"
says Singer. He encourages greater public awareness
of the signs and symptoms of neurotoxicity, suIveil
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lance of workers who are continually exposed to
neurotoxic chemicals, labeling of consumer products,
and testing of these products under chronic exposure
conditions. "Not only the public remains unaware of
the widespread and insidious nature of neurotoxic
chemicals, but also many health professionals," he
states. (#638)
Hazardous Wastes
Robert Meeks of the University of Alabama at
Birmingham writes that initial steps have been taken
to protect the environment and the public from
unsafe hazardous waste disposal through legislation.
This includes the Toxic Substances Control Act and
the Resource Conservation and Recovery Act. It is
now up to the scientific community, he claims, "to
develop an understanding of the potential and real
effects on the health of individuals resulting from
their exposure to toxic agents because they live near
hazardous waste sites." Meeks proposes comprehen-
sive risk assessment and health monitoring for
individuals who are faced with having hazardous waste
or toxic agent storage facilities in their communities.
(#622)
Even with public and private regulatory and control
mechanisms, lack of public understanding of the
means of disposal and public unwillingness to par-
ticipate in reducing barriers to safe disposal are
hurdles to action, according to Joan Sowinski of the
Colorado Department of Health. "If we are to
continue to manufacture products in this country,
there have got to be ways to safely treat wastes," she
says. If regulatory mechanisms are in place, the
public must support new waste disposal technologies.
Education in the schools is one method of resolving
this problem. "I would wager,n Sowinski comments,
"that elementary school kids know more about the
space shuttle than incinerators." Education must out-
line environmental problems and then provide an
awareness of possible solutions. (#379)
Water Contamination
Sheldon Murphy of the University of Washington
expresses concern about the quality of the nation's
water: "Seepage of toxic chemicals into groundwater
from toxic waste sites, agricultural applications, and
domestic and industrial discharges appears to present
a growing problem." (#357)
Carl Johnson, representing the American Associa-
tion of Public Health Physicians, speaks of the
contamination of well water in rural areas. He notes
that a significant percentage of rural wells in this
country are contaminated with nitrate from stoclyards,
septic tanks, and agricultural chemicals. To prevent
infant illness and death from nitrate contamination of
well water, management of environmental pollutants
must be maintained. Johnson also calls for a reduc-
tion in the number of pollutants in water. (#1114
Some of the most serious problems with the
nation's water quality stem frown land and air use
practices that have not yielded to regulation, report
David Freeman and his colleagues at the Lower
Colorado River Authority. Examples of these pro-
blems include "an increase in suspended sediments
from increased soil erosion; the increasing use of salt
on highways in the winter; the increasing use of
pesticides; and the increased use of fertilizers causing
eutrophication of receiving bodies of water." A spe-
cific result of these types of pollution is the nitri-
fication occurring today in the Chesapeake Bay. Iden-
ti~ing and implementing the necessary control mea-
sures to mitigate "nonpoint-source~ pollution will
require multiple strategies, some of which may be
expensive, he predicts. `~o677
Lead Poisoning
John Strauther of the Detroit Department of Health
says that childhood lead poisoning is "the most
common preventable pediatric disorder in the U.S. It
affects more children than measles, mumps, rubella,
and other communicable diseases combined. To
prevent its effects he calls for increased professional
awareness and screening.
The medical community needs to be better
informed about recent developments in the
identification and medical management of lead
poisoned children. Although lead poisoning is
best handled by public health facilities, it should
be part of every physician's responsibility to
advise, urge, and refer every parent to have
preschool children regularly screened until their
sloth birthday. (#412)
However, Despite almost 2000 years of experience
with the health hazards of lead, we know relatively
little about the different forms of lead and their
toxicity or even their relative absorption by humans,
reports Ellen Mangione of the Colorado Department
of Health. The 1990 objective on lead poisoning is
one of the four (out of twenty) trackable environmen
Environmental Public Health 149
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tat health objectives, but several testifiers comment
that changing knowledge of lead toxicity levels has
made the 1990 goal obsolete. (~362)
AIR POLLUTION
According to Murphy, indoor air pollution is going to
become a more apparent health issue over the next
decade. Energy conservation measures have led to
tighter buildings which, in turn, prevent the escape of
volatile components contained in many new building
materials; in addition, there are chemicals that may
seep into homes from soil or vaporize from polluted
water, fireplaces, stoves, and tobacco smoke. One
goal, Murphy argues, should be to better characterize
the exposure levels and health risks associated with
air contaminants in private and public buildings where
people spend most of their lives. (#357) Most of
those who discussed air pollution, however, were
concerned about outdoor pollution, especially that
caused by automobiles.
