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Environmental Policy and Public Health

Second Edition

Environmental Policy and Public Health

Second Edition

Barry L Johnson and Maureen Y Lichtveld

Taylor & Francis Group

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Library of Congress Cataloging‑in‑Publication Data

Names: Johnson, Barry L (Barry Lee), 1938- author | Lichtveld, Maureen Y., author.

Title: Environmental policy and public health / Barry L Johnson and Maureen Y Lichtveld.

Description: Second edition | Boca Raton : Taylor & Francis, 2017 |

“A CRC title, part of the Taylor & Francis imprint, a member of the Taylor &

Francis Group, the academic division of T&F Informa plc.”

Identifiers: LCCN 2017024274 | ISBN 9781498799393 (hardback : alk paper)

Subjects: LCSH: Environmental health Government policy United States |

Environmental policy United States | Medical policy United States.

Classification: LCC RA566.3 J64 2017 | DDC 362.10973 dc23

LC record available at https://lccn.loc.gov/2017024274

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About the Cover

The authors of this book intend the cover to speak about the book’s contents The centerpiece of the cover is planet Earth, as presented by a striking image from the National Aeronautics and Space Administration (NASA) Earth’s resources provide the basic essentials to sustain life on the planet: air, water, land, and energy Further, human life on our planet depends on healthful air, potable water, and safe sources of food Unfortunately, humankind has not always appreciated the essential nature

of Earth’s sustainable resources Arrayed on the cover are examples from the text of humankind’s mismanagement of air, water, and food resources, together with other environmental conditions that can affect human and ecosystem health The images arrayed around planet Earth pertain to climate change (polar bears), air pollution in a major Asian city, a point source of water pollution, devices for inhalation of tobacco products, food waste, plastic waste in the Pacific Ocean, the mosquito that carries the Zika virus, and an American bald eagle, a species saved from extinction, These images

on the cover presage the book’s description of specific environmental hazards and policies and practices purposed to prevent or diminish their deleterious effects on the residents of planet Earth.

This book is dedicated to those policymakers, scientists, medical investigators, environmental and public health agencies, nongovernmental organizations, and individuals who have advocated science-based environmental health policies that have led to human and ecosystem health protections and improvements in environmental quality Absent their dedicated efforts, our planet and its living organisms would be fewer in number and poorer in well-being.

Table of Contents

Preface xxv

Acknowledgments xxvii

Authors xxix

Section i: Policymaking Basics, Foundations, and Resources Chapter 1 Fundamentals of Environmental Health Policymaking 3

Chapter 2 Steps in Environmental Health Policymaking 25

Chapter 3 U.S Federal Government’s Environmental Health Structure 51

Chapter 4 General U.S Federal Environmental Statutes 85

Chapter 5 Global Environmental Health Programs and Policies 107

Section ii: Known environmental Hazards to Public Health Chapter 6 Climate Change 129

Chapter 7 Tobacco Products 159

Chapter 8 Air Quality 189

Chapter 9 Water Quality and Security 225

Chapter 10 Food Safety and Security 259

Chapter 11 Hazardous Chemical Substances 287

Chapter 12 Waste Generation and Management 317

Chapter 13 Environment-Related Infectious Diseases 351

Section iii: emerging Areas impacting environmental Health Chapter 14 Energy Production and Associated Policies 367

Chapter 15 Genetically Modified Organisms 383

Chapter 16 Biodiversity and Endangered Species 399

Chapter 17 The Built Environment 417

Section iV: influences on environmental Health Policymaking Chapter 18 Policy Impacts of Environmental Justice 435

Chapter 19 Policy Impacts of Risk Assessment 461

Chapter 20 Lessons Learned and Authors’ Reflection 481

Section V: Support Material

Appendix 1: List of Abbreviations 487

Appendix 2: List of Key Websites 489

Appendix 3: Glossary of Key Terms 491

Index 497

Contents

Preface xxv

Acknowledgments xxvii

Authors xxix

Section i: Policymaking Basics, Foundations, and Resources Chapter 1 Fundamentals of Environmental Health Policymaking 3

