My name is Alan S. Peterson M.D., Emeritus Director ofEnvironmental and Community Medicine ofLancaster General Health. I am representing my family as well as those generations yet to come. I am in full support ofthe EPA's proposed standardto decrease carbon pollution and help decrease climate change. This needs to be implementednow and without any weakening amendments. There are many personal reasons that Ifeel this way, as well as professional ones. I myselfhave asthma which is getting significantly worse as I live in Lancaster County, Pennsylvania. The American Lung Association has listed Lancaster County with a grade of"D" with our "particle pollution 24-hour". An article last yearinLancet Oncology 2013; DOl: 10. 1016/Sl474-2045 (13) 7927 9-1 synthesizes data from 17 cohorts studies in 9 European countries. They found that risk exists even when the levels ofparticulate matter air pollution were belowthe current European limit values. They found no threshold belowwhich there was no risk. There is no reason to think that the study would have a different outcome in the United States. Itis one ofthe largest studies ofits kind, including data on more than 300,000 individuals and 2,095 lung cancer cases with a median follow-up of 12.8 years. Even thoughthe lung cancerrisk associated withair pollutionis much lower than that associatedwith smoking, the editorialist points out that everybody is exposedto air pollution; therefore, the public health effect is quite large. The World Health Organization has estimatedthat air pollution caused 1.2 million deaths and 8% oflung cancerworldwide in 2004. For every increase of5 meg per cubic meter ofPM2.5pollution, the risk for lung cancer increasedby 18%, and for every increase of I0meg per cubic meter in PM10 pollution, the risk increased by 22%. The risks were even higher for specific adenocarcinomas of the lung. This new study overcame several limitations ofprevious air pollution studies and benefited from a high follow-up rate and adjustment ofpotential confounders, including a set ofsmoking variables. Ibelieve this article is very important in our significant ongoing accumulation ofscientific research literature demonstrating the significant risks ofparticle pollution from the burning ofcoal and other fossil fuels. Additional new research from the Journal ofGerontology: Series 8, on-line June 6, 2014, links cognitive (intellectual) decline in older adults. The authors state that based on the

Page 1 of2results, improvements in air quality may be an important strategy for reducing agerelated cognitive decline. There has been in the past some evidence that people living in more polluted areas have greaterrates ofcognitive decline and the link is not explained by wealth orother social factors. They gatheredinformation in this study from one wave ofa large ongoing survey started in 1986. They focused their analysis on780 participants who were 55 years ofage and older at the time ofthe 2001/2002 survey. Cognitive function was measured by math and memory tests. Air pollution levels for each participant's neighborhood were calculated using fine particulate levels reported by the EPA's Air Quality System. The emerging evidence showing a link between airpollutionand cognitive function suggests airpollution may harm the brain as well as the heart andthe lungs. They felt that the most important actionto take is one we take as a society, by regulating the amount of pollutionthat gets emittedinto our air. We need to continueto attemptto reduce air pollutionby reducing the burning ofcoal and petroleum products in our atmosphere. Once again I give my full support for the proposed standard and thank the EPA for the opportunity to be heard. Dr. Alan Peterson, ASPeters@lghealth.org

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