# ![](media/image1.wmf){width="2.3986111111111112in" height="2.2930555555555556in"} {#section .Chapter-#}

# 8 {#section-1 .Chapter-#}

# Environmental Health

Co-Lead Agencies: Agency for Toxic Substances and Disease\
Registry\
Centers for Disease Control and\
Prevention\
National Institutes of Health

### Contents {#contents .Heading-Special}

[Goal Page 8-3](#goal)

[Overview Page 8-3](#overview)

[Issues Page 8-4](#issues)

[Trends Page 8-8](#trends)

[Disparities Page 8-10](#disparities)

[Opportunities Page 8-11](#opportunities)

[Interim Progress Toward Year 2000 Objectives Page
8-12](#interim-progress-toward-year-2000-objectives)

[Healthy People 2010---Summary of Objectives Page
8-13](#healthy-people-2010summary-of-objectives)

[Healthy People 2010 Objectives Page
8-15](#healthy-people-2010-objectives)

[Outdoor Air Quality Page 8-15](#outdoor-air-quality)

[Water Quality Page 8-18](#water-quality)

[Toxics and Waste Page 8-21](#toxics-and-waste)

[Healthy Homes and Healthy Communities Page
8-24](#healthy-homes-and-healthy-communities)

[Infrastructure and Surveillance Page
8-28](#infrastructure-and-surveillance)

[Global Environmental Health Page 8-31](#global-environmental-health)

[Related Objectives From Other Focus Areas Page
8-32](#related-objectives-from-other-focus-areas)

[Terminology Page 8-34](#terminology)

[References Page 8-38](#references)

## Goal

**Promote health for all through a healthy environment.**

## Overview

According to the World Health Organization, "In its broadest sense,
environmental health comprises those aspects of human health, disease,
and injury that are determined or influenced by factors in the
environment. This includes the study of both the direct pathological
effects of various chemical, physical, and biological agents, as well as
the effects on health of the broad physical and social environment,
which includes housing, urban development, land-use and transportation,
industry, and agriculture."[^1] The term "environment" also may be used
to refer to air, water, and soil. This more narrow definition ignores
the manmade environment created by a society. Where and how a society
chooses to grow and develop affects the quality of life by determining
how long people spend traveling to work, shopping, or going to school.
Where and how a society builds its houses, schools, parks, and roadways
can also limit the ability of some people to move about and lead a
normal life.![](media/image2.png){width="4.499305555555556in"
height="4.5881944444444445in"}

Because the impact of the environment on human health is so great,
protecting the environment has long been a mainstay of public health
practice. National, State, and local efforts to ensure clean air and
safe supplies of food and water, to manage sewage and municipal wastes,
and to control or eliminate vector-borne illnesses have contributed a
great deal to improvements in public health in the United States.
Unfortunately, in spite of the billions of dollars spent to manage and
clean up hazardous waste sites in the Nation each year, little money has
been spent evaluating the health risks associated with chronic,
low-level exposures to hazardous substances. This imbalance results in
an inadequate amount of useful information to evaluate and manage these
sites effectively and to evaluate the health status of people who live
near the sites.[^2] In the past, research in environmental epidemiology
and toxicology has often been based on limited information. New
knowledge about the interactions between specific genetic variations
among individuals and specific environmental factors provides enormous
opportunity for further developing modifications in environmental
exposures that contribute to disease. Further research is needed to
address these and other problems and to improve the science and
management of health effects on people exposed to environmental
hazards.[^3]

### Issues

Environmental factors play a central role in human development, health,
and disease. Broadly defined, the environment, including infectious
agents, is one of three primary factors that affect human health. The
other two are genetic factors and personal behavior.

Human exposures to hazardous agents in the air, water, soil, and food
and to physical hazards in the environment are major contributors to
illness, disability, and death worldwide. Furthermore, deterioration of
environmental conditions in many parts of the world slows sustainable
development. Poor environmental quality is estimated to be directly
responsible for approximately 25 percent of all preventable ill health
in the world, with diarrheal diseases and respiratory infections heading
the list.[^4] Ill health resulting from poor environmental quality
varies considerably among countries. Poor environmental quality has its
greatest impact on people whose health status already may be at risk.

Because the effect of the environment on human health is so great,
protecting the environment has been a mainstay of public health practice
since 1878.[^5] National, Tribal, State, and local efforts to ensure
clean air and safe supplies of food and water, to manage sewage and
municipal wastes, and to control or eliminate vector-borne illnesses
have contributed significantly to improvements in public health in the
United States. However, the public's awareness of the environment's role
in health is more recent. Publication of Rachel Carson's *Silent Spring*
in the early 1960s, followed by the well-publicized poor health of
residents of Love Canal in western New York, a significant toxic waste
site, awakened public consciousness to environmental issues. The result
of these and other similar events is the so-called environmental
movement that has led to the introduction into everyday life of such
terms as Superfund sites, water quality, clean air, ozone, urban sprawl,
and agricultural runoff.

In 1993 alone, over \$109 billion was spent on pollution abatement and
control in the United States.[^6] However, many hazardous sites still
remain. Minimal research has been done to evaluate the health risks
associated with chronic low-level exposures to hazardous substances,
resulting in an inability to evaluate and manage such sites effectively
and to evaluate the health status of residents living near such sites.
Further environmental epidemiology and toxicology research is needed to
address such problems and to improve the science and public health
management of the health effects on people exposed to environmental
hazards.

To address the broad range of human health issues affected by the
environment, this chapter discusses six topics: outdoor air quality,
water quality, toxics and waste, healthy homes and healthy communities,
infrastructure and surveillance, and global environmental health issues.

**Outdoor air quality.** Air pollution continues to be a widespread
public health and environmental problem in the United States, causing
premature death, cancer, and long-term damage to respiratory and
cardiovascular systems. Air pollution also reduces visibility, damages
crops and buildings, and deposits pollutants on the soil and in bodies
of water where they affect the chemistry of the water and the organisms
living there. Approximately 113 million people live in U.S. areas
designated as nonattainment areas by the U.S. Environmental Protection
Agency (EPA) for one or more of the six commonly found air pollutants
for which the Federal Government has established health-based
standards.[^7] The problem of air pollution is national---even
international---in scope. Most of the U.S. population lives in expanding
urban areas where air pollution crosses local and State lines and, in
some cases, crosses U.S. borders with Canada and Mexico.[^8]**^,^** [^9]

Although some progress toward reducing unhealthy air emissions has been
made, a substantial air pollution problem remains, with millions of tons
of toxic air pollutants released into the air each year.[^10] The
presence of unacceptable levels of ground-level ozone is the largest
problem, as determined by the number of people affected and the number
of areas not meeting Federal standards.

Motor vehicles account for approximately one-fourth of emissions that
produce ozone and one-third of nitrogen oxide emissions. Particulate and
sulfur dioxide emissions from motor vehicles represent approximately 20
percent and 4 percent, respectively. Some 76.6 percent of carbon
monoxide emissions are produced each year by transportation sources (for
example, motor vehicles).Error: Reference source not found

Unhealthy air is expensive. The estimated annual health costs of human
exposure to all outdoor air pollutants from all sources range from \$40
billion to \$50 billion, with an associated 50,000 premature
deaths.[^11]

**Water quality.** Providing drinking water free of disease-causing
agents, whether biological or chemical, is the primary goal of all water
supply systems. During the first half of the 20th century the causes for
most waterborne disease outbreaks were bacteria; beginning in the 1970s
protozoa and chemicals became the dominant causes.[^12] Most outbreaks
involve only a few individuals.[^13]**^,^** [^14]**^,^** [^15] In 1993,
however, more than 403,000 people became sick during a single episode of
water-borne cryptosporidiosis.Error: Reference source not found

One problem in evaluating the relationship between drinking water and
infectious diseases is the lack of adequate technology to detect
parasitic contamination and to determine whether the organisms detected
are alive and infectious. The development of new molecular technologies
to detect and monitor water contamination will enhance water quality
monitoring and surveillance.

Contamination of water can come from both point (for example, industrial
sites) and nonpoint (for example, agricultural runoff) sources.
Biological and chemical contamination significantly reduces the value of
surface waters (streams, lakes, and estuaries) for fishing, swimming,
and other recreational activities. For example, during the summer of
1997, blooms of *Pfiesteria piscicida* were implicated as the likely
cause of fish kills in North Carolina and Maryland. The development of
intensive animal feeding operations has worsened the discharge of
improperly or inadequately treated wastes,[^16] which presents an
increased health threat in waters used either for recreation or for
producing fish and shellfish.

**Toxics and waste.** Critical information on the levels of exposure to
hazardous substances in the environment and their associated health
effects often is lacking. As a result, efficient health-outcome measures
of progress in eliminating health hazards in the environment are
unavailable. The identification of toxic substances and waste, whether
hazardous, industrial, or municipal, that pose an environmental health
risk represents a significant achievement in itself. Public health
strategies are aimed at tracking the Nation's success in eliminating
these substances or minimizing their effects.

Toxic and hazardous substances, including low-level radioactive wastes,
deposited on land often are carried far from their sources by air,
groundwater, and surface water runoff into streams, lakes, and rivers
where they can accumulate in the sediments beneath the waters. Ultimate
decisions about the cleanup and management of these sites must be made
keeping public health concerns in mind.