1.1 Introduction 3

1.2 Environmental Health Policy Framework 3

1.3 Key Definitions 5

1.3.1 Policy 5

1.3.2 Health 5

1.3.3 Public Health 5

1.3.4 Environment 6

1.3.5 Ecology and Ecosystem 6

1.3.6 Environmental Health 6

1.3.7 Politics 6

1.4 Evolution of Environmental Health 7

1.4.1 Historical Environmental Hazards 7

1.4.2 Necessities for Survival 7

1.4.2.1 Sanitary Waste Management 7

1.4.2.2 Potable Water 8

1.4.2.3 Healthful Air Quality 8

1.4.2.4 Food Security 8

1.4.2.5 Sustainable Environment 9

1.4.3 European Roots 9

1.4.4 Recent Trends 10

1.5 Nexus between Human and Ecological Health 11

1.6 Fundamentals of Public Health 11

1.6.1 Public Health Practice 13

1.6.1.1 Organizational Capacity 13

1.6.1.2 Workforce Competency 13

1.6.1.3 Information/Communication Capacity 14

1.6.1.4 Surveillance 14

1.6.1.5 Epidemic Investigation 14

1.6.1.6 Laboratory Science 14

1.6.1.7 Behavioral Science 15

1.6.1.8 Public Health Programs 15

1.6.2 Comparing Public Health Practice and Medical Practice 15

1.6.2.1 Benefits and Risks 16

1.6.2.2 Sociopolitical Factors 16

1.7 The Role of Government 16

1.7.1 U.S Federal Government 17

1.7.2 State Government 17

1.7.3 Local Government 17

1.7.3.1 Environmental Health Responsibilities 18

1.7.3.2 Case Study: DeKalb County, Georgia 18

1.8 Public’s Policy Expectations 19

1.8.1 Accountability 19

1.8.2 Communication of Risk 19

1.8.3 Cost–Benefit Analysis 19

1.8.4 Environmental Justice 20

1.8.5 Federalism 20

1.8.6 Polluter Pays for Consequences of Pollution 20

1.8.7 Prevention Is Preferred to Remediation 21

1.8.8 Product Safety 21

1.8.9 Public’s Right to Know 21

1.8.10 Risk Assessment 21

1.8.11 Social Support 22

1.9 Critical Thinking 22

1.10 Summary 22

1.11 Policy Questions 23

References 24

Chapter 2 Steps in Environmental Health Policymaking 25

2.1 Introduction 25

2.2 Influences on Environmental Health Policymaking 25

2.3 The Public’s Influence on Policymaking 26

2.3.1 Vested Interest Groups 27

2.3.2 Newsmedia, Internet Communications, and Social Media 27

2.3.3 Experts’ Input 28

2.3.4 Domestic Economic Policies 28

2.3.5 Free Trade Policies 29

2.3.6 Form of Governance 29

2.4 Establishing Environmental Health Policy 30

2.5 PACM Model 31

2.5.1 Pressure 31

2.5.2 Action 31

2.5.3 Change 32

2.5.4 Monitoring 32

2.6 Policies to Control Environmental Hazards 32

2.6.1 Command and Control 32

2.6.2 Alternatives to Command and Control 34

2.6.2.1 Litigation 35

2.6.2.2 Market Power 36

2.6.2.3 Performance Incentives 37

2.6.2.4 Precautionary Approach 37

2.6.3 Public Education 42

2.6.4 Sustainable Development 42

2.6.5 Voluntary Action by Private Sector Entities 45

2.6.6 Policy Cornucopia 45

2.7 Policy as a Means to Effect Public Health 46

2.8 Environmental Ethics 46

2.8.1 Ecoethics 47

2.8.2 Ethics of Organizations 47

2.8.3 Ethics of Individuals 47

2.9 Summary 48

2.10 Policy Questions 48

References 49

Chapter 3 U.S Federal Government’s Environmental Health Structure 51

3.1 Introduction 51

3.2 U.S Civics 101 51

3.2.1 Constitutional Basis of the U.S Federal Government 52

3.2.1.1 Legislative Branch 52

Contents

3.2.1.2 Executive Branch 53

3.2.1.3 Judicial Branch 54

3.3 Origins of U.S PHS and EPA 55

3.3.1 Emergence of the U.S Public Health Service 56

3.3.2 Department of Health, Education, and Welfare and DHHS 57

3.3.3 Role of PHS Surgeons General 58

3.3.4 Establishment of EPA 60

3.3.4.1 Societal Climate 61

3.3.4.2 Legislative Climate 61

3.3.4.3 Governance Climate 62

3.4 DHHS Agencies with Environmental Programs 63

3.4.1 Agency for Toxic Substances and Disease Registry 64

3.4.2 Centers for Disease Control and Prevention 65

3.4.2.1 National Center for Environmental Health 65

3.4.2.2 National Institute for Occupational Safety and Health 66

3.4.2.3 Office of Smoking and Health 67

3.4.3 Food and Drug Administration 67

3.4.3.1 National Center for Toxicological Research 67

3.4.3.2 Center for Tobacco Products 68

3.4.4 Indian Health Service 69

3.4.5 National Institutes of Health 69

3.4.5.1 National Cancer Institute 70

3.4.5.2 National Institute of Environmental Health Sciences 70

3.4.6 Office of the Assistant Secretary for Health, DHHS 71

3.5 Other U.S Federal Environmental Health Programs 72

3.5.1 Department of Agriculture 72

3.5.2 Department of Commerce 72

3.5.3 Department of Defense 73

3.5.4 Department of Energy 73

3.5.5 Department of Homeland Security 74

3.5.6 Department of Housing and Urban Development 74

3.5.7 Department of Interior 75

3.5.7.1 U.S Fish and Wildlife Service 75

3.5.7.2 Bureau of Land Management 75

3.5.7.3 U.S Geological Survey 75

3.5.8 Department of Justice 75

3.5.9 Department of Labor 76

3.5.10 Department of State 76

3.5.11 Department of Transportation 76

3.5.12 National Aeronautics and Space Administration 76

3.5.13 National Science Foundation 77

3.6 Administrative Procedures Act of 1946 77

3.7 U.S Federal Government’s Regulatory Programs 78

3.8 Summary 80

3.9 Policy Questions 80

References 81

Chapter 4 General U.S Federal Environmental Statutes 85

4.1 Introduction 85

4.1.1 Public Health Tradition 85

4.1.2 Fear of Catastrophic Events 85

4.1.3 Opportunistic Conditions 86

4.1.4 Confluence of Vested Interests 86

4.2 Regulations and Standards 87

4.3 Enforcement and Penalties 87

4.4 Public Health Service Act, 1912 87

4.4.1 History 88

4.4.2 Key Provisions of the PHSAct Relative to Public Health 88

4.5 National Contingency Plan, 1968 89

4.6 National Environmental Policy Act, 1969 89

4.6.1 History 89

4.6.2 Key Provisions of the NEPAct Relevant to Public Health 90

4.6.3 Public Health Implications of the NEPAct 91

4.7 Occupational Safety and Health Act, 1970 91

4.7.1 History 91

4.7.2 Public Health Implications of the OSHAct 92

4.7.2.1 Perspective 93

4.8 Consumer Product Safety Act, 1972 93

4.8.1 History 94

4.8.2 Key Provisions of the CPSAct Relevant to Public Health 94

4.8.3 Public Health Implications of the CPSAct 94

4.9 Noise Control Act, 1972 95

4.9.1 History 95

4.9.2 Public Health Implications of the Noise Control Act 95

4.10 Environmental Research and Development Demonstration Authorization Act, 1976 96

4.10.1 History 96

4.10.2 Public Health Implications of the ERDDAAct 97

4.11 Information Quality Act, 2001 97

4.11.1 History 97

4.11.2 Public Health Implications of the Information Quality Act 99

4.12 Public Health Security and Bioterrorism Preparedness and Response Act, 2002 100

4.12.1 History 100

4.12.2 Key Provisions of the Bioterrorism Preparedness Act Relevant to Public Health 100

4.12.2.1 Title I—National Preparedness for Bioterrorism and Other Public Health Emergencies 100

4.12.2.2 Title II—Enhancing Controls on Dangerous Biological Agents and Toxins 101

4.12.2.3 Title III—Protecting Safety and Security of Food and Drug Supply 102

4.12.2.4 Title IV—Drinking Water Security and Safety 102

4.12.2.5 Title V—Additional Provisions 102

4.12.3 Public Health Implications of the Bioterrorism and Preparedness Act 102

4.13 Pandemic and All-Hazards Preparedness Act, 2006 103

4.14 Summary 103

4.15 Policy Questions 103

References 104

Chapter 5 Global Environmental Health Programs and Policies 107

5.1 Introduction 107

5.2 United Nations 107

5.2.1 United Nations Environment Programme 108

5.2.1.1 The Basel Convention, 1989 109

5.2.1.2 UN Conference on Environment and Development, 1992 110

5.2.1.3 Convention on POPs, 2000 111

5.2.1.4 World Summit on Sustainable Development, 2002 111

5.2.2 World Health Organization 112

5.2.2.1 WHO’s Global Health Risk Factors 113

5.2.2.2 WHO’s Environmental Health Programs 115

5.2.3 International Labour Organization 115

5.2.4 Food and Agriculture Organization 116

5.2.5 United Nations Economic Commission for Europe 116

5.3 World Bank 117

5.4 World Trade Organization 118

5.5 European Union 119

Contents

5.5.1 European Environmental Agency 120

5.5.2 European Chemical Agency 121

5.5.3 European Food Safety Authority 121

5.6 Global Rankings of Environmental Status 121

5.7 Summary 122

5.8 Policy Questions 122

References 123

Section ii: Known environmental Hazards to Public Health Chapter 6 Climate Change 129

