Introduction to Environmental Health
Never does nature say one thing and wisdom another.
Juvenal (c.55-127 A.D.)
Food and Drug Safety
Occupational Safety and Health
Environmental Health: International Perspective
Prevalent topics in environmental health include air and water quality, waste management, food and drug safety, population growth, occupational health, toxicology, risk assessment, genetics in risk assessment, environmental law, standards, monitoring, and disaster response. From 3000 deaths within hours due to acute exposure to Methyl isocyanate in Bhopal, India, to an outbreak of Cryptosporidium in the Milwaukee water supply, to windblown dust from a dried up lake, Owens Lake, out west as a source of the worst particulate air pollution in the United States; the consideration of environment in health is not a topic to be viewed insouciantly. Following is a window into a topic whose scope is fit for a book unto itself.
standards familiar today in the
Often the protection of
the public’s health is at odds with the aims of an innovative
industrial/economic complex. Standard
setting and monitoring is an expensive and controversial enterprise. The main detriment for public health
advocates is the lack of a precautionary principle. Substances are often put on the market and
assumed safe until proven otherwise, rather than withheld until proven
safe. As Rachel Carson noted, focus is
often placed only on the blatantly obvious and grotesque immediate effects of
an exposure rather than on the exposures with insidious effects at low doses
that the population pervasively encounters. Regulation is a slow process by nature due to
the sheer amount of chemicals manufactured.
An estimated 1,000-1,600 new chemicals are introduced in the
The National Environmental Policy Act (1969)
The National Environmental Policy Act (NEPA) declared the consideration of environment an item requiring national policy. Under NEPA federal agencies that have/will have an impact on the environment are required to submit documentation, environmental impact statements (EIS) and environmental assessments (EA), on proposed actions and consequences thereof. This provides government with the information necessary to respond to such proposals.
Toxic Substances Control Act (1976)
Under the Toxic Substances Control Act new chemicals are required to be registered with the EPA prior to marketing. Imported and exported chemicals must also be reported to the EPA. However, the act stipulates that fulfilling the aims of the TSCA must not unnecessarily impede economic and technological innovation.
Federal Insecticide, Fungicide, and Rodenticide Act (1947)
The Federal Insecticide, Fungicide, and Rodenticide Act requires registration of pesticides with the EPA prior to marketing. The EPA sets tolerance levels for residue on food. States are responsible for enforcing the law under violations.
The Comprehensive Environmental Response, Compensation, and Liability Act (1980)
CERCLA (the Superfund law) focuses attention on the cleanup of hazardous sites. All owners present and past are liable for the cost of cleanup. Under the Superfund Congress provides funds for sites identified and ranked in order of priority by the EPA. The number of sites is estimated to be in the thousands.
Resource Conservation and Recovery Act (1984)
RCRA is the “cradle to grave” policy for regulating hazardous waste. RCRA covers transport, generators, disposal, storage, and treatment facilities. Implementation is carried out by the states.
Emergency Planning and Community Right-to-Know Act (1986)
This act encompasses emergency planning, toxic substances registry, and toxic release inventory programs. The act calls for state planning and public reporting.
Pollution Prevention Act (1990)
The Pollution Prevention Act is the national policy to reduce and prevent source pollution. Other aims include recycling and safe treatment of waste, and disposal into the environment only as a last resort. This act reduced hazardous substances used in industry and has significantly decreased work related exposures.
Occupational Safety and Health Act (1970)
The Occupational Safety and Health Act aims to provide “healthful” working conditions for men and women alike. This act created the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH). The aim of NIOSH is research and OSHA is responsible for the review of NIOSH research as well as proposing new standards and changes to existing standards.
Legislation neither aforementioned, nor covered later in this chapter, includes the Endangered Species Act (1973), Deepwater Port Act (1974), Energy Supply and Environmental Coordination Act (1974), Energy Conservation Act (1976), Nuclear Waste Policy Act (1982), Low Level Radioactive Waste Policy Amendments Act (1985), and the Energy Policy Act (1992), amongst many others.
Clean Air Act (1955, Amendments 1967, 1970 1977,1990)
The Clean Air Act is responsible for setting National Ambient Air Quality Standards (NAAQS). New sources of release are required to conform to the best available control technology (BACT). 1970 Amendment called for a ninety percent reduction in automobile emissions. 1990 Amendment allows pollution allowances to be bought and sold.
are six EPA identified and monitored criteria air pollutants: particulates,
carbon monoxide, ozone, sulfur dioxide, nitrogen oxides, and lead. All are products of combustion. The World Health Organization (1987) has adopted
guidelines for these same pollutants. However, air pollution in cities such as
Current air quality legislation primarily addresses outdoor ambient pollutants. Relatively little has been done to address indoor air quality. The issue becomes increasingly pertinent as lifestyle changes indicate that people now spend around ninety percent of their time indoors. Common indoor pollutants include radon, environmental tobacco smoke, molds, dust mites, and combustion products from gas stoves and other sources.