The introduction and widespread use of pesticides in the American
landscape continues in agricultural, commercial, recreational, and home
settings. As a result, these often very toxic substances pose a
potential threat to people using them, especially if they are handled,
mixed, or applied inappropriately or excessively. Furthermore, children
are at increased risk for pesticide poisoning because of their smaller
size and because pesticides may be stored improperly or applied to
surfaces that are more readily accessible by children.

**Healthy homes and communities.** The public's health, particularly its
environmental health, depends on the interaction of many factors. To
provide a healthy environment within the Nation's communities, the
places people spend the most time---their homes, schools, and
offices---must be considered. Potential risks\
include indoor air pollution; inadequate heating, cooling, and
sanitation; structural problems; electrical and fire hazards; and
lead-based paint hazards. More than 6 million housing units across the
country meet the Federal Government's definition of substandard
housing.[^17]

Many factors---including air quality; lead-based paint on walls, trim,
floors, ceilings, etc.; and hazardous household substances such as
cleaning products and pesticides---can affect health and safety. In
1996, the American Association of Poison Control Centers reported more
than 2 million poison exposures from 67 participating poison control
centers. The site of exposure was a residence in 91 percent of
cases.[^18]

**Infrastructure and surveillance.** Preventing health problems caused
by environmental hazards requires: (1) having enough personnel and
resources to investigate and respond to diseases and injuries
potentially caused by environmental hazards; (2) monitoring the
population and its environment to detect hazards, exposure of the public
and individuals to hazards, and diseases potentially caused by these
hazards; (3) monitoring the population and its environment to assess the
effectiveness of prevention programs; (4) educating the public and
select populations on the relationship between health and the
environment; (5) ensuring that laws, regulations, and practices protect
the public and the environment from hazardous agents; (6) providing
public access to understandable and useful information on hazards and
their sources, distribution, and health effects; (7) coordinating the
efforts of government agencies and nongovernmental groups responsible
for environmental health; and (8) providing adequate resources to
accomplish these tasks. Development of additional methods to measure
environmental hazards in people will permit more careful assessments of
exposures and health effects.

**Global environmental health.** Increased international travel and
improvements in telecommunications and computer technology are making
the world a smaller place. The term "global community" has real
significance, as shared resources---air, water, and soil---draw people
together. Actions in every country affect the environment and influence
events around the world. Undoubtedly, the environment affects everyone's
health. Sometimes benefits in one area inadvertently create worse
conditions for people in different areas of the world. For example, in
1996, the United States exported more than \$2.5 billion worth of
pesticides.[^19] Exported pesticides that are not registered, or
pesticides that are restricted for use in the United States, are often
used by developing countries. Their use not only endangers populations
in those countries but also can contaminate food being exported from
those countries to the United States. Sensitive populations, such as
children and pregnant women, may be at risk from these environmental
exposures. The United States can contribute to improving the health of
people internationally, not only as part of a shared goal for humanity,
but also because a healthy global population has positive social and
economic benefits throughout the world.

Additionally, a number of countries have resources available to protect
their populations from adverse health impacts, but because of inadequate
information they are unable to do so. Lead abatement technology, for
example, is one area where the United States can provide information to
other countries. Likewise, consultation and assistance on numerous
environmental health issues from lead poisoning to disaster preparedness
will help reduce illness, disability, and death in countries with these
problems, which can lead to a healthier global community.

The Nation should expand its efforts for improving environmental
conditions to enhance the health of developing countries. It should also
increase collaboration, coordination, and outreach efforts with the rest
of the world to help close the gap between existing and attainable
health status.

### Trends

During the 1990s, progress in improving environmental health was mixed.
The decline in childhood lead poisoning in the United States represents
a public health success. In 1984, between 2 million and 3 million
children aged 6 months to 5 years had blood lead levels (BLLs) greater
than 15 μg/dL, and almost a quarter of a million had BLLs above 25
μg/dL,[^20] a level that can affect vital organs and the brain. (Blood
levels are measured in micrograms of lead found in a deciliter of
blood.) By the early 1990s, fewer than 900,000 children had BLLs above
10μg/dL, the current standard for identifying children at risk.[^21]
This dramatic reduction is the result of research to identify persons at
risk, professional and public education campaigns to "spread the word,"
broad-based screening measures to find those at risk, and effective
community efforts to clean up problem areas, namely, substandard housing
units. However, despite the success achieved, more remains to be done
before childhood lead poisoning becomes a disease of the past. Although
childhood lead poisoning occurred in all population groups, the risk was
higher for persons having low income, living in older housing, and
belonging to certain racial and ethnic groups. For example, among
non-Hispanic black children living in homes built before 1946, 22
percent had elevated BBLs. Because the risk for lead poisoning is not
spread evenly throughout the population, efforts are continuing to
identify children at risk and ensure that they receive preventive
interventions.[^22]

Unfortunately, not all trends for environmental health issues are as
encouraging. Since the mid-1980s, asthma rates in the United States have
risen to the level of an epidemic.[^23] Asthma and other respiratory
conditions often are triggered or worsened by substances found in the
air, such as tobacco smoke, ozone, and other particles or chemicals.
Based on existing data, an estimated 14.9 million people in the United
States had asthma in 1995,[^24] including more than 5 million children
aged 17 years and under.[^25] Between 1980 and 1993, the overall death
rate for asthma increased 57 percent, from 12.8 to 20.1 deaths per
million population;Error: Reference source not found for people aged 17
years and under, the death rate increased 67 percent, from 1.8 to 3.0
deaths per million population.[^26] The direct economic and health care
costs of asthma and other respiratory conditions can be large. In 1990,
the estimated total cost of asthma was \$6.2 billion; the total cost was
projected to rise to \$14.5 billion by the year 2000.[^27] The indirect
costs of asthma, measured in reduced quality of life and lost
productivity, include the estimated 10 million school days each year
that children miss. Lost productivity from missed work days of parents
caring for children with asthma is estimated to be \$1 billion---not
including the cost of lost productivity from adults with asthma who miss
work.Error: Reference source not found (See Focus Area 24. Respiratory
Diseases.)

Although successes in environmental public health are possible, they are
difficult to achieve. Infectious and chemical agents still contaminate
food and water. Animals continue to carry diseases to human populations,
and outbreaks of once-common intestinal diseases (for example, typhoid
fever), although less frequent, still occur. (See Focus Area 10. Food
Safety.) These outbreaks underscore the need to maintain and improve
programs developed in the first half of the 20th century to ensure the
safety of food and water. The challenge is to retain these basic
capacities in the 21st century, with the added responsibilities for
dealing with emerging hazards. The control of well-known hazards must
coexist with ongoing research and the development of strategies and
methods to understand and control new hazards. Another challenge is the
need to help the public understand the link between human activity and
the destruction of the environment.

Within the United States, significant strides toward a reduction in
harmful air emissions can be achieved by individuals choosing not to
drive their cars. People need to use public transit, walk, or bicycle
more often. Laws can help improve street and highway design to
facilitate pedestrians and bicyclists, and employers can embrace
telecommuting, but the choice remains with the individual. Encouraging
individuals to walk or bike also may play a role in reducing the
problems of obesity and overweight individuals, which have risen to
alarming levels in the U.S. population.

Urban sprawl has become an increasingly important concern in the United
States for several reasons: increased outdoor air pollution in major
urban areas, reduced quality of life due to the loss of free time and
the stress of increased commuting time, and less green space in major
metropolitan areas. Between 1983 and 1995, the average annual vehicle
miles traveled increased 80 percent.[^28] These conditions lead to
negative health conditions, such as asthma and injuries from road rage
due to traffic-related stress.[^29] In addition, sprawl diminishes the
amount of land available for prime recreational and agricultural uses
and can bring two land uses together that do not coexist well. For
example, a residential development in an area that was previously
agricultural may expose residents to environmental hazards, such as
pesticides, which may pose a threat to their health.

On a global scale, the U.S.-Mexico border area illustrates how human
activity can contribute to damaging the environment, affecting
generations to come. Over the past 30 years, this region has experienced
a dramatic surge in population and industrialization. The region has had
great difficulty in supporting this growth and suffers from a lack of
resources and expertise to manage solid waste properly, handle and store
pesticides and other hazardous materials, supply sufficient drinking
water, and support other sustainable development efforts.Error:
Reference source not found Nations need to make choices about how to
deal with such regions; offering technical assistance is an option to
speed knowledge transfer and reduce environmental harm.

### Disparities

Studies have linked race and socioeconomic status to increased exposure
to environmental hazards, and information about gene-environment
interactions improves the ability to determine who has increased risk of
disease from these exposures. Table 8-A and Table 8-B summarize some
inequities in the United States regarding exposure to selected potential
environmental hazards.

