Health Effects of Air Pollution: Some Historical Notes

Environmental Health Perspectives Vol. 81, pp. 129-130, 1989 Commentary Health Effects of Air Pollution: Some Historical Notes by James L. Whittenberger* As I understand the objectives of this symposium, they are at least 2-fold: to describe some of the advances in the environmental health sciences in the past 40 years, and to acknowledge some of the roles of the Institute of En- vironmental Medicine in these scientific advances. This is a pleasant task and the occasion for a happy anniver- sary celebration. In my comments on air pollution, I expect to emphasize what is known to all of you-that environmental health sciences differ significantly from other health sciences in the extent to which they are intertwined with important public policy issues; in fact, the directions and progress of environmental health science research are often driven by public policy concerns and needs. The history of the Environmental Medicine Institute and the career of Nor- ton Nelson are full of examples of these science/policy in- teractions. Before 1948, which is approximately the founding date of the Institute, there was very little interest in air pol- lution as a cause of adverse health effects in this country. There was concern about dusts and other chemicals in the workplace, but so far as outdoor pollution was thought about, it was largely a question of pathologists speculat- ing whether the carbonaceous appearance of postmortem lungs of city dwellers might have influenced the fre- quency of pneumonia or other respiratory diseases. That picture changed rapidly after the lethal episode of air pollution in Donora, PA, and the severe episodes observed in London in 1952. By 1957 the U.S. Public Health Service had organized an air pollution division in the Bureau of State Services and started a program of health effects research, as well as training programs in universities to increase the number of people qualified to assess and regulate air pollution. The government-funded training lasted for only a few years, but the research on all aspects of community air pollution, including health ef- fects, has expanded greatly and is still going strong. When the Public Health Service started the health ef- fects of air pollution research program in the mid-1950s, *Community and Environmental Medicine, Southern Occupational Health Center, University of California, Irvine, CA 92717. it understandably set up an advisory committee of ex- perts from universities, and Norton Nelson was a found- ing member. I am not sure that was his first air pollution health effects committee assignment, but I know that through countless subsequent committees, commissions, task forces, and other advisory bodies, Nelson has played a key role in charting the course of health effects research ever since, in this country and internationally. This is not the time or place to talk about alternative air pollution control strategies, but the strategy followed in this country has important implications for the qual- ity and quantity of specific information about health ef- fects of air pollutants. This follows from the strategy that air quality for specific chemicals must be regulated, and the standards for quality should depend primarily on ad- verse human health effects at low levels of exposure. All scientific information relating to standards and health ef- fects are evaluated and published in Criteria Documents. In the early days of Public Health Service programs, the Air Pollution Division had a tendency to overempha- size the health effects of air pollution. Their public infor- mation office once put out a booklet, the cover of which showed people choking, gasping for breath, and collaps- ing in the streets. Even Donora never had scenes like that. The Agency's first Criteria Document, for sulfur di- oxide, seemed to have been written to alarm people, rather than to inform them. The document implied that drastic curtailment of use of high sulfur fuels would be required to save citizens from the toxic effects of sulfur dioxide. When staff members of the Bureau of the Budget (predecessor of OMB) saw the document they were stag- gered by the potential cost of regulating sulfur dioxide, and they asked for a review by the Office of Science and Technology. Ivan Bennett of NYU was then Deputy Di- rector of the Office, and he presided over a meeting of consultants to review the first sulfur dioxide criteria document. After it was proudly presented by the head of the Air Pollution Program, it was thoroughly criticized by the consultants, including Nelson. Subsequently the document was withdrawn. After that early experience, the successor agencies have progressively improved the quality of Criteria