ENVIRONMENTAL HEALTH

Environmental health is "the segment of public health that is concerned with assessing, understanding, and controlling the impacts of people on their environment and the impacts of the environment on them" (Moeller, p. 1). The importance of environmental health has received increasing attention since the early 1990s as the connections between health and environment have come to be better understood and environmental challenges to health have become more pronounced.

Environmental health problems arise from poor air quality, lack of clean water, unhygienic living conditions, dangerous workplaces, unsafe food, careless disposal and treatment of wastes, and toxic pollution. A number of longer-range and more globally dispersed problems also pose significant challenges to health, including global climate change, depletion of the ozone layer, acid rain, nitrogen loading, loss of biodiversity, deforestation, loss of topsoil, increased pressure on resources as a result of changing patterns of consumption, and a rapid increase in the human population (McMichael, 2001; McCally, 2002).

The Global Environmental Health Picture

Although health around the world improved on average over the last half century—due mainly to improvements in environmental health fundamentals such as access to clean water, nutritious food, and adequate sanitation, alongside public health basics such as prenatal care and immunizations— it is likely that these gains will be lost if the environmental foundation for health continues to deteriorate. Billions of people already suffer from the effects of degraded environments: At the beginning of the twenty-first century fully one-third of the global burden of disease was attributed to environmental factors (Murray and Lopez).

Lack of clean water for drinking, inadequate sanitation, and lack of hygiene affect a third to a half of the world's population and are responsible for 7 percent of all death and disease globally. Chemical agents, particularly in the form of air pollution, are considered major causative factors in increased rates of bronchitis, heart disease, and cancer. The incidence of asthma is mushrooming. Certain forms of cancer are on the rise. The health of people around the world is diminished by exposure to toxic substances such as lead, mercury, arsenic, cadmium, and dioxins. As local and global ecosystems show increasing signs of stress, human health is likely to become far less stable and far more difficult to maintain. Children are hit especially hard by environmental health problems: The World Health Organization estimates that environmental hazards kill at least 3 million children under age five each year (United Nations Environment Programme).

There is a broad international consensus that the earth's ecosystems are under considerable strain, and global environmental decline will be the defining public health context in the twenty-first century (McMichael, 2001). According to an international report, the overall health of the earth's natural systems declined by 37 percent in the 1990s (World Wildlife Fund), fueled largely by population growth combined with unsustainable levels of consumption and production, which have increased in aggregate even more quickly than have human numbers.

Environmental Health in the United States

Concern with environmental health in the United States has long focused almost exclusively on the problem of toxic pollution, and concern about toxins has shaped the American regulatory, legislative, and philosophical approach to environmental health. Since the publication of Silent Spring (Carson) the country has been alerted to the mortal danger of exposing human beings and other life-forms to many products and by-products of an industrialized lifestyle. Although the negative effects of environmental pollution on human health cannot be denied, the existence and magnitude of danger associated with particular processes and products remain controversial.

One reason for the controversy is that powerful interests typically have a stake in denying that their industries create health hazards. Nuclear industries deny that low-level radiation causes cancer. Cigarette manufacturers deny a causal link between passive smoking and cancer. Manufacturers of asbestos products take a similar stand about asbestos, as do manufacturers of agricultural pesticides in regard to their products.

A second reason for the continued controversy is that because causal connections between human health and environmental pollution are inherently difficult to establish, the affected industries can hire competent scientists to dispute claims of environmental hazards to human health. In general, three types of evidence can be used to show that an environmental constituent is a health hazard, but none can establish that connection beyond dispute (Luoma).

First, nonhuman animals can be exposed to a suspected health hazard and the effect can be observed. This cannot prove anything conclusively about human exposure because human beings are biochemically different from nonhuman animals. Also, to establish a connection quickly and at minimal cost, nonhuman animals often are exposed to doses much larger than those to which human beings are expected to be exposed. The effect of a small dose on human beings cannot be established conclusively from evidence about the effects of much larger doses on nonhuman animals.