  -------------------------------------------------------------------------
  **Table 8-A.**                                         
  Proportions of                                         
  African American,                                      
  Hispanic, and                                          
  white\                                                 
  populations                                            
  living in                                              
  air-quality                                            
  nonattainment                                          
  areas, 1992.[^30]                                      
  ----------------- ----------------- ------------------ ------------------
  **Pollutant**     **Demographic                        
                    Breakdowns**                         

                    **African\        **Hispanics**      **Whites**
                    Americans**                          

                    Percent Living in                    
                    Air-Quality                          
                    Nonattainment                        
                    Areas                                

  Particulates      16.5              34.0               14.7

  Carbon monoxide   46.0              57.1               33.6

  Ozone             62.2              71.2               52.5

  Sulfur dioxide    12.1              5.7                7.0

  Lead              9.2               18.5               6.0
  -------------------------------------------------------------------------

  ----------------------------------------------------------------------------------------
  **Table 8-B.** Proportions                                              
  of certain racial and                                                   
  ethnic and lower                                                        
  socioeconomic populations                                               
  in census tracts                                                        
  surrounding waste                                                       
  treatment, storage, and                                                 
  disposal facilities (TSDF)                                              
  compared with the                                                       
  proportions of these                                                    
  groups in other census                                                  
  tracts, 1994.Error:                                                     
  Reference source not found                                              
  -------------------------- --------------- --------------- ------------ ----------------
                             **Demographic                                
                             Breakdowns**                                 

  **Location of TSDFs**      **African\      **Hispanics**                **Persons
                             Americans**                                  Living\
                                                                          Below the\
                                                                          Poverty Line**

                             Percent                                      

  Census tracts with either  24.7                            10.7         19.0
  TSDFs or at least 50                                                    
  percent of their area                                                   
  within 2.5 miles of a                                                   
  tract with TSDF                                                         

  Census tracts without      13.6                            7.3          13.1
  TSDFs                                                                   
  ----------------------------------------------------------------------------------------

Disparities exist in the environmental exposures certain populations
face and in the health status of these populations. For example, in New
York City, African American, Hispanic, and low-income populations have
been found to have\
hospitalization and death rates from asthma three to five times higher
than those for all New York City residents. African American children
have been found to be three times more likely than white children to be
hospitalized for asthma and asthma-related conditions and four to six
times more likely to die from asthma.Error: Reference source not found
(See Focus Area 24. Respiratory Diseases.) With respect to BLL, children
from certain racial and ethnic groups are disproportionately affected.
While there are no studies to show rural and frontier dwellers are at
increased risk to exposure to contaminated drinking water, the
preponderance of this population depends on unregulated private wells
for their drinking water. The U.S. Geological Survey (USGS) reports that
42.8 million persons in the United States (17 percent of the total
population) were served by their own (self-supplied) water systems in
1990.[^31]

### Opportunities

An increase in public awareness of environmental health issues is key to
achieving this chapter's goal and objectives. Education---at all
levels---is a cornerstone of broad prevention efforts.

Improving the availability of environmental health data also will help
meet the objectives. The Internet has increased dramatically access to
environmental information. Databases such as TOXNET (at
http://toxnet.nlm.nih.gov/),[^32] Internet Grateful Med (at
http://igm.nlm.nih.gov),[^33] and TRI (the Toxics Release Inventory
www.epa.gov/ceisweb1/ceishome/ceisdata/xplor-tri/explorer.htm) may
provide useful information about environmental hazards or other
environmental problems in communities to health care providers,
policymakers, and the public. Moreover, better dissemination of global
environmental health information may reduce the occurrence of disease or
exposure to harmful environmental agents for U.S. citizens traveling
abroad.

To be successful, programs to improve environmental health must be based
on scientific evidence. The complex relationship between human health
and the acute and long-term effects of environmental exposures must be
studied so prevention measures can be developed. Surveillance systems to
track exposures to toxic substances such as commonly used pesticides and
heavy metals must be developed and maintained. To the extent possible,
these systems should use biomonitoring data, which provide measurements
of toxic substances in the human body. A mechanism is needed for
tracking the export of pesticides restricted or not registered for use
in the United States.

Environmental hazards are not limited by political boundaries. The scope
of public and environmental health must be global if the Nation is to
achieve good health for all persons in the United States. A global scope
will help develop and achieve effective ways to prevent disease
worldwide as well. The United States must work with other governments,
nongovernmental organizations, and international organizations to help
improve human health on a global scale.

## Interim Progress Toward Year 2000 Objectives

Healthy People 2000 targets have been met for objectives dealing with
outbreaks of waterborne diseases, with solid wastes, and with toxic
substances released through industrial processes. Substantial progress
has been made in objectives involving the proportion of people who live
in counties that meet EPA air standards for air pollution, the number of
States that require radon disclosures with real estate transactions, and
the recycling of household hazardous waste. More moderate progress has
taken place for the objectives involving radon and lead-based paint
testing in homes, asthma hospitalizations, and States with laws to track
environmental diseases. Mixed progress or movement away from the targets
is being seen in objectives dealing with mental retardation and impaired
surface waters (rivers, lakes, and estuaries). Data have been mixed or
difficult to assess for the cleanup of hazardous waste sites. The target
for blood lead levels in children has not been met, though some progress
has been made.

Note: Unless otherwise noted, data are from the Centers for Disease
Control and\
Prevention, National Center for Health Statistics, *Healthy People 2000
Review, 1998--99.*

## Healthy People 2010---Summary of Objectives

### Environmental Health {#environmental-health-1 .Heading-Special-Sub}

**Goal:** Promote health for all through a healthy environment.

  --------------------------------------------------------------------------------
  **Number**         **Objective Short Title**
  ------------------ -------------------------------------------------------------
  **Outdoor Air      
  Quality**          

  8-1                Harmful air pollutants

  8-2                Alternative modes of transportation

  8-3                Cleaner alternative fuels

  8-4                Airborne toxins

  **Water Quality**  

  8-5                Safe drinking water

  8-6                Waterborne disease outbreaks

  8-7                Water conservation

  8-8                Surface water health risks

  8-9                Beach closings

  8-10               Fish contamination

  **Toxics and       
  Waste**            

  8-11               Elevated blood lead levels in children

  8-12               Risks posed by hazardous sites

  8-13               Pesticide exposures

  8-14               Toxic pollutants

  8-15               Recycled municipal solid waste

  **Healthy Homes    
  and Healthy        
  Communities**      

  8-16               Indoor allergens

  8-17               Office building air quality

  8-18               Homes tested for radon

  8-19               Radon-resistant new home construction

  8-20               School policies to protect against environmental hazards

  8-21               Disaster preparedness plans and protocols

  8-22               Lead-based paint testing

  8-23               Substandard housing

  **Infrastructure   
  and Surveillance** 

  8-24               Exposure to pesticides

  8-25               Exposure to heavy metals and other toxic chemicals

  8-26               Information systems used for environmental health

  8-27               Monitoring environmentally related diseases

  8-28               Local agencies using surveillance data for vector control

  **Global           
  Environmental      
  Health**           

  8-29               Global burden of disease

  8-30               Water quality in the U.S.--Mexico border region
  --------------------------------------------------------------------------------

## Healthy People 2010 Objectives

### Outdoor Air Quality

8-1. Reduce the proportion of persons exposed to air that does not meet
the U.S. Environmental Protection Agency's health-based standards for
harmful air pollutants.

Target and baseline:

+---------+---------------------------+---------------+---------------+
| Ob      | Reduction in Air          | 1997 Baseline | 2010 Target   |
| jective | Pollutants                |               |               |
+---------+---------------------------+---------------+---------------+
|         |                           | ##            |               |
|         |                           | ##### Percent |               |
+---------+---------------------------+---------------+---------------+
| **      | Ozone\*                   | 43            | 0             |
| 8-1a.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Particulate matter\*      | 12            | 0             |
| 8-1b.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Carbon monoxide           | 19            | 0             |
| 8-1c.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Nitrogen dioxide          | 5             | 0             |
| 8-1d.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Sulfur dioxide            | 2             | 0             |
| 8-1e.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Lead                      | \<1           | 0             |
| 8-1f.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
|         |                           | #             |               |
|         |                           | ###### Number |               |
+---------+---------------------------+---------------+---------------+
| **      | Total number of people    | 119,803,000   | 0             |
| 8-1g.** |                           |               |               |
+---------+---------------------------+---------------+---------------+

\*The targets of zero percent for ozone and particulate matter are set
for 2012 and 2018, respectively.

**Target setting method:** Consistent with the Clean Air Act (Public Law
101-549).

**Data source:** Aerometric Information Retrieval System (AIRS), EPA,
OAR.

Note: For the purpose of this objective, EPA is counting persons living
in nonattainment areas only.

> **Data for population groups currently are not analyzed.**

Historically, EPA's air quality monitoring and National Ambient Air
Quality Standards data collection have taken place in large urban
centers and other areas generally considered to have the Nation's
poorest air quality. As nonattainment areas become attainment areas, EPA
will continue its monitoring efforts. (See Focus Area 24. Respiratory
Diseases.)

8-2. Increase use of alternative modes of transportation to\
reduce motor vehicle emissions and improve the Nation's air quality.

Target and baseline:

+---------+---------------------------+---------------+---------------+
| Ob      | Increase in Use of        | 1995\         | 2010\         |
| jective | Alternative Modes of      | Baseline      | Target        |
|         | Transportation            |               |               |
+---------+---------------------------+---------------+---------------+
|         |                           | ##            |               |
|         |                           | ##### Percent |               |
+---------+---------------------------+---------------+---------------+
| **      | Trips made by bicycling   | 0.9           | 1.8           |
| 8-2a.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Trips made by walking     | 5.4           | 10.8          |
| 8-2b.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Trips made by transit     | 1.8           | 3.6           |
| 8-2c.** |                           |               |               |
+---------+---------------------------+---------------+---------------+
| **      | Persons who telecommute   | Developmental |               |
| 8-2d.** |                           |               |               |
+---------+---------------------------+---------------+---------------+

**Target setting method:** Consistent with the goal of the National
Bicycling and Walking Study, U.S. Department of Transportation (DOT).