The EPA also regulates a variety of other chemical and carcinogenic emissions. It is the responsibility of the EPA to set emission standards for an ever increasing number of chemicals identified by Congress, but relatively few have been acted upon directly. Mercury, benzene, vinyl chloride, and arsenic are among the few that have been. The Clean Air Act largely addresses chemical emission sources, but does little to address individual constituents of pollution. Source categories include steel mills, oil refineries, chemical plants, as well as 45 others, as of 1998.
Epidemiologic studies on air pollution effects are extremely difficult to perform. They are costly and associations are often weak and difficult to detect. Misclassification of exposure is frequent. It is extremely difficult to determine which agents may be responsible for health effects when in a mixture, which is often the case. Historically reconstructing individual exposure presents one of the greatest difficulties. This makes standard setting extremely difficult and controversial.
Several technologies have aided the control of air pollution, such as catalytic converters, the ban on leaded gasoline, and scrubbers on smokestacks.
In addition the Montreal Protocol (1987) has been signed by more
than 160 nations to diminish production and use of chlorofluorocarbons (CFCs)
to address issues of ozone depletion. A
detriment to innovative policymaking has been the
Clean Water Act (1977, Amendment 1987)
The Clean Water Act addresses the state of the nation’s surface waters. Technology based standards dominate regulation. The National Pollution Discharge Elimination System (NPDES) regulates discharge of pollutants and provides necessary enforcement to comply. Permits are issued to point sources to provide emission limits. The 1987 Amendment put forth monitoring and control of wastewater and runoff.
Safe Drinking Water Act (1974 Amendment 1977, 1986, 1996)
The Safe Drinking Water Act regulates underground water quality. The EPA establishes maximum contaminant level goals (MCLGs) for each contaminant. However, while MCLs (Maximum Contaminant Levels) are enforceable, MCLGs are not enforceable. Adoption lies with the states.
water and potable water regulations fall under separate jurisdiction. Agricultural runoff provides the largest
contribution to water pollution in the
The Clean Water Act is a series of laws that commenced under the Rivers and Harbors Act in 1899 and progressed into Public Law 92-500. The Clean Water Act is comprised of five Titles, outlining activities such as waste treatment, funding for sewage plants, and standards for reviewing and enforcing water quality. Alternative solutions for keeping the finite source of water on the planet clean include planting vegetation, preventing soil erosion, and reducing pesticide use, among many others.
Pesticides such as
the chlorinated hydrocarbons (DDT, PBB) and the alkyl/organophosphates
(parathion, malathion), since being introduced, have become pervasive
throughout the entire food chain. Waters
under the Safe Drinking Water Act are inspected irregularly and often states
are unable to monitor the 83 identified contaminants (such as benzene,
heptachlor, and vinyl chloride). Most
treatment facilities do not treat for pesticides, lead, and other heavy metals
in water. There has also been concern over the
byproducts of disinfectants, such as chlorine, which may provide additional
contaminants. Inspection methods that
are outdated continue to be used, such as measures of turbidity. In general most treatment methods are
directed towards bacteria and tend to be ineffective against viruses,
parasites, and chemical contaminants. In
recent years community systems have been required to provide annual
reports. In addition to compliance
issues such as those in
Food and Drug Safety
The Food and Drug
Administration (FDA) oversees the regulation of food, drugs, and cosmetics,
primarily. The United States Department
of Agriculture (USDA) oversees meat and poultry inspection while the FDA
oversees most other food including fish and seafood but wields little real
power to act. The prevalence of food contaminants has
shifted over the years from infectious agents to metals and chemicals.
Agents include mercury, cadmium, and food additives, amongst a variety of other
components. Outbreaks due to chemical
agents include toxic oil syndrome in
Some chemicals, including the chlorinated hydrocarbons (DDT, PCB, PBB), which are extremely toxic in acute doses, since being introduced have come to reside in almost every source imaginable. In Silent Spring Rachel Carson reports that prior to the introduction of DDT (dichlorodiphenyltrichloroethane) no chemical like it was found in the body, but post-introduction it is found in almost all body fat sampled and one would be hard pressed to find places in the environment throughout the world where it does not now reside. DDT is understood to be a potent pesticide which is insoluble in fat tissue where it is stored and distributed throughout the food chain.