A second method of investigation is to expose human beings over short periods to mild doses of materials suspected of causing serious health problems when exposure is considerably greater or more prolonged. The problem here is that some substances may be so toxic that it would violate human rights to expose people deliberately even to mild doses. Other substances, in contrast, may not have a deleterious effect at low levels of exposure but may be toxic at higher concentrations or over longer periods. In these cases public health hazards may be underestimated or missed entirely.

Third, in epidemiological studies a substance is tested by comparing the rate of disease in one population with that in another in an attempt to correlate differences between the two populations' rates of disease with differences in their rates of exposure. However, it is difficult to establish in that way a connection between a specific suspected toxin and illness or death because under normal conditions people are exposed constantly to many suspected toxins of various strengths for varying periods. It therefore is difficult to isolate the effect of any single substance. Also, the effect of exposure, if there is one, is often weak. In a small population, for example, few additional cancers can be expected to result from exposure to low-level radiation. In addition, the cancer effect is long delayed and spread out in the population over a forty-year period, making it difficult to detect at any specific time (Stewart). Finally, radiation exposure and cancer exist in the human population in any case, and so it is impossible to determine that any given cancer is caused by exposure to low-level radiation or that the low-level radiation in question is related, for example, to a nuclear industry (Stewart).

Basically the same considerations apply when the issue is the effect of exposure to passive smoking, asbestos, or agricultural pesticides. Thus, controversies can continue for decades. Nevertheless, the weight of evidence supports the claim that the exposure of human beings to chemicals and other products and by-products of industrial civilization is often harmful to human health.

The Problem of Toxins in the United States

"Since the 1950s, age-standardized cancer incidence rates in the U.S. have increased by 43.5 percent" (Epstein, 1992, p.233). Death from cancer has increased at a similar rate. The best attempts to isolate the causes of cancer have resulted in the conclusion that environmental factors account for 60 to 90 percent of cancers. The rest are attributable to inherited tendencies and internal biochemical malfunctions (Ep-stein, 1987).

Studies have shown cancer effects from doses of radiation that previously were thought to be safe. In one study a distinguishing fact about children who died of cancer before age ten compared with both those who died of other causes and those who survived to age ten is that the cancer victims' mothers received on average twice as many X rays while pregnant (Stewart). Another study showed a strong statistical association between a father's exposure to external radiation while working at a nuclear-waste reprocessing plant before a child was conceived and that child's chance of contracting leukemia (Gardner).

Radiation is not the only risk factor for cancer: Pesticides and other chemicals are implicated as well. A study showed that the mammary adipose tissue of women with breast cancer contained significantly more residues of chemicals associated with pesticides than did the mammary tissue of women with nonmalignant tumors (Falck et al.). Another study revealed that among white male scientists and engineers those who were members of the American Chemical Society had significantly more deaths from leukemia and lymphatic cancer (Arnetz et al.). A study of men from Iowa and Minnesota showed a link between elevated environmental chemical exposures that resulted from living near a factory and two types of cancer: non-Hodgkin's lymphoma and leukemia (Linos et al.). Non-Hodgkin's lymphoma also has been linked to the use of certain pesticides (Weber). Foundry workers in Denmark who were exposed to elevated levels of silica dust, metallic fumes, carbon monoxide, and several organic chemicals had markedly elevated rates of lung cancer (Sherson et al.). Occupational exposure to asbestos is considered responsible for 8,000 to 12,000 deaths each year in the United States (Rauber).

Typically, years intervene between exposure to environmental contaminants and an associated cancer or death. However, in some cases the connection between environmental pollution and human mortality is more direct. The "U.S. Office of Technology Assessment estimates that the mix of sulphates and particulates in ambient air may cause 50,000 premature deaths in the United States each year— about 2 percent of annual mortality" (Postel, 1986, p. 34). Toxic chemicals released into the air in 1988 were estimated by the U.S. Environmental Protection Agency (EPA) to cause "up to 3,000 cases of fatal cancer yearly as well as birth defects, lung disease, nervous system disorders, liver damage, and other health problems" (U.S. General Accounting Office, p. 8). When all types and sources of air pollution are considered, the American Lung Association puts the toll at 120,000 premature deaths per year (French).