**Data source:** Nationwide Personal Transportation Survey (NPTS), U.S.
Department of Transportation.

For many communities in the United States, motor vehicle emissions are
the primary cause of air pollution. Increasing use of alternative modes
of transportation is a comprehensive approach that each citizen can take
to affect local levels of air pollution. An increase in neighborhood
streets with ways to slow traffic and with more sidewalks and bike
lanes, offroad pedestrian or bike routes, and bicycle and pedestrian
plans and programs will aid in reaching the targets for biking, walking,
and transit objectives. (See Focus Area 22. Physical Activity and
Fitness.) As technology improves, telecommuting will play an increasing
role in U.S. business. Many people will be able to do some or all of
their work from home, thus reducing peak-period demand for
transportation.

8-3. Improve the Nation's air quality by increasing the use\
of cleaner alternative fuels.

**Target:** 30 percent.

**Baseline:** Cleaner alternative fuels represented 2.7 percent of U.S.
motor fuel consumption in 1997.

**Target setting method:** 10-fold improvement.

**Data source:** Alternatives to Traditional Transportation Fuels, U.S.
Department of Energy, Energy Information Administration.

Privately owned cars, vans, and trucks; commercial fleets, trucks, and
buses; and power plants are the major users of alternative fuels.
Ethanol-blended fuels have been used in small engines and other
nonautomotive gasoline engines since the fuels first came into the
marketplace over 25 years ago. Today, all mainstream manufacturers of
power equipment, motorcycles, snowmobiles, and outboard motors permit
the use of ethanol blends in their products.

The primary force behind development of an alternative fuels
infrastructure is the U.S. Department of Energy Clean Cities Program---a
voluntary program and locally based government and industry partnership
designed to promote the use of alternative fuels and alternative fuel
vehicles, cleaner air in major U.S. cities, reduced dependence on
imported oil, and stimulate local economic activity.[^34]

Infrastructure building also is aided by development of alternative fuel
vehicles by the major automobile manufacturers. Also, ethanol blends of
up to 10 percent are approved under the warranties of all major auto
manufacturers, domestic and foreign, marketing vehicles in the United
States. In fact, some recommend the use of cleaner-burning fuels such as
ethanol in their vehicle owner manuals because of ethanol's clean air
benefits. Ethanol actually can enhance engine performance by increasing
octane and raising oxygen, cleaning and preventing engine deposits, and
acting as a gas-line antifreeze.[^35]

More than a trillion miles have been driven on ethanol-blended
gasolines, and ethanol-blended fuels represent more than 12 percent of
U.S. motor gasoline sales. Congress established the Federal ethanol
program in 1979 to stimulate rural economies and reduce the Nation's
alarming dependence on imported oil through the production of a
domestic, renewable energy source. The program has helped build a strong
domestic energy industry. From just over 10 million gallons of
production in 1979, the U.S. fuel ethanol industry has grown to more
than 1.8 billion gallons of annual production capacity. Ethanol is
marketed widely across the country as a high-quality octane enhancer and
as an oxygenate capable of reducing air pollution and improving
automobile performance.

8-4. Reduce air toxic emissions to decrease the risk of adverse health
effects caused by airborne toxics.

**Target:** 2.0 million tons.

**Baseline:** 8.1 million tons of air toxics were released into the air
in 1993.

**Target setting method:** 75 percent improvement.

**Data source:** U.S National Toxics Inventory, EPA.

Toxic air pollutants are those pollutants known or suspected to cause
cancer or other serious health effects, such as reproductive effects or
birth defects, or to cause adverse environmental effects. The degree to
which a toxic air pollutant affects a person's health depends on many
factors, including the quantity of pollutant the person is exposed to,
the duration and frequency of exposures, the toxicity of the chemical,
and the person's state of health and susceptibility. Examples of toxic
air pollutants include benzene, which is found in gasoline;
perchloroethylene, which is emitted from some dry cleaning facilities;
and methylene chloride, which is used as a solvent and paint stripper by
a number of industries. Examples of other listed air toxics include
dioxin, asbestos, toluene, and metals such as cadmium, mercury,
chromium, and lead compounds.

Scientists estimate that millions of tons of toxic pollutants are
released into the air each year. Some air toxics are released from
natural sources such as volcanic eruptions and forest fires. Most,
however, originate from manmade sources, including both mobile sources
(for example, cars, buses, trucks) and stationary sources (for example,
factories, refineries, power plants). Emissions from stationary sources
constitute almost two-thirds of all manmade air toxics emissions. (See
Focus Area 24. Respiratory Diseases.)

### Water Quality

8-5. Increase the proportion of persons served by community water
systems who receive a supply of drinking water that meets the
regulations of the Safe Drinking Water Act.

**Target:** 95 percent.

**Baseline:** 85 percent of persons served by community water systems
received drinking water that met SDWA (Public Law 93-523) regulations in
1995.

**Target setting method:** Consistent with EPA's strategic plan.

**Data sources:** Potable Water Surveillance System (PWSS) and Safe
Drinking Water Information System (SDWIS), EPA.

Most people in the United States obtain their drinking water from public
water supply systems. EPA has established regulations intended to ensure
that community water systems supply safe drinking water to their
customers. Compliance with the established regulations is one measure of
the public's receipt of a safe water supply, free from disease-causing
agents. In 1997, small systems (serving 25 to 3,300 people) accounted
for more than 85 percent of the community water systems in the United
States but served only about 10 percent of the population. These systems
accounted for 91 percent of the violations of the EPA drinking water
regulations.[^36] According to USGS, 17 percent of the Nation's total
population were served by their own water supply systems in 1990,
compared with 18 percent in 1985.Error: Reference source not found

8-6. Reduce waterborne disease outbreaks arising from\
water intended for drinking among persons served\
by community water systems.

**Target:** 2 outbreaks.

**Baseline:** 6 outbreaks per year originated from community water
systems (1987--96 average).

**Target setting method:** 67 percent improvement.

**Data source:** State Reporting Systems, CDC, NCID.

The Centers for Disease Control and Prevention (CDC) compiles the
results of State investigations into waterborne disease outbreaks
arising from water intended for drinking. Between 1987 and 1996, the
States reported an average of 15.5 outbreaks per year, of which 6
outbreaks were identified as originating from community water
supplies.Error: Reference source not
found**^,\ Error:\ Reference\ source\ not\ found,\ Error:\ Reference\ source\ not\ found^**
Limited existing data suggest that State and CDC surveillance systems
for detecting waterborne disease outbreaks are able to detect most
waterborne disease outbreaks.

8-7. Reduce per capita domestic water withdrawals.

**Target:** 90.9 gallons.

**Baseline:** 101 gallons of domestic water per capita per day were
withdrawn in 1995.

**Target setting method:** 10 percent improvement.

**Data source:** U.S. Department of Interior, U.S. Geological Survey
(USGS).

Historically, water management in the United States has focused on
directing the country's abundant supplies of fresh water to meet the
needs of users. This approach has resulted in the building of large
storage reservoirs and conveyance systems, especially in the West.
Increasing development costs, capital shortages, government fiscal
restraint, diminishing sources of water supply, polluted water, and a
growing concern for the environment have forced water managers and
planners to begin to rethink traditional approaches to management and to
experiment with new ones. Experts on the subject of water supply and
demand agree that the West is in transition from the era of water-supply
development to an era of water-demand management and conservation. As
the population increases in the Eastern United States, the water
quantity problems already facing the West will become apparent there as
well. Estimates place the amount of water withdrawn for public supply
during 1990 at about 5 percent more than during 1985.Error: Reference
source not found Public-supply domestic deliveries averaged 105 gallons
per day for each person served, the same as during 1985.Error: Reference
source not found The per capita use remained about the same for the past
decade as the result of active conservation programs that include the
installation of additional meters and water-conserving plumbing
fixtures.Error: Reference source not found Information about water use
is available from USGS at <http://water.usgs.gov/watuse>/\
wudo.html.[^37]

8-8. (Developmental) Increase the proportion of assessed\
rivers, lakes, and estuaries that are safe for fishing and recreational
purposes.

**Potential data source:** Clean Water Act (Public Law 92-500), Section
305-b Report, EPA.

EPA reported that about 40 percent of the Nation's surface waters
(streams, lakes, and estuaries) are too polluted for fishing, swimming,
or other uses designated for them by States and Tribes.[^38] Water
quality in lakes, streams, and estuaries of the United States affects
both the recreational and food production use of these waters. States
and Tribes have water-quality management programs that address
recreational use and fish and shellfish harvesting. EPA establishes
water-quality objectives for these waters and monitors progress toward
these goals. Discharging inadequately treated or inappropriate
quantities of human, industrial, or agriculture wastes reduces the
ability of water to provide conditions that support the growth and
harvesting of fish and shellfish for human consumption. Such discharging
also prevents water's use as a recreational resource.

8-9. (Developmental) Reduce the number of beach closings that result
from the presence of harmful bacteria.

**Potential data source:** EPA Beach Program.

During the first half of the decade, EPA plans to focus on conserving
and enhancing the Nation's waters and aquatic ecosystems so that 75
percent of waters will support healthy aquatic communities.[^39] Part of
this effort will include developing a national beach-closing survey to
monitor efforts to improve the quality of water used for recreational
purposes. Although small streams, private lakes, and ponds will not be
addressed by the EPA beach-closing survey (available at
http://www.epa.gov/ost/beaches), this program will provide a method to
evaluate progress toward improving water quality on U.S. swimming
beaches. Information from the 1997 and 1998 EPA surveys has been
expanded on by the Natural Resources Defense Council (NRDC) and
published in its annual beach-closing report. The latest version is
available from NRDC and on its Web site (http://www.nrdc.org).

