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Suggested Citation:"2 Keynote Address ." Institute of Medicine. 2001. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10044.
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Suggested Citation:"2 Keynote Address ." Institute of Medicine. 2001. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10044.
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Suggested Citation:"2 Keynote Address ." Institute of Medicine. 2001. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10044.
Page 9
Suggested Citation:"2 Keynote Address ." Institute of Medicine. 2001. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10044.
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KEYNOTE ADDRESS 7 2 Keynote Address ENVIRONMENT AND HEALTH: A CONNECTION TO THE CURRENT DEBATE Timothy E. Wirth President, United Nations Foundation Significant progress has been made in addressing environmental health concerns since the Cuyahoga River caught fire in 1969, including the Rio Conference in 1992 and the 1994 Cairo Conference on Population, where over 180 countries came together and developed an aggressive program of action concerning the urgent need to stabilize the globe’s population. The environment has entered the political lexicon; most leaders at least acknowledge the issue, if for no other reason than fear of the environmental constituency. In the United States, in an amazingly short period of time in the 1970s, we passed a number of bills designed to protect our air, water, and soil. In slightly more than 6 years, Congress laid the groundwork for what is still the most sophisticated framework of environmental law and regulation constructed by any nation, including the following: • The Safe Drinking Water Act of 1974 was designed to set basic federal standards for drinking water quality in response to an avalanche of data showing that state and local governments were failing to protect the public from water-borne diseases, chemicals, and heavy metals. • The Clean Air Act Amendments of 1977 established the regulatory structure and an enforceable timetable for reducing urban air pollution, when the serious public threats presented by ozone and particulate matter were being quantified for the first time. • The Clean Water Act of 1977 sought to make rivers and lakes safe for fishing and swimming.

KEYNOTE ADDRESS 8 • The Superfund statute enacted in 1980, in response to Love Canal and Times Beach, to protect communities from the health dangers of hazardous waste disposal sites. • The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Toxic Substance Control Act (TSCA, pronounced Tosca) enacted in 1972 and 1976, respectively, to require analysis of chemicals to which the public might be exposed through food or other pathways. It is striking, however, how little policy progress has been made in the years since, even though we were then proceeding on the most rudimentary scientific knowledge about the highly complex relationship between the environment and public health. Our policy proposals were correspondingly crude, with a heavy focus on protecting adult Americans from pathogens and carcinogens. Now we know so much more, and we are doing so much less. For example, 20 years of research have produced a wealth of new knowledge, an enormous amount of it pointing to the special vulnerability of children to their environment. Yet politicians and policymakers have yet to lead the public by drawing clear connections among education, health, and the environment. Over the past decade, environmental health research has revealed that infancy and the prenatal period are critical in the development of intellectual capacity. As the brain develops, critical micronutrients and the corrosive effects of microcontaminants that function as neurotoxins have long-lasting impacts, and children can be permanently deprived of their intellectual potential. Examples include the health effects of iodine, zinc, and iron deficiencies; and elevated blood levels of and fetal exposure to mercury, polychlorinated biphenyls (PCBs), and common pesticides. A growing body of evidence shows that far lower levels of some neurotoxins can have more serious impacts on intelligence and behavior than anyone had previously believed. In addition, new research has raised substantial concerns about these contaminants’ contributions to a wave of behavioral disorders now affecting our schools. These range from attention deficit hyperactivity disorder, to aggression, to impulsive behavior. These disabilities are clearly the result of complex interactions among genetic, environmental, and social factors, and their apparent increased prevalence is, in part, due to improved detection or record keeping. Yet, these trends are still disturbing and should be part of any discussion about education and health. Because children’s special vulnerability to microcontaminants has become clear only in the past 15 years, virtually all of our exposure standards for neurotoxins are failing to protect American children. Fifteen years ago, we were largely ignorant about the lower thresholds at which children are sensitive to toxic exposures, due to lower body weight and other factors; the multiple pathways through which children are exposed to a chemical, resulting in an increased cumulative exposure far above safe levels; and the synergistic effects of multiple chemical exposures.