6.1 Introduction 129

6.2 Global Perspective 130

6.3 History of Global Climate Change Policies 133

6.3.1 Montreal Protocol on Substances That Deplete the Ozone Layer, 1987 134

6.3.2 Establishment of the Intergovernmental Panel on Climate Change, 1988 135

6.3.3 United Nations Framework Convention on Climate Change, 1992 135

6.3.4 Kyoto Protocol of the UNFCCC, 1987 136

6.3.5 The Marrakesh, Morocco, Accord, 2001 138

6.3.6 The Bali Action Plan, Bali, Indonesia, 2007 138

6.3.7 The Cancún, Mexico, Agreements, 2010 139

6.3.8 UN Climate Change Conference, Doha, Qatar, 2012 139

6.3.9 UN Climate Change Conference, Paris, France, 2015 140

6.4 Portent of Climate Change on Agriculture and Species Endangerment 141

6.5 Portent of Climate Change on Human Health 143

6.6 Portent of Climate Change on Ecosystem Health 144

6.7 Policy Issues 146

6.7.1 Overview of U.S Climate Change Policymaking 146

6.7.2 Obama Administration’s Policymaking on Climate Change 146

6.7.2.1 U.S Supreme Court Decisions 146

6.7.2.2 GHG Reporting Program, 2008 148

6.7.2.3 Climate Action Plan, 2013 148

6.7.2.4 Clean Power Plan, 2015 149

6.7.3 Global Policies on Climate Change 150

6.7.3.1 EU Climate Change Policies 150

6.7.3.2 China’s Climate Change Policies 151

6.7.4 Policy Frameworks for Mitigating Climate Change 152

6.7.4.1 Carbon Taxes and Emissions Trading Systems 152

6.7.4 2 Cap and Trade of GHGs 153

6.7.5 Policies on Climate Change Adaptation 155

6.7.6 The Public’s Role in Climate Change Policymaking 155

6.8 Hazard Interventions 155

6.9 Summary 155

6.10 Policy Questions 156

References 157

Chapter 7 Tobacco Products 159

7.1 Introduction 159

7.2 Précis History of Tobacco Use 159

7.3 Prevalence of Tobacco Products and Users in the U.S .161

7.3.1 Cigarettes: Adults and Youth 161

7.3.2 Other Tobacco Products 161

7.3.3 Electronic Cigarettes (e-Cigarettes) 163

7.4 Global Prevalence of Tobacco Products and Users 164

7.5 Associations between Use of Tobacco Products and Human Health 165

7.5.1 Cigarettes 165

7.5.1.1 Secondhand Tobacco Smoke 167

7.5.1.2 Thirdhand Tobacco Smoke 168

7.5.2 Other Tobacco Products 168

7.5.2.1 Cigars 168

7.5.2.2 Pipes 168

7.5.2.3 Smokeless Tobacco Products 169

7.5.3 Electronic Cigarettes 169

7.6 Associations between Use of Tobacco Products and Ecosystem Health 169

7.7 U.S Federal Policies on Tobacco Use and Control 170

7.8 State and Local Tobacco Policies 175

7.9 Private Sector Tobacco Policies 180

7.10 Global Control of Tobacco and Related Products 180

7.10.1 WHO Framework Convention on Tobacco Control, 2005 180

7.10.2 WHO Key Facts on Global Tobacco Control 181

7.10.3 European Union Directive on Tobacco, 2001 182

7.10.4 Tobacco Use in China 183

7.10.4.1 Factors Affecting Tobacco Use in China 184

7.10.4.2 Tobacco Control Progress in China 184

7.11 Hazard Interventions 184

7.12 Summary 185

7.13 Policy Questions 185

References 186

Chapter 8 Air Quality 189

8.1 Introduction 189

8.2 Sources of Emissions of Air Pollutants 190

8.3 Toxicology and Standards for Criteria and Other Key Air Pollutants 191

8.4 Global Prevalence of Air Pollution 192

8.4.1 Prevalence of Air Pollution in the U.S 193

8.4.2 Prevalence of Air Pollution in the EU 194

8.4.3 Prevalence of Air Pollution in China 194

8.4.4 Prevalence of Air Pollution in India 195

8.4.5 Global Indoor Air Pollution Prevalence 196

8.5 Associations between Ambient (Outdoor) Air Pollution and Human Health 197

8.5.1 Effects on Morbidity 197

8.5.2 Effects on Mortality 198

8.5.3 Effects on Children’s Health 199

8.6 Associations between Air Pollution and Ecosystem Health 201

8.7 Air Quality Monitoring Technology and Models 202

8.7.1 AQM Technology 202

8.7.2 Air Quality Modeling 203

8.7.3 Where Monitoring and Modeling Meet: Policy 203

8.8 Policies on Air Pollution Control 204

8.8.1 U.S Primary Policy: CAAct, 1955 204

8.8.1.1 History of the CAAct 204

8.8.1.2 Key Provisions of the CAAct Relevant to Public Health 207

8.8.1.3 EPA’s Air Quality Index 210

8.8.1.4 CAAct Regulations on GHGs 210

8.8.2 EU’s Policies on Air Pollution Control 211

8.8.3 China’s Policies on Air Pollution Control 215

8.8.4 India’s Policies on Air Pollution Control 216

8.9 Case Study: VW Corporation & Diesel Emissions, 2014–2016 216

8.10 Costs and Benefits of U.S Air Pollution Control 217

8.11 Global Economic Impact of Air Pollution 218

8.12 Hazard Interventions 218

Contents

8.13 Summary 219

8.14 Policy Questions 219

References 220

Chapter 9 Water Quality and Security 225

9.1 Introduction 225

9.2 Water Contamination and Security 225

9.3 Global State of Water Quality and Security 227

9.4 U.S Water Policies 229

9.4.1 The Clean Water Act, 1972 229

9.4.1.1 History 229

9.4.1.2 Clean Water Act Perspective 232

9.4.1.3 Key Provisions of the CWAct Relevant to Public Health 233

9.4.1.4 Associations between Contaminated Water and Human Health 234

9.4.1.5 Associations between Contaminated Water and Ecosystem Health 235

9.4.1.6 The EPA Water Quality Trading Policy, 2003 236

9.4.1.7 The EPA Clean Water Rule, 2015 236

9.4.1.8 Cost and Benefits of Water Pollution Control 237

9.4.2 The Safe Drinking Water Act, 1974 237

9.4.2.1 History 237

9.4.2.2 SDWAct Amendments 238

9.4.2.3 Key Provisions of the SDWAct, as Amended, Relevant to Public Health 239

9.4.2.4 EPA Drinking Water Requirements for States and PWS 242

9.4.2.5 Associations between Nonpotable Water and Human Health 242

9.4.2.6 Associations between Nonpotable Water and Ecosystem Health 243

9.4.2.7 Bottled Drinking Water 244

9.4.2.8 Case Study: Flint, Michigan, Water Crisis, 2014–2016 245

9.5 Global Water Pollution Policies 246

9.5.1 EU Water Pollution Policies 246

9.5.2 China’s Water Pollution Policies 248

9.5.3 India’s Water Pollution Policies 248

9.6 Global Water Security Policies 249

9.6.1 Climate Change’s Impact on Water Security 250

9.6.2 State of California’s Drought Policies 250

9.6.3 Water Security and Produced Water 251

9.6.4 Water Security and Gray Water 251

9.6.5 Water Security and Desalination 252

9.7 Improved Water Efficiency and Other Successes 252

9.8 Hazard Interventions 253

9.9 Summary 253

9.10 Policy Questions 254

References 255

Chapter 10 Food Safety and Security 259

10.1 Introduction 259

10.2 Food Safety and Security Policies 259

10.3 U.S Food Safety and Security Policies 260

10.3.1 U.S Food, Drug, and Cosmetic Act, 1906 260

10.3.1.1 History 260

10.3.1.2 Key Provisions of the FDCAct Relevant to Public Health 261

10.3.1.3 Public Health Implications of the FDCAct, as Amended 261

10.3.1.4 Associations between Unsafe Food and Human Health 263

10.3.1.5 Associations between Unsafe Food and Ecosystem Health 263

10.3.2 U.S Federal Meat Inspection Act, 1906 264

10.3.2.1 History 264

10.3.2.2 Public Health Implications of the FMIAct 265

10.3.2.3 Associations between Unsafe Meat and Human Health 266

10.3.2.4 Associations between Unsafe Meat and Ecosystem Health 266

10.3.3 Nutrition Labeling and Education Act, 1990 267

10.3.4 FDA Food Safety Modernization Act, 2011 267

10.3.5 USDA Food Security Policies 269

10.3.6 U.S State and Local Food Safety Policies 270

10.4 Global Food Safety and Security Policies 272

10.4.1 EU Food Safety Policies 272

10.4.2 Food Safety Policies in China 273

10.4.3 Food Safety Policies in India 274

10.4.4 U.S Global Food Security Act, 2016 274

10.5 State of Food Security in the U.S 275

10.6 Global State of Food Security 275

10.6.1 Threats to Food Security 276

10.6.1.1 Human Population Growth and Food Security 276

10.6.1.2 Food Waste 277

10.6.1.3 Climate Change 278

10.6.1.4 Loss of Pollinators 279

10.6.1.5 Soil Security and Arable Land 279

10.6.1.6 Genetically Modified Food 280

10.6.2 Resources for Enhancing Food Security 280

10.6.2.1 UN World Food Programme 280

10.6.2.2 Famine Early Warning Systems Network 280