8-10. (Developmental) Reduce the potential human exposure\
to persistent chemicals by decreasing fish contaminant levels.

**Potential data sources:** U.S. Department of the Interior, U.S. Fish
and Wildlife Service and USGS.

The Biomonitoring of Environmental Status and Trends (BEST) program
(http://www.best.usgs.gov) is a cooperative activity of the USGS and the
U.S. Fish and Wildlife Service. Designed to assess and monitor the
effects of environmental contaminants on biological resources, the
program measures 51 organochlorine persistent chemicals, organophosphate
and carbamate insecticides, and 21 metals.

### Toxics and Waste

8-11. Eliminate elevated blood lead levels in children.

**Target:** Zero percent.

**Baseline:** 4.4 percent of children aged 1 to 6 years had blood lead
levels\
exceeding 10 μg/dL during 1991--94.

**Target setting method:** Total elimination.

**Data source:** National Health and Nutrition Examination Survey
(NHANES), CDC, NCHS.

Note: The table below may continue to the following page.

+-------------------------------+--------+--------+--------+--------+
| **Children Aged 1 to 6 Years, | **Ch   |        |        |        |
| 1991--94**                    | ildren |        |        |        |
|                               | With   |        |        |        |
|                               | Blood  |        |        |        |
|                               | Lead   |        |        |        |
|                               | Levels |        |        |        |
|                               | G      |        |        |        |
|                               | reater |        |        |        |
|                               | Than   |        |        |        |
|                               | or     |        |        |        |
|                               | Equal  |        |        |        |
|                               | to 10  |        |        |        |
|                               | μ      |        |        |        |
|                               | g/dL** |        |        |        |
+===============================+========+========+========+========+
|                               | **     | **Re   |        |        |
|                               | 8-11.\ | siding |        |        |
|                               | Re     | in     |        |        |
|                               | siding | H      |        |        |
|                               | in     | ousing |        |        |
|                               | All\   | Bu     |        |        |
|                               | Hou    | ilt:** |        |        |
|                               | sing** |        |        |        |
+-------------------------------+--------+--------+--------+--------+
|                               |        | **     | **1946 | **     |
|                               |        | Before | to\    | After\ |
|                               |        | 19     | 19     | 19     |
|                               |        | 46\*** | 73\*** | 73\*** |
+-------------------------------+--------+--------+--------+--------+
|                               | P      |        |        |        |
|                               | ercent |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > **TOTAL**                   | 4.4    | 8.6    | 4.6    | 1.6    |
+-------------------------------+--------+--------+--------+--------+
| **Race and ethnicity**        |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > American Indian or Alaska   | DSU    | DSU    | DSU    | DSU    |
| > Native                      |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Asian or Pacific Islander   | DSU    | DSU    | DSU    | DSU    |
+-------------------------------+--------+--------+--------+--------+
| > Asian                       | DNC    | DNC    | DNC    | DNC    |
+-------------------------------+--------+--------+--------+--------+
| > Native Hawaiian and other\  | DNC    | DNC    | DNC    | DNC    |
| > Pacific Islander            |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Black or African American   | 11.5   | 22.7   | 13.2   | 3.3    |
+-------------------------------+--------+--------+--------+--------+
| > White                       | 2.6    | 6.6    | 1.9    | 1.4    |
+-------------------------------+--------+--------+--------+--------+
|                               |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Hispanic or Latino          | DSU    | DSU    | DSU    | DSU    |
+-------------------------------+--------+--------+--------+--------+
| > Mexican American            | 4.0    | 13.0   | 2.3    | 1.6    |
+-------------------------------+--------+--------+--------+--------+
| > Not Hispanic or Latino      | 4.2    | DNA    | DNA    | DNA    |
+-------------------------------+--------+--------+--------+--------+
| > Black or African American   | 11.2   | 21.9   | 13.7   | 3.4    |
+-------------------------------+--------+--------+--------+--------+
| > White                       | 2.3    | 5.6    | 1.4    | 1.5    |
+-------------------------------+--------+--------+--------+--------+
| ###### Gender                 |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Female                      | 3.3    | 7.1    | 2.8    | 1.5    |
+-------------------------------+--------+--------+--------+--------+
| > Male                        | 5.5    | 9.6    | 6.6    | 1.7    |
+-------------------------------+--------+--------+--------+--------+
| **Family income level**^†^    |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Low                         | 1.9    | 4.1    | 2.0    | 0.4    |
+-------------------------------+--------+--------+--------+--------+
| > High                        | 1.0    | 0.9    | 2.7    | 0      |
+-------------------------------+--------+--------+--------+--------+
| ###### Geographic location    |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Population [\>]{.underline} | 5.4    | 11.5   | 5.8    | 0.8    |
| > 1 million                   |        |        |        |        |
+-------------------------------+--------+--------+--------+--------+
| > Population \< 1 million     | 3.3    | 5.8    | 3.1    | 2.5    |
+-------------------------------+--------+--------+--------+--------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

\*Data for "all houses" are from a separate analysis of NHANES data;
data for specific periods of time provided for information purposes.

^†^Income categories defined using poverty-income ratio (PIR) (the ratio
of total family income to the poverty threshold for the year). Low
equals PIR [\<]{.underline}1.300; middle equals PIR 1.301 -- 3.500; high
equals PIR [\>]{.underline}3.501.

Note: The table above may have continued from the previous page.

Although considerable progress has been made in reducing BLLs in the
Nation's children, lead poisoning remains a preventable environmental
health problem in the United States. Culturally and linguistically
appropriate information is needed alerting persons to the dangers of
lead poisonings.

8-12. Minimize the risks to human health and the environment posed by
hazardous sites.

**Target:** 98 percent of sites on the following lists:

  ------------ ------------------------------------------------------------
  **8-12a.**   National Priority List sites

  **8-12b.**   Resource Conservation and Recovery Act facilities

  **8-12c.**   Leaking underground storage facilities

  **8-12d.**   Brownfield properties
  ------------ ------------------------------------------------------------

**Baseline:** 1,200 National Priority List sites; 2,475 Resource
Conservation and Recovery Act facilities; 370,000 leaking underground
storage facilities; 1,500 brownfield properties in 1998.

**Target setting method:** Consistent with EPA's 1997 Strategic Plan.

**Data source:** Comprehensive Environmental Response and Cleanup
Liability Information System (CERCLIS), EPA, OSWER.

The National Priorities List (NPL) is a published list of the most
hazardous waste sites in the country eligible for extensive, long-term
cleanup under the Superfund program. Sites listed on the NPL often are
initially discovered by local or State agencies, businesses, EPA, the
Coast Guard, or the public. If a site poses a significant risk to human
health, as determined by the number and toxicity of substances
discovered at the site and its capacity to affect surrounding
populations, then the site is placed on the NPL. The Agency for Toxic
Substances and Disease Registry (ATSDR) is the Federal health agency
that issues recommendations to EPA, State health and environmental
agencies, and the public concerning the elimination of public health
threats at these sites. This advice often also includes recommendations
to the public and the health care community concerning practices to
identify and prevent exposures and adverse health effects.

The Resource Conservation and Recovery Act (RCRA) was enacted by
Congress in 1976 to find a safe way to manage and dispose of the huge
volumes of municipal and industrial waste generated nationwide. RCRA
facilities are authorized and regulated by this act. With several
amendments, the act and its subsequent regulations govern the management
of nonhazardous (solid) waste, hazardous waste, and underground storage
tanks (USTs). The Leaking Underground Storage Tanks Program attempts to
identify and eliminate the threat to human health posed by groundwater
or soil contamination from petroleum released from these tanks. The term
"brownfields" denotes abandoned, idle, or underused industrial or
commercial sites where expansion or redevelopment is complicated by real
or perceived environmental contamination.

8-13. Reduce pesticide exposures that result in visits to a health care
facility.

**Target:** 13,500 visits per year.

**Baseline:** 27,156 visits to health care facilities were due to
pesticides in 1997. (A total of 129,592 pesticide exposures were
documented in 1997.)

**Target setting method:** 50 percent improvement.

**Data source:** Toxic Exposure Surveillance System (TESS), American
Association of Poison Control Centers.

Pesticide exposures include those involving disinfectants, fungicides,
herbicides, insecticides, moth repellants, and rodenticides, as defined
by EPA. The American Association of Poison Control Centers surveillance
covers approximately 93 percent of the U.S. population.

8-14. (Developmental) Reduce the amount of toxic pollutants released,
disposed of, treated, or used for energy recovery.

**Potential data source:** Toxics Release Inventory (TRI), EPA.

Reductions in toxic pollutants released, disposed of, treated, or used
for energy recovery can be measured by industry's success in reducing
pollution at the source---that is, not producing pollutants at all,
through manufacturing process changes, shifting to less polluting
ingredients, packaging changes, and other source reduction methods. For
that reason, all pollutants, those released and those treated or
disposed of in some manner, should be measured.

8-15. Increase recycling of municipal solid waste.

**Target:** 38 percent.

**Baseline:** 27 percent of total municipal solid waste generated was
recycled in 1996 (includes composting).

**Target setting method:** Consistent with the EPA's 1997 Strategic
Plan.

**Data source:** Characterization of Municipal Solid Waste, EPA.

### Healthy Homes and Healthy Communities

8-16. Reduce indoor allergen levels.

