I 

Mona Sarfaty, MD MPH, EPA Hearing, 07/31/14 

Respected EPA panelists and fellow citizens. My name is Mona Sarfaty. I am a 

physician trained in family medicine and public health; I have taught students in medicine and 

public health for over 35 years. I am here today to speak in favor of EPA clean power proposal 

and regulation of new power plants. For the last 10 years, I have been an Associate Professor in 

the Department of Family and Community Medicine at Thomas Jefferson University in 

Philadelphia. During this time, I have been actively involved in efforts to improve the quality of 

health care as part of the Pennsylvania Chronic Care Initiative and a follow-on national initiative 

funded by the Center for Medicare and Medicaid. Primary care practices from across the state 

have worked together to improve outcomes from chronic medical conditions by strengthening 

their team structures, approaches, and use of evidence based care. Medical care institutions are 

under increasing pressure to show improved quality outcomes by reducing emergency room use, 

hospitalizations, and other outcomes in part because of the significant percentage of the national 

budget that we spend on chronic diseases--especially heart disease, lung disease, and diabetes. 

But better outcomes not only require improved health care systems; they require clean air in a 

healthful environment. 

The greenhouse gases that are coming from power plants are accumulating in our 

atmosphere and contributing significantly to the problem. Warmer weather caused by this 

accumulation is increasing ground level ozone formation while simultaneously lengthening the 

pollen season by 10 to 24 days depending on latitude. This ozone forms when heat and light act 

on volatile organic compounds that come from power plants as well as from vehicles and other 

minor sources. (Activities like mowing the lawn with a gasoline powered mower or the dry 

cleaning process can add a little.) Once formed, the ozone spreads easily and is an irritant to the 

lungs. The irritated lungs become far more vulnerable to other factors. Pollen is also a lung 

stressor and causes allergic reactions in many people. Small particles in the air which also come 

from power plants, or the smoke from vehicle exhaust and forest fires, or the ambient dust and 

drought are also having an adverse effect on the lungs. The combination of ozone, pollen, and 

small particles is a triple threat to the large and growing number of people who have asthma, 

chronic lung disease, or heart disease. Children and older persons are also especially vulnerable. 

Two cases of teenagers with asthma illustrate this triple threat. 

• Case I comes from a pediatrician on the West Coast in the East Bay near San 

Francisco who has observed an unusually large number of new allergy 

patients this year. In May/June 2014, during hot and very dry weather against 

a background of dusty drought, a teenage patient developed uncontrolled 

asthma for the first time. This 17 year old girl had played soccer all her life 

despite well controlled intermittent asthma. Earlier allergy testing for this 

young lady had indicated pollen allergy. At the time of the attack she 

received prolonged treatment. She had to stop playing soccer and was sent for 

specialty care which recommended a new continuous treatment regimen with 

multiple medications. Happily, with the new regimen, she was able to return 

to playing soccer. 

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Mona Sarfaty, MD MPH, EPA Hearing, 07/31114 

• Case 2 comes from a pediatrician in Atlanta, Georgia on the East Coast. She 

introduced me to an 18 year old African American patient of hers who told her 

own story. At age 15, she moved from Terra Haute, Indiana to Atlanta, 

Georgia to live with her Aunt after her mother passed away. In Terra Haute, 

she was a high school athlete, playing 5 sports (soccer, basketball, dancing, 

cheerleading, and track). But the air quality in Atlanta was poor in 

comparison to Terra Haute and she developed asthma. The pollen season 

around Atlanta caused yellow pollen dust to blanket the ground, and get into 

her hair and onto her clothing. She had to stop outdoor activity, take multiple 

medications, and was able to play only I sport (indoor volleyball). Asthma 

attacks were more problematic during pollen season and when ozone levels 

were high. The American Lung Association State of the Air Report Card 

shows elevated particle and ozone levels for the Atlanta area. 

Both of these cases illustrate the triple threat of ozone, pollen and particulates that 

originate with the rising temperatures caused by carbon pollution and the ongoing output of 

ozone and particle pollutants from power plants. At Jefferson's family medicine practice in 

Philadelphia, the common wisdom was that all the patients who moved to Philadelphia 

eventually developed asthma, a cough, or allergies. This observation could be made about many 

areas of the country and is supported by real trends in the development of disease. Between 

1980 and 1995, the U.S. asthma rate doubled from 3% to 6%. By 2009, it had risen to 8% 

overall, and 9.5% for children. In many inner City school systems, 20% of the school children 

have asthma. This is a startling development and global warming caused by carbon pollution 

and conditions that result from warming and from pollution emitting power plants play a major 

causative role. But the problems do not begin and end with asthma. There is significant 

evidence that worsening of heart disease and chronic lung disease is caused by this same set of 

factors and leads to medical visits including ER visits and hospitalizations and even mortality. 

An MIT study report that appeared recently in the journal Atmospheric Environment put specific 

numbers to the toll in mortality. Based on state and local monitoring of air quality, there were 

200,000 deaths that occurred in the U.S. in the course of2005 because of polluted air. 1 Of these, 

52,000 were attributed to the poor air created by power plants emissions. They estimated 5 73 

deaths in Philadelphia due to electric power generation, and nearly 3864 in the state. With better 

regulated cleaner and more efficient power generation leading to cleaner air these lives might be 

saved. Missed days from school or work, emergency room visits, and hospitalizations could be 

fewer. The perils of inaction are very real as are the benefits of taking action. The human 

misery that is caused by these conditions and the societal cost that accrues are real. The effort of 

all medical institutions is undermined when air quality report card show poor grades. 

A colleague of mine participated in an asthma project in Philadelphia called Allies 

Against Asthma. The project was a collaboration involving Jefferson's physicians, various local 

hospitals, and elementary schools. Several other cities were conducting similar activities. The 

project arranged to have school nurses coordinate with hospital emergency rooms to identifY and 

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Mona Sarfaty, MD MPH, EPA Hearing, 07/31114 

work with families of asthmatic children to help them use every technique available to protect 

the children from asthma. But, the reality is that the quality of the air in many counties in our 

state does not meet the safer standards of the EPA and contributes disproportionately to poor 

health outcomes. We must address carbon and other pollution and protect the health of the 

people who live in Pennsylvania and the rest of the country. While there is a tremendous amount 

that modern medicine can offer, the improvement that comes from health care will not 

compensate for poor air quality. Poor air quality must be addressed at its source. Pennsylvania 

has some of the most seriously polluting coal fire power plants in the nation. The particulate 

matter, ozone, and other air pollutants that are generated by these plants belch into the air and 

threaten the lung function of people who are exposed to them. The medical literature is full of 

publications from this country and from foreign countries demonstrating that cleaner air leads to 

improvement in health status for people with lung conditions and chronic diseases. 

We must take this opportunity to make progress because we still have a long road to 

travel. If energy efficiency and public health guide our decisions, we will be on sounder footing 

as we go forward. Knowledge and the technology have advanced to the point where significant 

improvements are possible. The time to make these advances is right now. Thank You. I 

appreciate your attention to this presentation and your work on this vital public health issue. 

1 Caiazzo, eta!. Atmospheric Environment ; 79 (20 13): 179-208 

Mona Sarfaty, MD MPH 

Director, Program on Climate and Health 

Center for Climate Change Communication 

George Mason University 

(703) 993-2086 

240-338-7255 (cell) 

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