Allen Bell of the Texas Air Control Board suggests
a mixture of public and private initiatives to reduce
contamination of the environment and keep the
public safe from environmental health threats. These
include product bans, required or voluntary emission
standards, voluntary changes in products to reduce
emissions from product manufacture and use, informa-
tion strategies to promote private behavior that
reduces emissions, government subsidies to promote
emission reductions, legal sanctions and financial
penalties to compensate for past damages, and other
economic incentives. (#017)
According to Dave Anderson, the American
Automobile Association (AAA) believes that auto
manufacturers should play a role in reducing harmful
car emissions by developing cleaner automobiles that
operate efficiently under real-world driving conditions.
Anderson, like Bell, underlines the role of public
concern in controlling environmental risk. The public
wants better air quality, the AAA argues, but has
demonstrated concern about the cost of various air
quality improvement programs. The AAA concludes,
Officials at all levels of government have an obliga-
tion to ensure that costs of such programs are not
excessive in relation to proven benefits." (~008)
More specifically, the AAA supports the lead
phasedown program, already in process, that would
permit one-tenth (0.10) of a gram of lead per gallon
of leaded gasoline and a method to ensure the
availability of additives that would protect engines
designed to run on leaded gasoline. (#OOBJ
150 Healthy People 2000: Citizens Chart the Course
Denver's solution to its air pollution problem, says
Beckham, involves a number of major new steps that
include year-round daylight saving time to move the
afternoon rush out of the central Denver area before
the temperature inversion establishes itself; a ban on
wood burning during high-pollution days; voluntary
driving reduction; expanding mass transit; an enhanced
auto inspection program using computerized emission
test equipment; and use of high-oxygen gasoline in the
winter pollution season. (~469) Most of these com-
nonents could be employed in programs elsewhere.
FOOD-BORNE DISEASE
The Association of Food and Drug Officials (AFDO)
reports significant public health problems from food-
borne transmission of infectious disease. The total
incidence of diarrhea! food-borne illness in the United
States may be as high as 24 to 81 million cases per
year, and the estimated cost of food-borne illnesses is
in the range of $1 to $10 billion annually.4 f#384)
James Black of the Oregon Department of Agricul-
ture, representing AFDO, contends that Concern for
food-borne pathogens and subsequent illness desenes
a higher priority than it has been receiving in the
public health system. (#342) Pathogens introduced
into a community through the food and dairy supply
are now recognized to have a potential long-term
effect on that community's health. Food-borne patho-
gens "may lead to such diseases as chronic diarrhea,
arthritis, certain types of heart disease, malabsorption
of nutrients among the young, and Guillain-Barrd syn-
drome,n writes Black. (#342)
The AFDO recommendations for addressing the
problem of food-borne illness include a reemphasis in
schools of the basic sanitation principles that can
prevent most of these disease occurrences and a
consistent effort by federal, state, and local agencies
to address the issues from a research, reporting, and
regulatory approach. (~384)
Roy Morse, representing the Institute of Food
Technologists, offers similar solutions to food poison-
ing outbreaks: (1) more reporting on the causes of
the outbreaks, (2) more research on nutrition by the
federal government, (3) increased funding for research
and development in the food area, and (4) licensing
public health inspectors for restaurant inspection.
(~733J
Positive identification of the causative agent in a
water- or food-borne disease outbreak is the exception
rather than the rule, according to Charles Treser,
representing the Washington State Public Health
OCR for page 151
Association. Thus, "it is probably not feasible, or
necessarily desirable, to establish objectives for spe-
cific causative agents." Instead, he recommends that
the Year 2000 Health Objectives include "an explicit
objective calling for a 50 percent reduction in the
incidence of gastrointestinal illnesses by the year
2000. (#348)
IMPLEMENTATION
Public awareness of a range of environmental
influences, and the consequent concern, Justin the
inclusion of environmental health in the Year 2000
Health Objectives, says Bell. The concern of the
public "appears to be intensified by the complexity of
issues relating to environmental exposure to hazar-
dous substances and the involuntary nature of the
health risks.n Assessment of the total and relative
risks to human health, he argues, could aid tremen-
dously in directing resources and In helping the public
evaluate the health impact of environmental condi-
tions. (#01 7)
The rapidity with which new substances are intro-
duced into the market has stymied many attempts to
isolate and assess environmental risks to humans.