KEYNOTE ADDRESS 9 We were also in the dark about the massive amounts of neurotoxins being released in the United States every year. More than a billion pounds of neurotoxins were released by large industrial facilities into the air, the water, and on land. Even after all we have learned about the danger of lead, Massachusetts’ data showed that the use of lead in manufacturing increased 77 percent in that state alone from 1990 to 1997. Moreover, the reach of many of these chemicals is global. For example, Inuit mothers in the Arctic, far from sources of industrial pollution, show some of the highest worldwide levels of PCBs in their breast milk as a result of a diet high in fat from marine mammals, as the toxins emitted at lower latitudes moved up the food chain. The costs to society of impaired learning capacity in children because of environmental contamination are difficult to measure, but we know that the cumulative loss of intellectual capacity is tragic not only at the personal level, but at the societal level. Moreover, the social costs of caring for a larger fraction of the population classified as mentally retarded far exceeds the cost of the needed environmental protection and prevention. For example, the elimination of lead from gasoline and paint may be one of the most significant educational advances of the 20th century. Research results equate a 10-point drop in blood lead levels with an average 2.8- point gain in IQ. Since the elimination of lead from gasoline in the United States, we have witnessed a 15-point drop in blood lead levels. This gives every baby born today a gift of 4–5 additional IQ points. What is this worth economically? These concerns extend around the globe. UNICEF estimates that around the world, iodine deficiency has produced lowered mental ability in some 300 million people. In many, if not most, of the large cities in the developing world, the percentage of children affected by lead poisoning is staggering; in some African cities, it is as high as 90 percent. These issues also tap a deep well of social injustice. While lead poisoning, inadequate nutrition, and exposure to neurotoxins cross all socioeconomic, geographic, and racial boundaries, the burden falls disproportionately on low-income families and families of color. In the United States, children from poor families are eight times more likely to be lead poisoned than children from higher-income families. African- American children are five times more likely to be lead poisoned than white children. In addition, the astonishing statistics about today’s Russia grimly illustrate the health effects of a poisoned environment. The greatest legacy of the communist era will be not only the poisoned rivers, depleted soils, and toxic dumps, but also the birth defects, learning impairments, and rampant childhood diseases now overwhelming that nation’s young. This pattern is repeated internationally. Poor nutrition and greater contamination go hand in hand. Together, they reinforce for entire communities a vicious cycle of learning deficiency and poverty. The result is poor productivity and substandard lives—communities that cannot compete in the global economy. Too many nations, already pressed by appalling poverty and sharply in

KEYNOTE ADDRESS 10 creased levels of population, are simply unable to invest in the public health and nutritional measures that would halt this cycle. These causes of intellectual decline are a potent threat to any attempt to move the world toward sustainable development. Poverty is both a cause and an effect of high birth rates. Lowered intellectual capacity leads to economic difficulties, an inability to manage the environment in a sustainable manner, increasing poverty, and high birth rates. High birth rates mean that populations grow beyond the capacity of the environment to feed them, and poor nutrition results. Poor nutrition contributes to intellectual decline, which, through illiteracy, may precipitate high birth rates and poverty. This is a global problem, and we must respond globally, through a strong Convention on Persistent Organic Pollutants. This treaty is currently being negotiated under the auspices of the United Nations. This convention will enable measures to be taken to reduce or eliminate exposure to the most potent persistent organic pollutants now found in the environment and will also establish a framework for considering additional compounds as the science advances. The convention is about public health. It is also about intellectual development, and ultimately economic competitiveness, because virtually all of the compounds under consideration are known or suspected to interfere with developmental processes in the fetus. We allowed too many compounds such as DDT and PCBs to move into global use before we understood their tragic consequences. The proper place to carry out experiments is not in our children’s bodies or in the ecosystems of the world. It is in government, industry, and academic laboratories, resolving health questions before a chemical goes into widespread use and its recall becomes problematic. Here at home, we are operating with a regulatory framework that is 20 years out of date, built on the rudimentary science of the 1970s. The Environmental Protection Agency (EPA) has required complete tests for developmental neurotoxicity for only 12 pesticides and has only recently begun to require further testing. Nearly 75 percent of the top high-volume industrial chemicals have undergone little or no neurotoxicity testing, despite the fact that 28 percent of the current inventory of 80,000 chemicals in commerce has neurotoxic potential. Under the 1970s SCA statute, EPA cannot require testing unless it has evidence of danger and cannot prove it has evidence of danger without testing. Changing this increasingly dangerous situation will require a major shift in our approach to chemical regulation and in our debate over education in America. We can no longer act to protect society from the impacts of chemicals only after a scientific consensus is reached and hundreds of thousands or millions of Americans and their children have been exposed without their knowledge or consent. The disturbingly long time it has taken the federal government to act on dioxin, the most potent carcinogen identified, makes this clear. We must substitute a far more protective standard and follow the Europeans in developing a broad precautionary approach to chemical regulation. Public health, economics, and the future of our children demand it.

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This is a summary of the workshop Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. The goal of this workshop was to emphasize the connection between human health and the natural, built, and social environments. This workshop integrated talks from many fields and created a dialogue among various environmental health stakeholders. The language presented in this respect should not be viewed as an endorsement by the Environmental Health Sciences Roundtable or the Institute of Medicine of what action is needed for the future, but rather as an effort to synthesize the various perspectives presented.

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