There is increasing evidence that indoor air is often a health hazard. Radon in homes is believed to be a leading cause of cancer. The "sick building" syndrome is also a concern; it is the phenomenon of buildings inducing illnesses of various sorts in a large percentage of the people who spend considerable amounts of time in them. For example, chemicals in materials used to build and decorate the Dupage County Judicial and Office Facility in Wheaton, Illinois, were considered responsible for a variety of employee illnesses. As a result, a nearly new building was evacuated temporarily.

Scientists have been concerned particularly about exposure to heavy metals such as lead and mercury. Although exposure to lead has been reduced greatly, pockets of the population still are exposed to lead in peeling household paint, and everyone is exposed to lead in outdoor air pollution and food. The health effects of lead are well documented and include serious and irreversible impairment of children's neurobehavioral development (Brooks et al.). Mercury contamination also has been of particular concern. As with lead, the health effects of mercury are relatively well understood, largely because of several largescale exposures, including the Minimata Bay disaster, in which a whole Japanese village was poisoned after eating mercury-laced fish. Methylmercury is absorbed readily by fish in polluted aquatic environments. When humans eat contaminated fish, the methylmercury is absorbed readily into the bloodstream and tissues. Mercury can cause tremors, dementia, and congenital neurological deformities (Brooks et al.).

Beginning in the 1990s, concern has intensified about a group of chemicals called persistent organic pollutants (POPs). Those chemicals include the polychlorinated biphenyls (PCBs); pesticides such as DDT, chlordane, aldrin, and heptachlor; and industrial by-products such as dioxins. POPs are fat-soluble and accumulate in the fatty tissues of animals, where they persist for long periods. Research suggests that POPs are "endocrine disruptors": They mimic hormones and may play a significant and largely unacknowledged role in altering reproduction and development. Endocrine disruptors have long concerned wildlife biologists, who believe that declines in avian and amphibian populations are linked to POPs in the environment (Colborn, Dumanoski, and Myers). The way in which these chemicals affect humans is unknown, although some research has connected exposure to POPs with diminished sperm quality and quantity, impaired sexual function, increased testicular cancer, hypospadias, and cryptorchidism (Solomon and Schettler).

Environmental Racism

The risks of contracting environmentally influenced diseases and deaths are not distributed evenly across the population in the United States. Geographically, the people at greatest risk are those who live near sources of industrial pollution such as factories and certain types of mines and those who live near deposits of toxic waste. For example, it seems that a geometrically increasing cancer rate for people in some communities in Cape Cod, Massachusetts, is due to toxic deposits from the nearby Otis Air Force Base (Hallowell). By 1989, 14,401 sites of toxic contamination had been noted in 1,579 military installations around the United States (Renner). When cancer rates are plotted on a map of the nation, the places that show the highest rates are areas of industrial production such as Chicago, Detroit, northern New Jersey, and the lower Mississippi valley.

There is also a disparate impact on minority communities that is referred to as environmental racism. "Three out of every five African Americans and Hispanics live in a neighborhood with a hazardous waste site, and … race is the most significant variable in differentiating communities with such sites from the communities without them" (Steinhart, p.18). "Probably the greatest concentration of hazardous-waste sites in the United States is on the predominantly black and Hispanic South Side of Chicago" (Russell, p. 25). With 28 million pounds of toxics poured into that area annually, the U.S. Environmental Protection Agency (EPA) estimates that the risk of cancer is 100 to 1,000 times the normal risk (Lavelle). According to the federal Centers for Disease Control, "lead poisoning endangers the health of nearly 8 million inner-city, largely black and Hispanic children" all over the United States (Russell, p. 24). Rural minority groups suffer disproportionately as well: "2 million tons of radioactive uranium tailings have been dumped on Native American lands; reproductive organ cancer among Navajo teenagers is seventeen times the national average" (Russell, p. 24).