10.6.2.3 Natural Resources Conservation Service 280

10.6.2.4 Required Agricultural Practices (Vermont) 281

10.7 Hazard Interventions 281

10.8 Summary 282

10.9 Policy Questions 282

References 283

Chapter 11 Hazardous Chemical Substances 287

11.1 Introduction 287

11.2 U.S Policies on Hazardous Chemical Substances 287

11.2.1 Federal Insecticide, Fungicide and Rodenticide Act, 1947 287

11.2.1.1 History 288

11.2.1.2 Key Provisions of the FIFRAct Relevant to Public Health 290

11.2.1.3 Associations between Pesticides and Human Health 290

11.2.1.4 Associations between Pesticides and Ecosystem Health 291

11.2.2 Federal Hazardous Substances Act, 1960 293

11.2.3 Toxic Substances Control Act, 1976 293

11.2.3.1 History 293

11.2.3.2 Key Provisions Relevant to Public Health 294

11.2.3.3 Amendments to the TSCAct 296

11.2.3.4 Public Health Implications of the TSCAct 296

11.2.3.5 Associations between Hazardous Substances and Human Health 297

11.2.3.6 Associations between Hazardous Substances and Ecosystem Health 301

11.2.4 Lautenberg Chemical Safety for the 21st Century Act, 2016 302

11.2.4.1 History 302

11.2.4.2 Key Provisions Relevant to Public Health 302

11.2.5 The Food Quality Protection Act, 1996 303

11.2.5.1 History 303

11.2.5.2 Key Provisions of the FQPAct Relevant to Public Health 304

11.2.5.3 Public Health Implications of the FQPAct 304

11.3 U.S Agencies with Hazardous Substances Policies 305

Contents

11.3.1 U.S Department of Labor 305

11.3.2 U.S Chemical Safety Board 305

11.3.3 National Toxicology Program 306

11.4 U.S State Policies on Hazardous Substances 306

11.4.1 State of California 306

11.4.2 State of Massachusetts 307

11.4.3 States’ Legislation on Consumers’ Right to Know 307

11.5 Global Perspective on Toxic Substances 308

11.5.1 EU Policies on Hazardous Substances 308

11.5.2 WHO Polices on Hazardous Substances 309

11.5.2.1 International Agency for Research on Cancer 309

11.5.2.2 International Programme on Chemical Safety 310

11.5.3 World Health Assembly’s Resolution on Chemicals Management, 2016 311

11.6 Hazard Interventions 312

11.7 Summary 313

11.8 Policy Questions 313

References 314

Chapter 12 Waste Generation and Management 317

12.1 Introduction 317

12.2 Policy Overview 317

12.3 U.S Resource Conservation and Recovery Act, 1976 318

12.3.1 History 318

12.3.2 Amendments to the RCRAct 321

12.3.3 Key Provisions of the RCRAct Relevant to Public Health 322

12.3.4 Associations between Solid Waste and Human Health 323

12.3.5 Associations between Solid Waste and Ecosystem Health 324

12.3.6 Illustrative State Solid Waste Act 324

12.3.6.1 Permits 324

12.3.6.2 Permit Revocation 324

12.3.6.3 Site Modification 325

12.3.6.4 Site Inspection 325

12.3.7 Policy Issues 325

12.4 Comprehensive Environmental Response, Compensation, and Liability Act, 1980 325

12.4.1 History 325

12.4.2 Key Provisions of the CERCLAct, as Amended, Relevant to Public Health 328

12.4.3 Associations between Uncontrolled Hazardous Waste and Human Health 330

12.4.4 Associations between Uncontrolled Hazardous Waste and Ecosystem Health 330

12.4.5 Successes and Criticisms of the CERCLAct 331

12.4.6 EPA’s Brownfields Program 332

12.5 Ocean Waste Pollution 332

12.5.1 U.S Policies on Maritime Pollution 333

12.5.1.1 Ocean Dumping Act, 1972 333

12.5.1.2 Act to Prevent Pollution from Ships, 1980 334

12.5.2 International Policies on Maritime Pollution 335

12.5.2.1 London Convention and Protocol, 1972 335

12.5.2.2 International Maritime Organization 335

12.5.2.3 EU Maritime Pollution Policies 335

12.6 U.S Oil Pollution Act, 1990 336

12.6.1 History 336

12.6.2 Public Health and Ecosystem Implications of the OPAct 336

12.7 U.S Pollution Prevention Act, 1990 337

12.7.1 History 337

12.7.2 Public Health Implications of the PPAct 338

12.8 Global Perspective of Waste Generation 338

12.8.1 Food Waste 338

12.8.2 Plastics Waste 339

12.8.2.1 Plastics as Solid Waste 339

12.8.2.2 Plastics in Oceans 340

12.8.2.3 Microbeads in Waste 341

12.8.2.4 Human Health and Ecological Effects of Plastics Waste 341

12.8.3 Electronic Products Waste 342

12.9 Waste Reduction: Recycling of Waste 342

12.9.1 Recycling Issues 343

12.9.2 Innovative Technology for Waste Reduction 343

12.9.3 The Circular Economy 344

12.10 Hazard Interventions 344

12.11 Summary 344

12.12 Policy Questions 345

References 346

Chapter 13 Environment-Related Infectious Diseases 351

13.1 Introduction 351

13.2 Infectious Diseases: A Global Perspective 351

13.3 The Environment and Infectious Diseases 351

13.3.1 Cholera 351

13.3.2 Typhus 352

13.3.3 Implications for Environmental Health Policy: Clean Water and Sanitation 353

13.4 Zoonotic Diseases and Human Health 353

13.4.1 H1N1 Global Pandemic 353

13.4.2 West Africa Ebola Epidemic 354

13.4.3 Implications for Environmental Health Policy: Quarantine and Public Health 355

13.5 Emergence of Vector-Borne Diseases 355

13.5.1 Mosquito-Borne Diseases 355

13.5.1.1 Malaria 355

13.5.1.2 Yellow Fever 356

13.5.1.3 Dengue 357

13.5.1.4 West Nile Virus 357

13.5.1.5 Chikungunya Virus 357

13.5.1.6 Zika Virus 357

13.5.1.7 Implications for Environmental Health Policy: Vector Control and Pesticides 358

13.5.2 Tick-Borne Diseases 358

13.5.3 Rodent-Borne Diseases 359

13.5.4 Implications for Environmental Health Policy 359

13.6 Tropical Infectious Diseases 360

13.7 Implications for Environmental Policy: Climate Change 360

13.8 Implications for Ecosystem Health 360

13.9 Hazard Interventions 361

13.10 Summary 361

13.11 Policy Questions 361

References 362

Section iii: emerging Areas impacting environmental Health Chapter 14 Energy Production and Associated Policies 367

14.1 Introduction 367

14.2 Précis History of U.S Energy Production Policies 367

14.2.1 Early History 367

Contents

14.2.2 Postwar Changes 36814.3 U.S Energy Production 36914.3.1 Introduction 36914.3.2 Influences on U.S Production and Policy 37014.3.3 Policy Instruments 37014.3.4 Sources of U.S Energy 37114.3.4.1 Fossil Fuels 37114.3.4.2 Renewable Energy Sources 37214.3.4.3 Nuclear Energy 37414.4 U.S Energy Policies 37514.4.1 Pipeline and Hazardous Materials Safety Administration 37514.4.2 Energy Policy Act, 2005 37514.4.3 State Renewable Portfolio Standards (RPS) 37514.5 Energy Production and Climate Change 37514.6 Global Implications 37614.6.1 China’s Energy Policies 37614.6.2 India’s Energy Policies 37614.6.3 Europe’s Energy Policies 37714.7 Associations between Energy Development and Human Health 37714.8 Associations between Energy Development and Ecosystem Health 37814.9 Hazard Interventions 37814.10 Summary 37814.11 Policy Questions 379References 380

Chapter 15 Genetically Modified Organisms 383

15.1 Introduction 38315.2 History 38415.3 Current GMO Prevalence and Practices in the U.S 38415.4 Current Global Prevalence of GMOs and Practices 38515.5 U.S Policies on GMOs and Practices 38515.5.1 U.S Coordinated Framework for Regulation of Biotechnology, 1986 38515.5.2 Cartagena Protocol on Biosafety, 2003 38615.5.3 U.S GMO Policy and Authorities 38715.5.3.1 U.S Food and Drug Administration 38715.5.3.2 U.S Department of Agriculture 38715.5.3.3 Environmental Protection Agency 38815.5.3.4 U.S National Environmental Policy Act 38815.5.3.5 U.S State Laws 38815.6 Global Policies on GMOs and Practices 38915.6.1 European Union GMO Policies 38915.6.2 GMO Policies in China 39015.6.3 GMO Policies in Brazil 39115.7 Labeling of Products Containing GMO Ingredients 39215.7.1 U.S Policies on Labeling of GMOs 39215.7.2 Industry’s Voluntary Labeling of GMO Products 39215.7.3 EU Policies on Labeling of GMOs 39315.7.4 Other Nations’ Policies on Labeling of GMOs 39315.8 Public’s Perceptions of GMOs 39415.9 Associations between GMOs and Human Health 39415.10 Associations between GMOs and Ecosystem Health 39515.11 Hazard Interventions 39515.12 Summary 39515.13 Policy Questions 396References 397