Target and baseline:

  ------------ --------------------------- ---------------- ---------------
  Objective    Allergen                    1998--99\        2010\
                                           Baseline         Target

                                           *Number of Homes 
                                           (in millions)*   

  **8-16a.**   Group I dust mite allergens 36.3             29.0
               that exceed 2 micrograms                     
               per gram of dust in the bed                  

  **8-16b**.   Group I dust mite allergens 18.6             14.9
               that exceed 10 micrograms                    
               per gram of dust in the bed                  

  **8-16c.**   German cockroach allergens  4.7              3.8
               that exceed 0.1 microgram                    
               per gram of dust in the bed                  
  ------------ --------------------------- ---------------- ---------------

**Target setting method:** 20 percent improvement.

**Data source:** National Survey of Lead and Allergens in Housing,
NIEHS, and U.S. Department of Housing and Urban Development.

Indoor allergens---such as from house dust mites, cockroaches, mold,
rodents, and pets---can worsen symptoms of respiratory conditions, such
as asthma and allergies. These allergens are an important public health
issue because most people spend the majority of their time indoors, both
at home and at work. In addition, effective methods to reduce exposure
to some of these allergens exist (for example, placement of impermeable
covers on mattresses and pillows reduces dust mite allergen exposures in
beds). (See Focus Area 24. Respiratory Diseases.)

8-17. (Developmental) Increase the number of office buildings that are
managed using good indoor air quality practices.

**Potential data source:** Indoor Environment Division, EPA.

The air quality inside a building impacts both the comfort and health of
its occupants. Pollutants are found at higher levels in indoor air as
compared to outdoor air. In addition, most people spend over 90 percent
of their time indoors.[^40]

8-18. Increase the proportion of persons who live in homes tested for
radon concentrations.

**Target:** 20 percent.

**Baseline:** 17 percent of the population lived in homes in 1998 that
had been tested for radon (age adjusted to the year 2000 standard
population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Total Population, 1998**                     | **Persons Living in |
|                                                | Homes Tested for    |
|                                                | Radon**             |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 17                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 19                  |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 17                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 17                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | 17                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 18                  |
+------------------------------------------------+---------------------+
| > White                                        | 17                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 14                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 17                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 18                  |
+------------------------------------------------+---------------------+
| > White                                        | 17                  |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 17                  |
+------------------------------------------------+---------------------+
| > Male                                         | 17                  |
+------------------------------------------------+---------------------+
| **Family income level**                        |                     |
+------------------------------------------------+---------------------+
| > Poor                                         | 15                  |
+------------------------------------------------+---------------------+
| > Near poor                                    | 12                  |
+------------------------------------------------+---------------------+
| > Middle/high income                           | 18                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

8-19. Increase the number of new homes constructed to be\
radon resistant.

**Target:** 2.1 million additional new homes.

**Baseline:** 1.4 million new homes as of 1997.

**Target setting method:** 50 percent improvement.

**Data source:** National Association of Home Builders Research Center
Survey, National Association of Home Builders.

8-20. (Developmental) Increase the proportion of the Nation's primary
and secondary schools that have official school policies ensuring the
safety of students and staff from\
environmental hazards, such as chemicals in special classrooms, poor
indoor air quality, asbestos, and\
exposure to pesticides.

**Potential data source:** School Health Policies and Programs Study
(SHPPS), CDC, NCCDPHP.

8-21. (Developmental) Ensure that State health departments establish
training, plans, and protocols and conduct annual multi-institutional
exercises to prepare for response to natural and technological
disasters.

**Potential data sources:** Association of State and Territorial Health
Officials (ASTHO); Public Health Foundation.

8-22. Increase the proportion of persons living in pre-1950s housing
that has been tested for the presence of lead-based paint.

**Target:** 50 percent.

**Baseline:** 16 percent of persons living in homes built before 1950 in
1998\
reported that their homes had been tested for the presence of lead-based
paint (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

+------------------------------------------------+---------------------+
| **Persons Living in Pre-1950s Housing, 1998**  | **Persons Living in |
|                                                | Homes Tested for    |
|                                                | Lead-Based Paint**  |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 16                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DSU                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 13                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 11                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | 24                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 22                  |
+------------------------------------------------+---------------------+
| > White                                        | 14                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 14                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 16                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 23                  |
+------------------------------------------------+---------------------+
| > White                                        | 15                  |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 17                  |
+------------------------------------------------+---------------------+
| > Male                                         | 15                  |
+------------------------------------------------+---------------------+
| **Family income level**                        |                     |
+------------------------------------------------+---------------------+
| > Poor                                         | 19                  |
+------------------------------------------------+---------------------+
| > Near poor                                    | 16                  |
+------------------------------------------------+---------------------+
| > Middle/high income                           | 15                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

8-23. Reduce the proportion of occupied housing units that\
are substandard.

**Target:** 3 percent.

**Baseline:** 6.2 percent of occupied U.S. housing units had moderate or
severe physical problems in 1995.

**Target setting method:** 52 percent improvement.

**Data source:** American Housing Survey, U.S. Department of Commerce,
Bureau of the Census.

Residents of substandard housing are at increased risk for fire,
electrical injuries, lead poisoning, falls, rat bites, and other
illnesses and injuries.

### Infrastructure and Surveillance

8-24. Reduce exposure to pesticides as measured by urine\
concentrations of metabolites.

Target and baseline:

+---------+----------------------------+---------------+--------------+
| Ob      | Reduction in Pesticide\    | 1988--94\     | 2010\        |
| jective | Exposure as Measured by\   | Baseline\*    | Target       |
|         | Metabolites (Pesticide)    |               |              |
+---------+----------------------------+---------------+--------------+
|         |                            | #             |              |
|         |                            | ###### Urine  |              |
|         |                            | Concentration |              |
+---------+----------------------------+---------------+--------------+
| **8     | 1-naphthol (carbaryl)      | 36.0 μg/g\    | 25.2 μg/g\   |
| -24a.** |                            | creatinine    | creatinine   |
+---------+----------------------------+---------------+--------------+
| **8     | Paranitrophenol (methyl    | 3.8 μg/g\     | 2.7 μg/g\    |
| -24b.** | parathion and parathions)  | creatinine    | creatinine   |
+---------+----------------------------+---------------+--------------+
| **8     | 3, 5,                      | 8.3 μg/g\     | 5.8 μg/g\    |
| -24c.** | 6-trichloro-2-pyridinol\   | creatinine    | creatinine   |
|         | (chlorpyrifos)             |               |              |
+---------+----------------------------+---------------+--------------+
| **8     | Isopropoxyphenol           | 1.6 μg/g\     | 1.1 μg/g\    |
| -24d.** | (propoxur)                 | creatinine    | creatinine   |
+---------+----------------------------+---------------+--------------+

\*95 percent of the population had concentrations below this level.

**Target setting method:** 30 percent improvement.

**Data source:** National Health and Nutrition Examination Survey
(NHANES), CDC, NCHS.

Note: Data are from a subset of NHANES data and are not nationally
representative. Therefore, a population data template is not available.

Pesticides included in the table inhibit cholinesterase, an enzyme found
in the human body. These pesticides are among those commonly used in the
home and garden, agriculture, and industry.[^41] Metabolites (or
breakdown products) of pesticides are measured in urine samples obtained
from persons aged 6 years and older. Urinary measurements of pesticide
metabolites are an accurate way to measure recent exposure to pesticides
that inhibit cholinesterase. Concentrations of pesticide metabolites in
urine are corrected for kidney function and expressed in μg/g
creatinine, a measure of kidney function.

8-25. (Developmental) Reduce exposure of the population to pesticides,
heavy metals, and other toxic chemicals, as measured by blood and urine
concentrations of the\
substances or their metabolites.

  --------------- -------------------------------------------------------
  Objective       Exposure Item

                  **Heavy metals**

  **8-25a.**      Arsenic

  **8-25b.**      Cadmium

  **8-25c.**      Lead

  **8-25d.**      Manganese

  **8-25e.**      Mercury

                  **Pesticides**

  **8-25f.**      2, 4-D

  **8-25g.**      o-phenylphenol

  **8-25h.**      Permethrins

  **8-25i.**      Diazinon

                  **Persistent chemicals**

  **8-25j.**      Polychlorinated biphenyls

  **8-25k.**      Dioxins

  **8-25l.**      Furans

                  **Organochlorine compounds**

  **8-25m.**      Chlordane

  **8-25n.**      Dieldrin

  **8-25o.**      DDT

  **8-25p.**      Lindane
  --------------- -------------------------------------------------------

**Potential data source:** National Health and Nutrition Examination
Survey (NHANES), CDC, NCHS.

Heavy metals, polychlorinated biphenyls (PCBs), dioxins, furans, and\
organochlorines are in use or have been used in the past. These
compounds are known or suspected causes of cancer, birth defects, or
other diseases in people.

8-26. (Developmental) Improve the quality, utility, awareness, and use
of existing information systems for environmental health.

**Potential data sources:** Toxics Release Inventory, EPA; Environmental
Defense Fund.

Other environmental health information systems include TOXLINE,
Integrated Risk Information System (IRIS), Registry of Toxic Effects of
Chemical Substances (RTECS^®^), HazDat, and Aerometric Information
Retrieval System (AIRS). They can be accessed via the Internet.

8-27. Increase or maintain the number of Territories, Tribes, and
States, and the District of Columbia that monitor diseases or conditions
that can be caused by exposure to\
environmental hazards.