Environmental racism is international as well as domestic. Toxic waste from industrial countries has been deposited in Africa (Jacobson). Some corporations in industrial countries continue to manufacture pesticides that are considered too dangerous for use in their own countries. Those pesticides are sold to farmers in the Third World, resulting in 10,000 to 40,000 poisonings per year (Postel, 1988). The Bhopal accident, in which 2,000 people were poisoned by a chemical leak from a factory in India, highlights the fact that environmental safeguards in the Third World are sometimes inadequate. The company that owns the factory is based in the United States, where it maintains higher standards of safety in its factories.

The Legal Structure

According to traditional Anglo-American jurisprudence, when one person injures another person, the injured party can sue in court to recover damages. The legal rules governing those proceedings constitute the law of torts. This body of law is largely unhelpful, however, when injuries are due to most forms of environmental pollution because it is difficult to prove that a harm such as a case of cancer resulted from a particular emission of radioactivity or a certain dumping of toxic waste. Also, it would be inefficient for each injured party to sue individually, as was done traditionally, when the activity in question is alleged to affect many people, possibly thousands. Finally, tort actions can take place only after harm is done, and it is preferable to use the law to avoid harms when possible. Thus, the major role of government in the area of environmental health lies in the regulatory process.

In 1970 the National Environmental Policy Act was signed into law to "fulfill the responsibilities of each generation as trustee of the environment for succeeding generations." The EPA, which was established soon afterward, required that most federally funded projects be accompanied by an environmental impact statement so that the deleterious effects of those projects could be recognized and possibly ameliorated. Subsequent legislation has given the EPA the authority, for example, to regulate processes that pollute the air and water (the Clean Air Act and the Clean Water Act); locate, authorize, and fund the cleanup of hazardous wastes (the Resource Conservation and Recovery Act, which established the Superfund); and control the use of pesticides (the Federal Insecticide, Fungicide, and Rodenticide Act). States have their own EPAs that perform similar functions.

The U.S. EPA is not the only agency with the responsibility to oversee activities that can affect environmental health. The U.S. Department of Energy (DOE) oversees the disposal of nuclear waste, the U.S. Department of Agriculture (USDA) helps determine consumer exposure to pesticide residues in food, and the U.S. Department of Labor protects the health of workers through the Occupational Safety and Health Administration (OSHA). In addition, most states have administrative agencies with similar responsibilities for intrastate activities.

Because Congress has authorized those agencies and the many subagencies through which they operate to protect the public, courts are reluctant to intervene, making private lawsuits particularly difficult. If an agency is operating within its congressional mandate and arguably is doing its job in a reasonable fashion, the courts usually will protect both the agency and those in compliance with its standards from private lawsuits seeking compensation for environmentally related illnesses. Thus, the protection of environmental health depends much more directly on the actions of those agencies than on the concerns of private citizens and their elected representatives.

Enforcement Problems

As was noted above, the protection of human health from environmental contamination in the United States is largely the responsibility of the EPA and other federal and state agencies. Unfortunately, the performance of those agencies is sometimes disappointing. The EPA's regulation of pesticides exemplifies the general problem. The EPA regulates pesticides under the Federal Insecticide, Fungicide, and Rodenticide Act. The general public is exposed to pesticides primarily through residues in food and contamination of the groundwater that serves as a major source of drinking water. The EPA recognized in 1988 that "forty-six pesticides … contaminate groundwater solely as a result of normal agricultural use" (Fultz, p. 3). However, a registered chemical can remain in use for up to fifteen years after it is discovered in groundwater before a decision is made about its continued use. An example is atrazine, a pesticide that is in widespread agricultural use (Fultz). For pesticides that already have been found to be toxic, the EPA has not lowered acceptable exposure through residues in food in light of additional exposure through drinking water.