Cleanup of wastes
generated by municipalities and hazardous substances is an area of concern as
retaining space becomes a rare commodity.
Americans generate an estimated 210 million tons of municipal waste per
year. Laws have banned incinerators and dumping of
waste into bodies of water. Nearly fifty
five percent of solid waste is sent to landfills. The Resource Conservation and Recovery Act
(RCRA) sets standards for landfills.
However, as space runs out, coupled by the fact that most people oppose
new landfills in their backyards, more creative solutions will be
necessary. Resource recovery, recycling,
is one such alternative. In 1996, the
Hazardous wastes are covered under the RCRA “cradle to grave” policy. All waste of a hazardous nature must be accounted for, and to be in violation of this amendment is a criminal act. The Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), otherwise known as the Superfund, identifies and prioritize sites requiring cleanup. As of 1994, twenty two percent of the EPA’s budget was allocated to the Superfund. The Superfund is another controversial, expensive, and slow moving endeavor. Nearly a quarter of the funds allocated to the Superfund have paid for legal battles spent defining liable parties. Superfund sites number in the thousands.
Occupational Safety and Health
Most of what we presently know about toxins has come to us from occupational epidemiology studies. However, workplace exposures usually occur at high doses with acute effects. Extrapolation to the general population has been difficult due to the nature of widespread exposure, which occurs at low doses and long term effects are of interest. Workplace exposure has been very useful in identifying and characterizing toxins such as lead, silicate, and polyvinyl chloride. However, industry is a powerful and driving economic force and it has often been difficult to garner evidence and good science when chemicals or practices are called into question. Many epidemiologic studies have been funded by industry itself. This has introduced a great deal of bias into the process and the outcome of studies.
The National Institute for Occupational Safety and Health (NIOSH) is the primary data collection body that supplies research information on worker safety and health to the Occupational Safety and Health Administration (OSHA). OSHA develops programs with the states and reviews NIOSH recommendations when making changes in current standards. OSHA is also responsible for workplace inspections. A major limitation of the Occupational Safety and Health Act is the number of inspectors, state and federal, responsible for over 6 million sites: 2000.
Environmental Health: International Perspective
the developed world contributes three-fourths of all greenhouse gas emissions,
despite being comprised of a mere one-fifth of the world’s population,
developing countries have a unique profile concerning pollution and
environmental health stressors. Environmental
exposures in developing countries tend to differ in nature from those in industrialized
nations. Household exposures and limited
access to resources are prevalent predicaments.
WHO (1993) estimates nearly 50% DALYs are due to diseases associated
with environmental exposures in the household and 30% due to diseases within
the community. In sub-Saharan
As certain facts
have come to light and communities have begun to become involved a new precedent
has been set. Issues such as
environmental racism/justice may no longer be ignored. In 1992 the EPA established the Office of
Environmental Justice to monitor activities of industry that disproportionately
affect minority communities. Community
members have started to take action and high profile cases such as those taken
on by the Tulane Environmental Law Clinic in
In other parts of
the global community different tactics have been employed. In 1996 in
In the future more creative solutions and preventive measures will need to be applied. The paradigm will need to shift to one in which economic advantages do not trump good practices and good health. Any change in the biosphere is a change in our (human) habitat as well. It is in the interest of all to know just what we are “adapting” to. The environment does not have an infinite ability to sustain us and surely even technology is not more powerful nor awesome than what has always been out there and we are just now discovering.
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Agency for Toxic Substances and Disease Registry www.atsdr.cdc.gov
Center for Health, Environment, and Justice www.chej.org
Children’s Environmental Health Network www.cehn.org
Citizens for a Better Environment www.cbew.org
Earth First www.earthfirst.org
Environmental Health Perspectives ehp.niehs.nih.gov
Environmental Law Institute www.eli.org
Greenpeace International www.greenpeace.org/international
Laws and Regulations www.epa.gov/epahome/laws.htm
National Institute for Occupational Safety and Health www.cdc.gov/niosh/homepage.html
National Oceanic and Atmospheric Administration www.noaa.gov
New Ideas in Pollution Regulation www.worldbank.org/nipr/index.htm
Occupational Safety and Health Administration www.osha.gov
Tulane Environmental Law Clinic www.tulane.edu/~telc
United Nations Environment Programme www.unep.org
United States Geological Survey www.usgs.gov
US Environmental Protection Agency www.epa.gov
USEPA Maximum Contaminant Levels www.epa.gov/safewater/mcl/html
USEPA Office of Groundwater and Drinking Water www.epa.gov/ogwdw
USEPA Office of Wastewater www.epa.gov/owmitnet
Working Group on Community Right to Know www.crtk.org