Target and baseline:

+---------+---------------------+------------------+------------------+
| Ob      | Disease             | 1997 Baseline    | 2010 Target      |
| jective |                     |                  |                  |
+---------+---------------------+------------------+------------------+
|         |                     | ####### Number   |                  |
|         |                     | of Jurisdictions |                  |
+---------+---------------------+------------------+------------------+
| **8     | Lead poisoning      | 51               | 51               |
| -27a.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Pesticide poisoning | 20               | 25               |
| -27b.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Mercury poisoning   | 14               | 20               |
| -27c.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Arsenic poisoning   | 10               | 15               |
| -27d.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Cadmium poisoning   | 10               | 15               |
| -27e.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Methemoglobinemia   | 9                | 15               |
| -27f.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Acute chemical      | 8                | 15               |
| -27g.** | poisoning\*         |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Carbon monoxide\    | 7                | 51               |
| -27h.** | poisoning           |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Asthma              | 6                | 25               |
| -27i.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Hyperthermia        | 4                | 10               |
| -27j.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Hypothermia         | Developmental    |                  |
| -27k.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Skin cancer         | Developmental    |                  |
| -27l.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Malignant melanoma  | Developmental    |                  |
| -27m.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Other skin cancer   | Developmental    |                  |
| -27n.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+
| **8     | Birth defects       | Developmental    |                  |
| -27o.** |                     |                  |                  |
+---------+---------------------+------------------+------------------+

\*Includes chemicals not covered elsewhere in the table.

Note: Target and baseline data are for States and the District of
Columbia. The targets will be adjusted as data for Tribes and
Territories become available.

**Target setting method:** Total coverage or expert opinion.

**Data sources:** Periodic surveys, Public Health Foundation and Council
of State and Territorial Epidemiologists.

8-28. (Developmental) Increase the number of local health\
departments or agencies that use data from surveillance\
of environmental risk factors as part of their vector control programs.

**Potential data source:** Profile of local health departments, National
Association of County and City Health Officials (NACCHO).

### Global Environmental Health

8-29. Reduce the global burden of disease due to poor water quality,
sanitation, and personal and domestic hygiene.

**Target:** 2,135,000 deaths.

**Baseline:** 2,668,200 deaths worldwide were attributable to these
factors in 1990.

**Target setting method:** 20 percent improvement.

**Data source:** Global Burden of Disease, World Health Organization.

Improving access to clean water and sanitation has been cited as the
single most effective means of alleviating human distress. Better water
supply and sanitation may increase the average life expectancy in
developing countries by 15 years. Furthermore, poor sanitation ranks as
one of the highest contributing factors to the global burden of disease
and injury. Diarrheal diseases, which kill nearly 3 million persons a
year in developing countries, typically result from poor sanitation
practices and the consumption of substandard drinking water. These
diseases are mostly preventable by improving environmental
services.[^42]**^,^** [^43]

8-30. Increase the proportion of the population in the U.S.-Mexico
border region that have adequate drinking water and sanitation
facilities.

Target and baseline:

  ------------ ------------------------- ---------------- ----------------
  Objective    Type of Drinking Water    1997 Baseline    2010 Target
               and\                                       
               Sanitation Service                         

                                         *Percent of      
                                         Population       
                                         Receiving\       
                                         Water Service or 
                                         Treatment*       

               **Wastewater sewer                         
               service\                                   
               provided**                                 

  **8-30a.**   Ciudad Acuna              39               49

  **8-30b.**   Matamoros                 47               57

  **8-30c.**   Mexicali                  80               90

  **8-30d.**   Nogales, Sonora           81               91

  **8-30e.**   Piedras Negras            80               90

  **8-30f.**   Reynosa                   57               67

               **Wastewater receiving\                    
               treatment**                                

  **8-30g.**   Ciudad Acuna              0                10

  **8-30h.**   Matamoros                 0                10

  **8-30i.**   Mexicali                  72               82

  **8-30j.**   Nogales, Sonora           100              100

  **8-30k.**   Piedras Negras            0                10

  **8-30l.**   Reynosa                   100              100
  ------------ ------------------------- ---------------- ----------------

**Target setting method:** 10 percentage point improvement.

**Data sources:** EPA; Mexico's Comisión Nacional de Agua; State and
local health departments; American Water Works Association; Rural Water
Association; U.S.-Mexican Border Health Association.

Water pollution is one of the principal environmental and public health
problems facing the U.S.-Mexico border area. Deficiencies in the
treatment of wastewater, the disposal of untreated sewage, and
inadequate operation and maintenance of treatment plants result in
health risks.Error: Reference source not found**^,^** [^44] Better
environmental services such as sewer service, wastewater treatment
service, and safe drinking water may help achieve a balance among social
and economic factors and protecting the environment in border
communities and natural areas.

## Related Objectives From Other Focus Areas

1\. Access to Quality Health Services

1-7. Core competencies in health provider training

1-12. Single toll-free number for poison control centers

3\. Cancer

3-1. Overall cancer deaths

3-2. Lung cancer deaths

3-8. Melanoma deaths

3.9. Sun exposure and skin cancer

3-10. Provider counseling about cancer prevention

3-14. Statewide cancer registries

4\. Chronic Kidney Disease

4-1. End-stage renal disease

6\. Disability and Secondary Conditions

6-12. Environmental barriers affecting participation in activities

7\. Educational and Community-Based Programs

7-2. School health education

7-10. Community health promotion programs

10\. Food Safety

10-1. Foodborne Infections

10-2. Outbreaks of foodborne infections

10-5. Consumer food safety practices

11\. Health Communication

11-1. Households with Internet access

11-2. Health literacy

11-4. Quality of Internet health information sources

12\. Heart Disease and Stroke

12-1. Coronary heart disease (CHD) deaths

14\. Immunization and Infectious Diseases

14-31. Active surveillance for vaccine safety

15\. Injury and Violence Prevention

15-7. Nonfatal poisonings

15-8. Deaths from poisoning

15-10. Emergency department surveillance systems

15-11. Hospital discharge surveillance systems

15-12. Emergency department visits

15-13. Deaths from unintentional injuries

15-14. Nonfatal unintentional injuries

16\. Maternal, Infant, and Child Health

16-10. Low birth weight and very low birth weight

16-11. Preterm births

16-14. Developmental disabilities

20\. Occupational Safety and Health

20-1. Work-related injury deaths

20-2. Work-related injuries

20-7. Elevated blood lead levels from work exposure

20-8. Occupational skin diseases or disorders

22\. Physical Activity and Fitness

22-14. Community walking

22-15. Community bicycling

23\. Public Health Infrastructure

23-1. Public health employee access to the Internet

23-2. Public access to information and surveillance data

23-3. Use of geocoding in health data systems

23-4. Data for all population groups

23-5. Data for Leading Health Indicators, Health Status Indicators, and
Priority Data Needs at State, Tribal, and local levels

23-6. National tracking of Healthy People 2010 objectives

23-7. Timely release of data on objectives

23-8. Competencies for public health workers

23-9. Training in essential public health services

23-10. Continuing education and training by public health agencies

23-11. Performance standards for essential public health services

23-12. Health improvement plans

23-13. Access to public health laboratory services

23-14. Access to epidemiology services

23-15. Model statutes related to essential public health services

23-16. Data on public health expenditures

23-17. Population-based prevention research

24\. Respiratory Diseases

24-1. Deaths from asthma

24-2. Hospitalizations for asthma

24-3. Hospital emergency department visits for asthma

24-4. Activity limitations

24-5. School or work days lost

24-6. Patient education

24-7. Appropriate asthma care

24-8. Surveillance systems

27\. Tobacco Use

27-9. Exposure to tobacco smoke at home among children

27-10. Exposure to environmental tobacco smoke

27-11. Smoke-free and tobacco-free schools

27-12. Worksite smoking policies

27-13. Smoke-free indoor air laws

28\. Vision and Hearing

28-16. Hearing protection

28-17. Noise‑induced hearing loss in children

28-21. Noise‑induced hearing loss in adults

## Terminology

(A listing of abbreviations and acronyms used in this publication
appears in Appendix H.)

**Acute chemical poisoning:** Unintentional poisoning caused by
chemicals that are not medicines.

**Aerometric Information Retrieval System** **(AIRS):** This system,
administered by EPA, contains information about air pollution in the
United States and other countries.

**Algae:** Small one- or many-celled plants that live in the water and
do not have roots, stems, or leaves but usually contain chlorophyll.

**Annual vehicle miles:** The distance traveled by a passenger vehicle
over a given interval of time.

**Bloom:** Populations of algae that have grown so large that they can
be seen in water with the naked eye.

**Brownfields:** Abandoned, idle, or underused industrial or commercial
sites that raise concern in nearby communities that any expansion or
redevelopment could contaminate the environment.

**Chlorophyll:** The green photosynthetic pigment found chiefly in
plants.

**Community water system:** A public water system that provides water to
at least 15 service connections used by year-round residents or that
regularly serves at least 25 year-round residents.

**Disaster:** Any event, either natural (such as hurricanes, wind
storms, earthquakes, volcanic eruptions, or floods) or technological
(such as the release of radiation or chemical or biologic substances),
that, because of its scope or severity, overwhelms a population's
ability to respond.

**Domestic water use:** Using water for household purposes, such as
drinking, preparing food, bathing, washing clothes and dishes, flushing
toilets, or watering lawns and gardens. Also called residential water
use. The water may be obtained from a public supply or may be
self-supplied by a homeowner (such as by a well).