Chapter 16 Biodiversity and Endangered Species 399

16.1 Introduction 39916.2 History 39916.3 The Importance of Biodiversity 40116.3.1 Biological Services Performed by Ecosystems 40116.3.2 Economic Values 40116.3.3 Intrinsic Values 40216.4 U.S and Global Policies on Endangered Species and Biodiversity 40216.4.1 Marine Mammal Protection Act, 1972 40216.4.2 U.S Endangered Species Act, 1973 40216.4.3 Convention on International Trade in Endangered Species, 1973 40316.4.4 EU Directives on Species and Biodiversity 40416.4.4.1 EU Birds Directive, 1979 40416.4.4.2 The Habitats Directive, 1992 40516.4.4.3 The North American Bird Conservation Initiative, 1999 40516.4.4.4 Natura 2000 40616.4.4.5 EU Biodiversity Strategy 40616.4.5 Australia’s Environment Protection and Biodiversity Conservation Act, 1999 40716.4.6 Convention on Biological Diversity 40716.5 Current U.S Endangered Species Practices and Issues 40816.5.1 U.S Fish and Wildlife Service 40816.5.2 National Marine Fisheries Service 41016.5.3 EPA’s Responsibilities under the Endangered Species Act 41016.6 Species at Risk of Endangerment 41016.7 Successful Rescues of Endangered Species 41216.8 Associations between Endangered Species and Human Health 41216.9 Associations between Endangered Species and Global Ecosystem Health 41216.10 Hazard Interventions 41316.11 Summary 41416.12 Policy Questions 414References 415

Chapter 17 The Built Environment 417

17.1 Introduction 41717.2 Terms and Concepts 41717.2.1 Land-Use Policy Tools 41717.2.2 Land-Use Policy Actors 41817.3 History of U.S Planning Practices 41817.3.1 Industrialization and the Birth of a Movement 41917.3.2 U.S Federal Government’s Growth into Planning 42017.3.3 New Federalism and the Reemergence of Public Health 42117.4 Social Environment 42117.5 Policy Overview 42217.6 Current Practices and Issues 42217.7 Policies 42417.7.1 Health in All Policies 42417.7.2 Complete Streets 42417.7.3 Leadership in Energy and Environmental Design 42517.7.4 Other Built Environment Policies 42517.8 Global Perspective 42617.8.1 Europe’s Built Environment 42617.8.2 China’s Built Environment 42617.8.3 India’s Built Environment 42717.8.4 Seminal Issue of Selected Global Built Policies 42717.9 Associations between the Built Environment and Human Health 428

Contents

17.10 Associations between the Built Environment and Ecosystem Health 42917.11 Hazard Interventions 42917.12 Summary 42917.13 Policy Questions 430References 430

Section iV: influences on environmental Health Policymaking

Chapter 18 Policy Impacts of Environmental Justice 435

18.1 Introduction 43518.2 The Matter of Definition 43518.3 History 43718.3.1 Warren County, North Carolina, Protest, 1982 43718.3.2 Bullard’s 1990 Book and Thesis 43718.3.3 Five Key Conferences/Meetings 43818.3.3.1 University of Michigan’s Natural Resources Conference, 1990 43818.3.3.2 ATSDR Environmental Justice Conference, 1990 43818.3.3.3 First National People of Color Environmental Leadership Summit, 1991 43918.3.3.4 National Environmental Justice Conference, 1994 44018.3.3.5 Second National People of Color Environmental Leadership Summit, 2002 44018.3.4 Seven Seminal Studies 44018.3.4.1 GAO Study, 1983 44018.3.4.2 United Church of Christ Report, 1987 44118.3.4.3 Mohai and Bryant Study, 1992 44118.3.4.4 EPA Study, 1992 442

18.3.4.5 National Law Journal Study, 1992 444

18.3.4.6 Metzger et al Study of Environmental Hazards and Hispanics’ Health, 1995 44418.3.4.7 Maantay Study of Municipal Zoning Laws and Environmental Justice, 2002 44418.3.5 Demographics Investigations 44418.3.5.1 Hird Study, 1993 44418.3.5.2 Anderton et al Study, 1994 44518.3.5.3 Zimmerman Study, 1993 44618.3.5.4 GAO Study, 1995 44618.3.5.5 Been Study, 1995 44718.3.5.6 Heitgerd et al Study, 1995 44818.3.5.7 Oakes et al Study, 1996 44818.3.5.8 Anderton et al Study, 1997 44918.3.5.9 Baden and Coursey Study, 1997 44918.3.5.10 Carlin and Xia Study, 1999 45018.3.5.11 Davidson and Anderton Study, 2000 45018.3.5.12 Morello-Frosch et al Study, 2002 45018.3.5.13 Mohai and Saha Study of 2015 45018.3.6 Tabulation of Studies 45018.4 President Clinton’s Executive Order on Environmental Justice 45118.5 Global Perspective 45218.6 Poverty and Environmental Justice 45318.7 Tribal Issues of Environmental Justice 45318.8 Title VI of the Civil Rights Act, 1964 45418.9 NAACP Environmental and Climate Justice Program 45418.10 Perspective on Evolution of Environmental Justice 45518.11 Policy Implications of Environmental Justice 45618.12 Summary 45718.13 Policy Questions 457References 458

Chapter 19 Policy Impacts of Risk Assessment 461

19.1 Introduction 46119.2 Key Definitions and Abbreviations 46119.3 Evolution of Risk Assessment in the U.S 46219.4 U.S Federal Government’s Involvement 46319.5 Human Health Risk Assessment 46419.5.1 Methods for Quantifying Human Health Risks 46519.5.1.1 Traditional Regulatory Approach to Characterizing Noncancer Risks 46519.5.1.2 Regulatory Approaches to Characterization of Cancer Risks 46619.5.2 Case Study: Arsenic Risk Brouhaha 46719.5.3 What Is the Value of a Human’s Life? 46819.6 Ecological Risk Assessment 46919.7 Ecological Risk of Chlorpyrifos 47019.8 Occupational Injury Risk Assessment 47019.9 Other Applications of Risk Assessment 47119.9.1 Comparative Risk Assessment 47119.9.2 Risk-Based Corrective Action 47319.9.3 Data-Derived SFs 47419.10 Public Health Concerns about Risk Assessment 47519.11 Other Critics of Risk Assessment 47619.12 Summary 47719.13 Policy Questions 477References 478

Chapter 20 Lessons Learned and Authors’ Reflection 481

20.1 Introduction 48120.2 Summary of Lessons Learned 48120.3 Closure 484References 484

Section V: Support Material

Appendix 1: List of Abbreviations 487 Appendix 2: List of Key Websites 489 Appendix 3: Glossary of Key Terms 491 Index 497

Preface

Ten years have passed since this book’s first edition was

pub-lished Quoting from the Foreword in that edition, “We all

benefit from potable water, clean air, food safe to consume,

and sanitary disposal of wastes, all environmental conditions

that were goals of our ancestors.” Although a decade has

passed, these goals remain since they are intimately linked to

human survival and well-being But the passage of a decade

has resulted in considerable changes, issues, and challenges

that may attend the well-being of humankind, indeed, attend

the very survival of our planet These rather dramatic changes

have necessitated a second edition of Environmental Policy

and Public Health

As with the first edition, this second edition describes how

environmental health policies are developed, the statutes and

other policies that have evolved to address public health

con-cerns associated with specific environmental hazards, and

the public health foundations of the policies This edition

describes policies for what we consider the major

environ-mental physical hazards to human health Specifically, we

describe hazards from air, water, food, hazardous substances,

and wastes To this list we have added the additional concerns

from climate change, tobacco products, genetically modified

organisms, environment-related diseases, energy production,

biodiversity and species endangerment, and the built

environ-ment And as with the first edition, we describe histories of

policymaking for specific environmental hazards Our

expe-rience has shown us that knowledge of history gives a vital

perspective on how various societies have developed policies

to protect against specific environmental hazards History

imparts wisdom, and in absence of wisdom, we all have to

struggle

This edition differs from its antecedent in three significant

themes First, environmental hazards and their consequences

are a global issue and concern We have therefore added

global perspectives to chapters that describe specific

environ-mental hazards, e.g., air pollution Second, we acknowledge

that humankind exists in a complex ecosystem We therefore

provide narrative material wherever possible on the

conse-quences of environmental hazards on both human and

ecosys-tem health Moreover, we consider it essential to link human

and ecosystem health as fundamental branches of the same tree of well-being and sustainability Third, we have added material about interventions that policymakers and individu-als can consider in mitigating or preventing specific environ-mental hazards