Not all pesticides in widespread use are registered with the EPA, resulting in the continued exposure of the public through food and water to pesticides that have not been tested for their "potential to cause birth defects, cancer, and other chronic health effects" (Fultz, p. 5). Exemption from the registration requirement is given in so-called emergencies for one year at a time, but some exemptions have been granted for more than a decade, during which time people have been exposed to pesticides of unknown toxicity (Guerrero, 1991b). Also, the EPA continues to emphasize the control of point sources of water pollution such as factories and municipal sewer systems instead of nonpoint sources such as agricultural runoff despite evidence that nonpoint sources pose a greater water pollution problem (Guerrero, 1991b). This may be due to the fact that the USDA promotes the use of many pesticides to increase crop yields even though those chemicals constitute health hazards.

Unfortunately, the EPA's inadequate protection of public health from the dangers of pesticides is typical. Similar stories can be told about surface-water pollution, hazardous waste management and cleanup, enforcement of the Clean Air Act, and U.S. Department of Energy (DOE) decisions about the disposal of nuclear waste: "The National Research Council estimated that only 2 percent of at least 60,000 chemicals that are used widely have been comprehensively studied for toxic effects" (Ziem and Davidoff, p. 88).

In addition to poor funding, a general reason for inadequate protection is that agencies tend to establish such close ties to the industries they are charged with regulating that they identify with industry perspectives and needs. An agency's capture by industry results partly from industry offers of future high-paying employment to regulatory personnel who are "reasonable." Another factor may be pressure on an agency by the legislators who are responsible for approving its budget. Those legislators may depend on the regulated industry for campaign contributions (Sanjour).

Conscientious federal employees who try to regulate effectively are relegated to tasks that have little impact. Employees who blow the whistle on an agency's failure to do its job must go before the presidentially appointed Merit System Protection Board, which may be more interested in protecting the president and "the system" than in protecting the whistle-blower (Sanjour).

There is also the appearance of racism in the EPA's enforcement efforts: "Penalties under hazardous waste laws at sites having the greatest white population were about 500 percent higher than penalties at sites with the greatest minority population" (Lavelle, p. S2). This disparity can be accounted for only by race, not by income. There is a similar disparity of 46 percent in penalties concerning nontoxic waste, air pollution, and water pollution. It takes 20 percent longer for toxic waste sites in minority areas to be placed on the priority list for cleanup, and the cleanup in minority areas is more likely than that in white areas to consist only of containment of the waste rather than treatment that removes its toxicity.

Environmental racism also appears to affect government regulation of international trade. For example, pesticides banned in the United States because of their toxicity to human beings can be manufactured and then sold abroad. Some return as residues on imported food.

Decisional Frameworks

How should decisions about environmental health be made? Advocates of free trade and free markets suggest that market mechanisms can protect public health adequately. However, from the perspective of firms competing for customers, environmental protection seldom makes sense. A manufacturer's plastic toys, for example, seldom are more attractive to customers because the water and air used in its manufacturing processes were purified before being released into the environment. Similarly, catalytic converters on automobiles add to cost but do not improve cars in most customers' eyes. Without government mandates requiring all the producers in an industry to protect the environment, the cost of such protection impairs the competitiveness, or reduces the profits, of conscientious firms that act alone. Thus, the free market discourages the protection of environmental health in the absence of government-mandated regulations such as those administered by OSHA and the EPA.

The EPA and other government agencies have been faulted for their failure to oppose the market-driven activities of private enterprise with sufficient vigor. Three kinds of reforms may be ameliorative. First, agency personnel could be barred for five years from employment, directly or indirectly, by companies that their agency regulates. This would encourage greater independence of agency personnel from the perspectives of regulated companies. Second, campaign finance reform could help diminish the influence of financial interests on the regulatory process. Third, whistle-blowers could be given special job and financial protection (Sanjour).

What decisional framework should those agencies employ? Some libertarians, who stress the importance of individual rights, maintain that any environmental pollution that may harm anyone should be disallowed. The government should "enjoin anyone from injecting pollutants into the air, and thereby invading the rights of persons and property. Period" (Rothbard, p. 5). However, this purist approach seems unrealistic because it would disallow, for example, most manufacturing and almost all uses of fossil fuels, including use in automobiles. Polluting the environment in ways that are potentially harmful to human health is too ingrained in industrial ways of life to be eliminated entirely.