**Environmental epidemiology:** The study of the effect on human health
of physical, biological, and chemical factors in the external
environment. Can include examining specific populations or communities
exposed to different ambient environments to clarify the relationship
between physical, biological, or chemical factors and human health.

**Environmental hazards:** Situations or conditions in which something
in the environment, such as radiation, a chemical, or other pollutant,
can cause human illness or injury.

**Environmental tobacco smoke:** Smoke given off by cigarettes, pipes,
or cigars to which nonsmokers can be exposed.

**Environmental toxicology:** Scientific analysis of the relationship
between exposure to hazardous substances found in the environment and
adverse health effects in people.

**Epidemic:** The occurrence in a community or region of cases of an
illness, specific health-related behavior, or other health-related
events clearly in excess of normal expectancy.

**Evidence based:** Empirical proof that accurately validates
professional guidance or recommendations or illustrates how an approach
has been used successfully in the past.

**Good indoor air quality practices:** Operation and maintenance
procedures designed to provide air quality inside a building to increase
comfort and productivity and to reduce health risks for people in the
building.

**Greenhouse gas (GHG):** A gas that absorbs radiation of specific wave
lengths within the infrared spectrum of radiation released by the
earth's surface and clouds so that part of the absorbed energy is
trapped and the earth's surface warms up. Water vapor, carbon dioxide,
nitrous oxide, methane, and ozone are the primary greenhouse gases in
the earth's atmosphere.

**Hazard Ranking System (HRS):** The principal screening tool used by
EPA to evaluate risks to public health and the environment associated
with abandoned or uncontrolled hazardous waste sites. HRS calculates a
score based on the potential of hazardous substances spreading from the
site through the air, surface water, or ground water and on other
factors, such as density and proximity of human population. This score
is the primary factor in deciding whether the site should be on the
National Priorities List and, if so, what ranking it should have
compared to other sites on the list.

**Hazardous substances:** Any substance that possesses properties that
can cause harm to human health and ecologic systems. A subset of these
substances, toxics, or toxicants are substances not produced by a living
organism that can cause harm to human health and ecologic systems.

**HazDat:** A scientific database maintained by the Agency for Toxic
Substances and Disease Registry. Provides access to information on the
release of hazardous substances from Superfund sites or from emergency
events and on the effects of hazardous substances on health.

**Household lead dust:** Very fine particles containing lead that are
usually caused by the deterioration of lead paint.

**Humanitarian emergencies:** Emergencies that occur as a result of
disasters that destroy or have a negative effect on basic human needs,
such as food, shelter, and water.

**Indoor air quality (IAQ):** The overall state of the air inside a
building as reflected by the presence of pollutants, such as dust,
fungi, animal dander, volatile organic compounds, carbon monoxide, and
lead.

**Indoor allergens:** Fine particles in indoor air that can cause
allergic reactions and respiratory problems, including dust mites and
animal dander.

**Infectious agents:** Any organism, such as a virus, parasite, or
bacterium, that is capable of invading the body, multiplying, and
causing disease.

**Integrated Risk Information System** **(IRIS):** This database,
maintained by EPA, contains information on health hazards from over
5,000 substances.

**Metabolites:** Any substance produced by biological processes in the
human body. In some cases, it is not possible to measure certain
substances (for example, pesticides) in the human body to determine
exposure to those substances, but instead it is possible to measure the
secondary substance or metabolite that is created when the human body
breaks down the primary substance.

**Municipal solid waste:** Common garbage or trash generated by
industries, businesses, institutions, and homes.

**National Ambient Air Quality Standards (NAAQS):** Standards set by EPA
for the level of common air pollutants allowed by the Clean Air Act.

**National Priorities List (NPL):** EPA's list of the most serious
uncontrolled or abandoned hazardous waste sites identified for possible
long‑term cleanup under Superfund. The list is based primarily on the
score a site receives from the Hazard Ranking System. EPA updates the
NPL at least yearly. A site must be on the NPL to receive funds from the
Superfund Trust Fund for remedial action.

**Nonattainment area:** A locality where air pollution levels
persistently exceed EPA's National Ambient Air Quality Standards.

**Nonpoint source:** The source of runoff water coming from an area such
as a yard, parking lot, pasture, or other urban or agricultural area.

**Ozone:** Ozone occurs naturally in the stratosphere and provides a
protective layer high above the earth. At ground-level, however, ambient
ozone is the prime ingredient of smog. Ambient ozone refers to ozone in
the troposphere---the air that people breathe---which is different from
ozone in the stratosphere, the hole in the ozone layer. Ozone is not
emitted directly into the air but is formed readily in the atmosphere,
usually during hot summer weather, from volatile organic compounds
emitted by motor vehicles, chemical plants, refineries, factories,
consumer and commercial products, other industrial sources, and trees
and from nitrogen oxides emitted by motor vehicles, power plants, and
other sources of combustion. Changing weather patterns contribute to
yearly differences in ozone concentrations from city to city.

**Particulate matter:** General term used for a mixture of solid
particles and liquid droplets found in the air. These particles, which
come in a wide range of sizes, originate from "built" and natural
sources. Fine particles (PM2.5) result from fuel combustion from motor
vehicles, power generation, and industrial facilities, as well as from
residential fireplaces and wood stoves. Coarse particles (PM10)
generally are emitted from other sources, such as vehicles traveling on
unpaved roads, materials handling, and crushing and grinding operations,
as well as windblown dust.

**Per capita water use:** The average amount of water used per person
during a standard period, generally per day. In the United States, this
measure usually is reported in gallons per day.

**Persistent chemicals:** Chemicals, such as organochlorine compounds,
that remain in the environment for a long time and can accumulate in the
fat of people and animals exposed to them.

**Photosynthesis:** Formation of carbohydrates from carbon dioxide and a
source of hydrogen (as water) in the chlorophyll-containing tissues of
plants exposed to light.

**Point source:** The source of water coming from a specific location,
such as a drain pipe from a wastewater treatment plant or an industrial
plant.

**Poisoning:** An exposure to a toxic substance that produces negative
signs or symptoms.

**Premature death:** A death that occurs earlier than the life
expectancy for most members of the population.

**Protozoa:** A subkingdom of the animal kingdom, including all of the
so-called acellular or unicellular forms (for example, Amoeba, Giardia,
and Cryptosporidium).

**Radon:** A colorless, naturally occurring radioactive gas found in
some soils or rocks.

**Radon-resistant construction:** Affordable and simple techniques that,
when incorporated during construction of a new home, reduce indoor radon
levels by preventing radon entry and providing a means for venting radon
to the outdoors.

**Registry of Toxic Effects of Chemical Substances (RTECS^®^):**
Maintained by the National Institute for Occupational Safety and Health,
this database contains information on the toxic effects of chemical
substances. The list of substances includes drugs, food additives,
preservatives, ores, pesticides, dyes, detergents, lubricants, soaps,
plastics, extracts from plant and animal sources, plants or animals that
are toxic by contact or consumption, and industrial intermediates and
waste products from production\
processes.

**Service connection:** The point at which a customer's water supply
attaches to a water utilities distribution system.

**Special classrooms:** Classrooms with special characteristics, such as
laboratories and art rooms, in which particular environmental hazards
may be found.

**Substandard housing:** Housing with moderate or severe physical
problems in plumbing, heating, or electrical systems, upkeep and
sanitation, hallways, or kitchens.

**Superfund:** The program operated under the legislative authority of
Comprehensive Environmental Response, Compensation, and Liability Act
(CERCLA) and Superfund Amendments and Reauthorization Act (SARA) that
funds and carries out EPA solid waste emergency and long-term removal or
remedial activities. These activities include establishing the National
Priorities List, investigating sites for inclusion on the list,
determining their priority, and conducting or supervising cleanup and
other remedial actions or both.

**Sustainable development:** Growth and development within a society
that is intended to meet the needs of the present without compromising
the ability of future generations to meet their own needs.

**Toxic Release Inventory (TRI):** EPA's list of more that 600
designated chemicals that threaten health and the environment.
Authorized under the Emergency Planning and Community Right‑To‑Know Act
(EPCRA) of 1986, this system requires manufacturers to report releases
of these chemicals to EPA and State governments. EPA compiles the data
in an online, publicly accessible national computerized database.

**TOXLINE:** A collection of online information on drugs and other
chemicals maintained by the National Library of Medicine.

**Transit:** Represents what used to be called "mass transit." The 1990
Nationwide Personal Transportation Survey (NPTS/U.S. Department of
Transportation) included the following modes in its transit count: bus,
subway or elevated rail, commuter rail, streetcar, and trolley. The 1995
NPTS characterizes a "trip" as travel to a destination (for example,
worksite). Travel to work, for instance, that includes two stops along
the way (trip chains) would constitute three "trips."

**μg/dL:** Micrograms per deciliter.

**Urban sprawl:** Unplanned and inefficient development of open land.

**Vector-borne diseases:** Illnesses that are transmitted to people by
organisms, such as insects.

**Vector control:** Control of any object, organism, or thing that
transmits disease from one host to another.

**Waterborne disease outbreaks:** Includes only outbreaks from
infectious agents and chemical poisoning incidents in which two or more
people experience a similar illness after consumption or use of water
intended for drinking and epidemiologic evidence implicates water as the
source of illness. The stipulation that at least two people be ill is
waived for single cases of laboratory-confirmed, primary amebic
meningoencephalitis and for single cases of chemical poisoning if
water-quality data indicate contamination by the chemical.

## References

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