This work can be grouped into five sections The first tion comprises five chapters that provide basic information and data on policymaking basics, policy foundations, and resources for policymaking The second section describes policies, issues, and health foundations for specific, known environmental hazards, including chapters on climate change, tobacco products, air quality, water quality and security, food safety and security, hazardous chemical substances, waste generation and management, and environment-related infec-tious diseases The third section comprises four chapters that are emerging areas of relevance to environmental health: energy production, genetically modified organisms, biodiver-sity and endangered species, and the built environment The fourth section contains policy impacts of environmental jus-tice, policy impacts of risk assessment, and lessons learned and the authors’ reflection The fifth section comprises a set of abbreviations, relevant websites, and a glossary of key terms

sec-An index is provided as the terminus

We intend this work to be useful to students in demic programs of public health, environmental science, and environmental policy and to persons concerned about environmental hazards and policymaking Moreover, we consider it important to have an appreciation of the history

aca-of environmental health’s evolution and legislative opment Policies and actions that help protect the public from the adverse consequences of environmental hazards did not appear without a considerable struggle; knowing this history is vital if the protections they bring are to be maintained

devel-We have used many published sources that have uted to the content of this book, but some content represents the experiences and views of its authors, whose public health careers in environmental and occupational health provide experienced perspective for understanding policymaking and associated efforts

Acknowledgments

The authors express their sincere appreciation to several

persons who reviewed drafts of the first edition and who

made significant improvements in its content In particular,

we express our appreciation to several graduate students

at the Rollins School of Public Health, Emory University,

who provided editorial comments Similarly,

environmen-tal health students at the Morehouse School of Medicine

and Georgia State University provided helpful

edito-rial suggestions for the first edition The authors further

acknowledge the involvement of two faculty colleagues at

the Department of Global Environmental Health Sciences,

Tulane University: Dr Christopher Mundorf for his

signif-icant contribution to the chapters on energy and the built

environment and Dr Diana Hamer for lending her expertise

to the infectious disease chapter We also acknowledge Dr Seth Ebersviller, University of Findlay, for his contributions

to the air quality chapter on air monitoring in the context of policy We also acknowledge the contributions of Morris L Maslia, Senior Environmental/Water Resources Engineer, Agency for Toxic Substances and Disease Registry, for his contributions to the preparation of select graphics in this book The authors also appreciate the thoughtful feed-back on the policy questions provided by Carlo Basilio, Shayna Goldfine, Rebecca Timmons, and Imani White, students of environmental policy in the Department of Global Environmental Health Sciences, Tulane University

Authors

Barry L Johnson, PhD, is an adjunct professor, Rollins

School of Public Health, Department of Environmental Health,

Emory University He was editor-in-chief of International

Journal of Human and Ecological Risk Assessment from

2000 to 2015 He earned a doctorate in biomedical

engineer-ing at Iowa State University Dr Johnson began his public

health career at the U.S Public Health Service (PHS) air

pol-lution program in Cincinnati, Ohio, conducting

neurotoxi-cology research on criteria air pollutants He continued this

research when the U.S Environmental Protection Agency was

created, later joined the National Institute for Occupational

Safety and Health as a research scientist and administrator

Dr.  Johnson completed his public health career as director

of the Agency for Toxic Substances and Disease Registry, an

agency created by the federal Superfund law He is an elected

Fellow (Emeritus), Collegium Ramazzini In 1999, he retired

from the PHS with the rank of rear admiral and joined the

faculty of the Department of Environmental Health, Rollins

School of Public Health, Emory University, codeveloping

a syllabus for environmental health policy He co-taught

the course from 2000 to 2012 Dr Johnson is the author of

Legacy of Hope (2016), Environmental Policy and Public

Health (2007), Impact of Hazardous Waste on Human Health

(1999), and senior editor of Hazardous Waste: Impacts on

Human and Ecological Health (1997), Hazardous Waste and

Public Health (1996), National Minority Health Conference

Proceedings (1992), Advances in Neurobehavioral Toxicology

(1990), and Prevention of Neurotoxic Illness in Working

Populations (1987) Dr Johnson resides in Atlanta, Georgia

Maureen Y Lichtveld, MD, MPH, is a member of the

National Academy of Medicine with over 35 years of

expe-rience in environmental public health She is professor and

chair of the Department of Global Environmental Health

Sciences, Tulane University, School of Public Health and

Tropical Medicine She holds an endowed chair in

environ-mental policy and is associate director of Population Sciences,

Louisiana Cancer Research Consortium Beginning in 1987, she has served for one of the highest-ranking Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry environmental health scientists engaged

in designing research tools and protocols guiding national environmental health studies in communities living near hazardous waste sites and science-driven policies, often accompanied by congressional testimonies Her national and global research focuses on environmentally induced dis-ease, health disparities, environmental health policy, disas-ter preparedness, public health systems, and community resilience Lichtveld has a track record in community-based participatory research with a special emphasis on examining the impact of chemical and nonchemical stressors on com-munities facing environmental health threats, disasters, and health disparities As director of the Center for Gulf Coast Environmental Health Research, Leadership, and Strategic Initiatives, Lichtveld serves as principal investigator of sev-eral Gulf Coast-associated environmental health research and capacity building projects ascertaining the potential impact of the Gulf of Mexico oil spill

Lichtveld is a member of the National Advisory Environmental Health Sciences Council of the Institutes of Health’s National Institute of Environmental Health Sciences; the U.S EPA Scientific Advisory Board; the National Academy of Sciences—Institute of Medicine Roundtable on Environmental Health Sciences, Research, and Medicine; and a member of the Health Disparities Subcommittee of the Advisory Committee to the director of the CDC She was

elected as chair of the editorial board of the American Journal

of Public Health and serves as the current president of the Hispanic Serving Health Professions Schools Lichtveld was inducted in the Johns Hopkins University Society of Scholars, honored as CDC’s Environmental Health Scientist of the Year, and twice named Woman of the Year by the city of New Orleans

Section I

Policymaking Basics, Foundations, and Resources

Health Policymaking

1.1 INTRODUCTION

Humankind’s journey through the ages has been difficult Our

primordial ancestors faced threats to their survival in a hostile

environment Wild carnivorous animals abounded and

natu-ral disasters such as forest fires and floods surely presented

grievous challenges to our ancestors Over time the nature of

the environmental hazards changed as humans passed from a

nomadic, tribal existence to a more communal lifestyle in small

villages and, later, large cites As humans huddled together in

increasingly larger numbers, health problems magnified in

both numbers and severity of disease Perhaps no greater health

calamity has befallen humankind than the bubonic plague (also

called the Black Death) There were three major pandemics of

the plague, occurring in the sixth, fourteenth, and seventeenth

centuries The death toll approximated 137 million victims

The pandemic of the fourteenth century was particularly

dev-astating, causing the death of 25  million people Ultimately,

the plague killed about one-third of Europe’s population over

a 5-year period, beginning in the year 1347 The plague was

eventually found to be caused by the bacterium Yersinia pestis,

which is spread by fleas that infest animals such as the black rat

[1] The plague, an example

of an extreme environmental health problem, illustrates the importance of environ-mental hazards as a public health concern

A healthy environment promotes healthful condi-tions necessary to sustain living creatures While this observation seems obvious, in practice, societies that

have developed vigorous agricultural and industrial bases

have found that pollution became a consequence of those

activities Air quality deteriorated, water purity diminished,

and lands became fouled by chemical and other hazardous

substances As biomedical research on the effects of

ronmental hazards progressed, it became evident that

envi-ronmental degradation was associated with adverse effects

on the health of human populations and ecosys-tems.* Before proceeding, two definitions are impor-tant: hazard and risk As

* Ecosystem—The interacting system of a biological community and its

nonliving environmental surroundings [3].

we will discuss in Chapter

19, the U.S Environmental Protection Agency (EPA) defines “hazard” and “risk”

as shown herein Although similar definitions are available elsewhere, the cited definitions are pur-poseful for use in this book