Pointing to the benefits of industrialization—airconditioning in the summer, heating in the winter, rapid transportation, and sophisticated medical interventions— some people maintain that pollution should be allowed until the risks to people outweigh the benefits. According to this view, government agencies such as the EPA should use risk-benefit analysis to determine permissible kinds and levels of pollution (Ruckelshaus).

Critics maintain, however, that risk-benefit analysis favors continued pollution over health-related concerns. First, current levels of pollution often are assumed to be acceptable and are used as precedents for future decisions. Second, whereas the benefits of current pollution practices are assumed, risks must be proved scientifically, a task that is difficult. Third, risk-benefit analysis depends largely on subjective judgments of "experts" whose opinions may reflect employers' interests (Winner).

Some people suggest avoiding subjectivity by using cost-benefit analysis (CBA), in which all the costs and benefits of proposed pollution-controlling regulations are expressed in monetary terms. The alternative with the highest net benefit should be chosen. Costly health hazards thus would be taken into account. The EPA usually allows environmental impact statements to employ CBA, and the Nuclear Regulatory Commission uses CBA regularly.

However, there are many problems with CBA. First, the costs and benefits associated with the length and quality of human life, which are affected by environmental health, cannot be translated reliably into monetary terms. Second, subjectivism remains because there is great uncertainty in projections of health hazards (Shrader-Frechette). Third, by employing money as its standard, CBA takes into account views and desires only insofar as they are expressed in monetary terms. The opportunity for that expression is proportional to the money at people's disposal. Using CBA, then, agencies would give protection to people not equally but in proportion to their wealth or income. In regard to the actions of government agencies CBA denies equal protection of the law. Fourth, using normal economic techniques, CBA discounts the future, making a present cost or benefit larger than an otherwise equivalent but future cost or benefit. This biases public policy toward the short term. If the duty to avoid or minimize harming people is based on human rights, harming future generations is morally equivalent to harming contemporaries. CBA discounts the lives and well-being of future generations (Wenz).

Alternative Frameworks

Instead of CBA, the following are possible rules of thumb. First, the burden of proof should be reversed from that employed in risk-benefit analysis. Before a potentially harmful addition is made to the environment, its safety should be demonstrated. At the beginning of the twenty-first century, for example, potentially carcinogenic pesticides can be used widely for ten to fifteen years before investigations are completed. Products are withdrawn then only if they are demonstrated to harm public health. The burden to demonstrate its safety should be on those who want to expose people to a new chemical.

Second, the people at greatest risk should be given the greatest voice in decisions about creating or using potentially hazardous substances (Shrader-Frechette). For example, corporate officials and owners interested in manufacturing processes that create toxic wastes would retain a significant voice in regulatory decisions if they could and would store the wastes near themselves and their families.

Third, through subsidies the government should encourage sustainable agriculture, integrated pest management, mass transit, energy conservation, and other practices and products that reduce the introduction of health hazards into the environment.

Fourth, when the indirect costs of a product can be calculated reliably, those costs should over time be added as a tax to the consumer price of that product. For example, the price of gasoline should reflect the costs associated with the deleterious health effects of smog. Only then will consumers be guided by accurate information about how much a product actually costs them. Such information generally improves the results of reliance on market mechanisms.

Fifth, agencies should discourage practices that hide the existence or severity of environmental health problems. Storage of nuclear wastes underground so that the continuing health hazard is not noticed and the war on cancer that lulls people into thinking a cure is near lead the public to underestimate its jeopardy. This should be avoided in part because an informed public is central to addressing problems of pollution. In the absence of an objective formula for balancing alleged benefits against alleged harms to determine the acceptability of pollution, an informed public must be the ultimate judge of government decisions related to environmental health.

peter s. wenz (1995)

revised by jessica pierce

SEE ALSO: Environmental Ethics; Environmental Policy and Law; Future Generations, Reproductive Technologies and Obligations to; Hazardous Wastes and Toxic Substances; Occupational Safety and Health; Public Health; Sustainable Development

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INTERNET RESOURCE

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