One major restraint in Catching up" with industry
output is finance. According to the American Public
Health Association's Laboratory Section:
With the exception of the Food and Drug
Administration, there is very little monitoring
of commercial products on behalf of consumers.
The catalogue of drugs and chemicals used for
the control of infectious diseases is extensive. If
the trend continues of less federal dollars for
activities in protection of the consumer, then it
is anticipated that the state public health labora-
tories will have to become more involved in
testing consumer products for safety and effec-
tiveness. (#548)
REFERENCES
Many states and local agencies are given the lion's
share of responsibility for managing and maintaining
the community's healthful environment, says Larry
Kamberg of the Washington State Environmental
Health Association. They do not, however, get the
lion's share of funds. (#318)
For many testifiers, the EPA and the FDA are
essential to ensuring environmental public health.
For example, William Scheckler of the University of
Wisconsin feels that the EPA and FDA strategies
should be more public health oriented. Broader use
of epidemiological expertise' by the EPA, the FDA,
and other federal health agencies should be
mandated." Epidemiological evaluation is important
in goal setting as well. Scheckler suggests that All
major environmental health protection initiatives
undertaken by the federal government be analyzed by
appropriate experts in epidemiology and cost benefit
and then reviewed in the context of other health
promotion and disease prevention priorities before
being funded and implemented." (#194)
A representative of the Detroit Department of
Health feels that the EPA should "have established
firm guidelines for acceptable levels of risk for
exposure to asbestos and most toxic agents," based
on the assumptions that "the focus of safety and
health practice will continue to shift toward preven-
t~on as opposed to control" and that "technology
advances will continue to outgrow data requirements."
This testifier also feels that an expeditious method
of controlling potentially harmful chemicals would be
to change current EPA regulatory procedures. (#210)
For example, even though the Toxic Substances Con-
trol Act requires the EPA to screen all new chemicals
before they enter the marketplace, the agency has
been slow in accomplishing its task, according to Paul
Rogers of Hogan & Hartson in Washington, D.C.
(#782) The Detroit official continues, "chemicals are
currently regulated one by one. By the year 2000, the
EPA must develop a more systematic approach, i.e.,
regulating chemicals as recognized characteristic
groups." (#210)
1. Colorado Department of Health: Health Status in Colorado, 1985. Summary. Denver: June 1986
2. Anger K, Johnson B: Chemicals affecting behavior. Neurotoxicity of Industrial and Commercial Chemicals.
Edited by JL O'Donoghue. Boca Raton, Fla.: CRC Press, 1985
Environmental Public Health 151
OCR for page 152
3. Centers for Disease Control: Leading work-related diseases and injuries-United States. Morbid Mortal Wkly
Rep 32~2~:24-26,32, 1983
4. Kvenberg JE, Archer DL: Economic impact of colonization control on foodborne disease. Food Technol, July
1987
TESTIFIERS CITED IN CHAPTER 18
008 Anderson, Dave; American Automobile Association
017 Bell, Allen; Texas Air Control Board
067 Freeman, S. David, et al.; Lower Colorado River Authority
111 Johnson, Carl; South Dakota Department of Health
194 Scheckler, William; University of Wisconsin
210 Gaines, George; Detroit Department of Health
275 Spear, Robert; University of California, Berkeley
318 Kamberg, Larry; Washington State Environmental Health Association
342 Black, James; Oregon Department of Agriculture
348 Treser, Charles; University of Washington
357 Murphy, Sheldon; University of Washington
362 Mangione, Ellen; Colorado Department of Health
379 Sowinski, Joan; Colorado Department of Health
384 Messenger, Tom; Association of Food and Drug Officials
412- Strauther, John; Detroit Department of Health
456 Weinstein, I. Bernard; Columbia University
469 Beckham, Bradley; Colorado Department of Health
548 Blaine, James; American Public Health Association, Laboratory Section
622 Meeks, Robert; University of Alabama at Birmingham
638 Singer, Raymond; Mount Sinai School of Medicine
733 Morse, Roy; Institute of Food Technologists
781 Watts, Malcolm S. M.; University of California, San Francisco
782 Rogers, Paul; Hogan & Hartson (Washington, D.C.)
152 Healthy People 2000: Citizens Chart the Course
Representative terms from entire chapter:
detroit department