In response to concerns about environmental hazards, the federal, state, territorial, and local governments in the U.S have enacted various statutes meant to conserve the natu-ral environment, assure environmental quality, and protect human and ecological health Underpinning this effort are policies that shape the intent and implementation of the stat-utes This chapter presents an overview of key fundamentals that shape the development of environmental policy Included

in this chapter are a summary of how environmental health has evolved, the fundamentals of public health, the role of government in environmental health, and public policies of relevance to environmental health Moreover, how environ-mental policies have emerged in the U.S and other countries relevant to the practice of public health is also the focus of this book

1.2 ENVIRONMENTAL HEALTH POLICY FRAMEWORK

Environmental health policy comprises actions that are intended to eliminate the effects of exposure to environmen-tal hazards One way to consider this kind of policy is to con-sider its uses, users, and nonusers, yielding the following five considerations.†

Directness Some policies directly address environmental health Examples include the EPA‡ standards that regulate the levels of a contaminant in an environmental medium, e.g., lev-els of air pollutants in outdoor, ambient air Other policies are primarily environmental policies, without a health focus, but they indirectly affect human health or environmental qual-ity An example would include the National Environmental Policy Act, discussed in Chapter 4, wherein a national policy

of environmental protection is articulated And still other icies are not even environmental, but they incidentally have a

pol-† The authors express their gratitude to Dr Howard Frumkin, while at Rollins School of Public Health, Emory University, for this contribution.

‡ Lists of key definitions and abbreviations are found at the end of this book,

as is a glossary.

Policy: A definite course or

method of action selected

from among alternatives and

in light of given conditions

to guide and determine

present and future

directions [2]

Hazard: Potential for

radia-tion, a chemical or other

pollutant to cause human

illness or injury [3]

Risk: A measure of the ability that damage to life, health, property, and/or the environment will occur as a result of a given hazard [3]

prob-major impact on environmental health For example, national

energy policy has an impact on which motor vehicles and

heating fuels are used, which, in turn, can affect air quality

and therefore human health This book primarily addresses

those environmental health policies that most directly affect

human and ecosystem health, since they present a direct

course of action in controlling the adverse consequences of

environmental hazards

Level of government Environmental health policies span

the full spectrum of government This book gives emphasis

to U.S federal government policies, e.g., the Clean Water Act

and its attendant policies on controlling emissions of

contami-nants into bodies of water in the U.S However, state and local

governments also develop environmental health policies and

to enact legislation that addresses issues specific to a state’s

environmental conditions States enact statutes that are

nec-essary to comply with federal statutes and regulations For

instance, states will enact statutes and provide resources to

meet the provisions of the federal Clean Air Act (CAAct),

which stipulates specific requirements of states And local

governments establish environmental health policies through

ordinances, such as prohibitions on smoking of tobacco

prod-ucts in public facilities In general, environmental health

policies become more specific and targeted as they transition

from federal to state to local government

The federal preemption doctrine is important when issues

of disagreement occur between federal and state

policymak-ers, leading to seemingly conflicting policies These

disagree-ments usually find their way into the province of the judicial

system The preemption doctrine derives from the Supremacy

Clause of the Constitution, Article VI, which states that the

“Constitution and the laws of the United States […] shall be

the supreme law of the land […] anything in the constitutions

or laws of any State to the contrary notwithstanding.” This

means, of course, that any federal law—even a regulation of

a federal agency—trumps any conflicting state law Despite

the efforts of some states, even today, to “nullify” federal

laws of which they disapprove, few things in constitutional

law are any clearer than the fact that any such efforts by

states are grossly unconstitutional What remains as a much

more difficult question under Article VI is when a state law

or action, which is at least arguably consistent with federal

law, in fact creates sufficient conflict so as to justify finding

it “preempted” [4]

Preemption can be either expressed or implied When

Congress chooses to expressly preempt state law, the only

question for courts becomes one of determining whether the

challenged state law is one that the federal law is intended

to preempt Implied preemption presents more difficult issues

to courts, at least when the state law in question does not

directly conflict with the federal law The court then looks

beyond the express language of federal statutes to determine

whether Congress has “occupied the field” in which the state

is attempting to regulate, or whether a state law directly

con-flicts with the federal law, or whether enforcement of the state

law might frustrate federal purposes The matter of implied

preemption can be a thorny issue for courts to decide

Primary strategy Policymakers such as legislators and government officials have implemented several primary strategies into environmental health policy Some strategies directly aim to reduce the effects of hazards—some in a pro-spective manner (e.g., air pollution regulations), whereas oth-ers through retrospective action (e.g., cleanups of uncontrolled hazardous waste sites) Other policies do not directly regulate

a hazard, but provide information to the public about the ard, in effect relying on individuals to make informed health decisions This is a kind of laissez-faire approach to control-ling the effects of some environmental hazards Examples include health warnings on tobacco products; the Toxics Release Inventory, a public database compiled by the EPA

haz-on the compositihaz-on and amounts of pollutihaz-on released from industrial facilities; and workers’ right-to-know communica-tions under the Occupational Safety and Health Act (OSHA), wherein employers must provide employees with information

on workplace hazards

The prime actor in the policy There can be several prime actors in the development of environmental health policies While this chapter emphasizes the role of government as the prime actor, private parties can also play a significant role For example, the American Conference of Industrial Hygienists (ACGIH), a professional society, develops recom-mended exposure limits for substances found in workplaces Private industry uses the ACGIH exposure limits as voluntary guidelines for workplace controls when government stan-dards are not in effect Similarly, the International Standards Organization develops recommended guidelines that industry and some government agencies adopt As discussed later in this chapter, individuals can be prime actors in helping estab-lish an environmental health policy through litigation against

a government agency or a business Consider the example of a person who litigated a restaurant chain when a cup of very hot coffee spilled on her legs while driving The coffee’s temper-ature was sufficiently high to cause severe burns Litigation compensated the woman for her injuries and also contributed

to the restaurant chain’s voluntary decease in the temperature

of the coffee served throughout the restaurant chain As a sequence, one person’s litigation contributed to control of an environmental hazard that was potentially faced by millions

con-of people

What does not get regulated This chapter focuses on cies that relate to regulations and standards as the primary means to control environmental hazards Not described are important environmental issues for which regulatory poli-cies do not exist Examples of nonregulated environmental hazards include indoor air of domiciles, which is not covered under the federal CAAct and tobacco products for which product labeling is required, but product safety (i.e., sales of tobacco products) is not regulated These examples illustrate that unregulated environmental hazards can present deleteri-ous impacts on the public’s health

poli-Developing policy, according to our chosen definition, must involve the identification of alternatives that might be applied to specific situations From the alternatives, poli-cymakers involve the affected public to determine the best

Fundamentals of Environmental Health Policymaking

alternative, communicate their decision to interested parties,

and apply the policy when future circumstances arise where a

response must be based on policy

1.3 KEY DEFINITIONS

In order to understand and appreciate the complexities of

establishing and maintaining environmental health policy, we

need to have a common understanding of words and phrases

A common vocabulary is essential if communication and

debate over environmental health policies are to occur in any

productive manner Some might say that meanings of words

and phrases such as policy, health, public health,

environ-ment , ecology and ecosystem, environmental health, and

poli-tics are obvious and well known This is not the case, however,

because meanings of words reside in individuals themselves,

not in any inherent properties of words themselves Differences

in how people understand words occur because of variations

in individuals’ cultural backgrounds, educational levels, home

and business environments, and situational-specific set-tings As aids to understand-ing meanings of words, dictionaries help us achieve partial common agreement

on words’ meanings, but even they must use more words in

order to define meanings of specific words

We can approach a common understanding of a word or

phrase by accepting a definition chosen from a credible source

(e.g., a dictionary) and then discussing the definition within

the group needing a common definition (e.g., a group of

stu-dents) With this approach in mind, the definitions are

pro-posed for key words and phrases pertinent to discussions of

environmental health policy

1.3.1 P olicy

Policy : A definite course or method of action selected from

among alternatives and in light of given conditions to guide

and determine present and future directions [2] More to

the point of this book, policy is also defined as a plan that

embraces the general goals and acceptable procedures in

gov-ernmental action [2] Effective policymaking normally will

require choices among alternatives and will be based on

con-ditions at hand In a sense, making environmental health

pol-icy is no different from making family or business policies

Many families choose as a matter of policy to budget their

expenditures For businesses, some adopt a policy to service

all customer complaints within a specified period of time

In both examples, alternatives were surely considered and a

course selected to guide future actions

Developing policy, according to our chosen definition,

must involve the identification of alternatives that might be

applied to specific situations From the alternatives,

poli-cymakers (e.g., a legislative body, tribal council, or parent)

determine the best (applying stated criteria) alternative,

com-municate their decision to interested parties, and apply the

policy when future circumstances arise whose response must

be based on policy

1.3.2 H ealtH

Health : A state of complete physical, mental, and social

well-being and not merely the absence of disease or infirmity [5] This definition comes from the widely respected World Health Organization (WHO), headquartered in Geneva, Switzerland WHO is a component of the United Nations (UN) and its research, reports, and services are widely accepted by health agencies worldwide It provides technical assistance and resources globally on programs of human health, including preventing the spread of AIDS, polio, and infectious diseases Among its many contributions to global human health, WHO led the campaign against smallpox as a global scourge to human health, announcing in 1981 that the disease had been eradicated globally

By the WHO’s definition, a healthy individual, group, or population is free of physical and mental disease and infir-mity, as well as being in a state of social well-being As indi-viduals, the absence of conditions such as bodily injury, cancer, heart disease, depression, or paranoia either is obvious

or can be diagnosed by a medical provider Less obvious in

WHO’s definition of health is what is meant by social

well-being, certainly an altruistic component of the definition But

what might be intended by WHO? Several examples reflective of social well-being could include ade-quate housing, education, income, and living condi-tions; freedom from war, malnutrition, political abuse, and poverty; and ability to par-ticipate in political systems and public policymaking

1.3.3 P ublic H ealtH

Public health : The process of mobilizing local, state, national,

and international resources to solve the major health lems affecting communities [6] This definition, one of several

prob-in existence, is appealprob-ing for use prob-in a text on tal health policy This is because environmental hazards and problems are often community-based, increasingly global, and due to their complexity require multiple resources for risk management and problem solution Moreover, this defini-tion of public health implies that major health problems must take priority over those of lesser consequence Increasingly, risk assessment,* as described in Chapter 19, is a tool used by environmental health specialists to separate major hazards to human and ecological health from those of lesser importance.Public health can be understood as meaning “the public’s health.” Unfortunately, the U.S public has an unclear concept

environmen-* Risk assessment—Qualitative and quantitative evaluation of the risk posed to human health and/or the environment by the actual or potential presence and/or use of specific pollutants [3].

Meanings of words reside in

people, not in any

inher-ent property of words

themselves

The fundamental ciple of public health is the prevention of disease and disability

prin-of what public health agencies do and what their programs

accomplish, and often associate the term public health

pri-marily as being health services for indigent persons In

real-ity, the spectrum of U.S public health programs and services

encompasses such efforts as global vaccination and other

pro-grams, national programs of childhood immunization, cancer

research, mental health programs, lead exposure prevention,

disease surveillance, medical education, and funding for local

health centers Local health departments conduct such

pro-grams as restaurant inspections, vector* control, sanitation

programs, immunizations, and activities to prevent the spread

of infectious and chronic diseases From these examples, one

can appreciate the broad impact of public health programs on

the U.S public

1.3.4 e nvironment

Environment : The circumstances, objects, and conditions by

which one is surrounded [2] As an example, consider a

stu-dent’s classroom environment Circumstances of a stustu-dent’s

environment could include an assigned seat in the classroom,

thus placing the student in the same location for all class

ses-sions Another circumstance could be whether the class was

required or optional, which could determine which classroom

the student occupies Objects in a student’s classroom

envi-ronment could include other students, desks, tables, video

equipment, and such Conditions of the environment could

include ambient air temperature, barometric pressure, relative

humidity, lighting intensity, and noise levels

1.3.5 e cology and e cosystem

Ecology : The relationship of living things to one another

and their environment, or the study of such relationships

Ecosystem : The interacting system of a biological

commu-nity and its non-living environmental surroundings [3] An

example of an ecosystem would be the interacting system of

students, faculty, administrative personnel, trees, streams,

wildlife, and other biological communities within a college

campus On a larger scale, the Great Lakes region can be

defined and administered as an ecosystem

1.3.6 e nvironmental H ealtH

Environmental health : Comprises of those aspects of human

health, including quality of life, that are determined by

physi-cal, chemiphysi-cal, biologiphysi-cal, social and psychosocial factors in

the environment It refers also to the theory and practice of

assessing, correcting, controlling, and preventing those

fac-tors in the environment that can potentially affect adversely

the health of present and future generations [7] This verbose

definition is no doubt the product of a committee However,

it bears the imprimatur of the WHO, which adds credibility

and importance to the definition Note that this definition is

* Vectors are living organisms that can transmit infectious diseases between

humans or from animals to humans.

specific to human health and, like WHO’s definition of health, includes mention of physical, chemical, and social factors The second half of WHO’s definition expresses the elements

of both hazard assessment and risk management Noteworthy

in the definition is mention of quality of life, a subjective term

But given the overall environmental context of the definition,

quality of life could include examples such as the adverse psychological consequences of living near a foul-smelling industrial facility or by living in a metropolitan area where a major highway has been constructed through a formerly well-established neighborhood, thereby exposing residents to more noise and air pollutants and fracturing social relationships due to neighbors’ relocation

Remarkably, the WHO’s definition is but one of many existing definitions of environmental health One source col-lected 26 different definitions [8], which suggests insufficient effort has been given to achieving a consensus definition for use by environmental health specialists Given increasing global commitment to reducing the impact of environmental hazards (e.g., the Kyoto Protocol to reduce greenhouse gases (Chapter 6), which are chemicals that have the potential to increase global warming), a plea for a common definition needs action

There is an alternative definition for the phrase

environ-mental health that gives emphasis to the word environmental

[9] In this definition, environmental health refers to the health

of the environment, that is, considerations of environmental quality, ecosystems’ well-being, and conservation of natural resources For example, in this context, one could speak about the environmental health of equatorial ecosystems as affected

by deforestation and human population growth

1.3.7 P olitics

Politics : (a) The art or science of government, (b) political

affairs or business, (c) the total complex of relations between people living in society [2] Although most people associate politics with politicians and government, in fact, politics occur within families, businesses, civic organizations, schools, and other societal structures In all of these examples, politics must incorporate dialog, debate, negotiation, and, ultimately, compromise among the interested parties

Politics permeates the development and execution of ronmental health policy Some persons may have a negative opinion of politics and politicians because the practice of politics necessarily involves negotiation and compromise, and some politicians have been poor examples of ethical behavior Thus, to associate a somewhat unwholesome opinion of poli-tics with an altruistic image of public health might seem con-tradictory to some persons Moreover, if public health is about preventing disease and disabilities in human populations, should not something so important “be above” politics? The answer, of course, is no Politics involve relationships among people, and the core of public health rests with people How public health departments reach out to the public is a matter of politics, involving communication, negotiation, and compro-mise Further, government public health organizations must

Fundamentals of Environmental Health Policymaking

compete with other ment programs for budgets, personnel allocations, and operational authorities—all

govern-of which necessitates cal acumen and wisdom

politi-This collection of definitions of policy, health, public

health , environment, ecology and ecosystem,

environmen-tal health, hazard , risk, hazard evaluation, risk assessment,

and politics will help us better understand the development of

environmental health policy in the U.S and attendant actions

resulting from specific policies

1.4 EVOLUTION OF ENVIRONMENTAL HEALTH

An understanding of the evolution of environmental health is

necessary for an appreciation of modern environmental

pol-icy After all, as the Spanish-American philosopher George

Santayana [10] commented, “Those who cannot remember

history are condemned to repeat it.” As discussed in this

sec-tion, humankind long ago learned the importance of potable

water and proper disposal of human wastes, perhaps

dat-ing to the time of the Neolithic Revolution, which occurred

during the period 8000–7000 BCE [11] During this period

humankind began changing from a hunter-gatherer society to

a society that relied on agriculture and domesticated animals,

forming small tribal settlements in the process In fact, it can

be asserted that modern public health has its historic roots

in what we now call environmental health Later, as human

populations increased, clean air and safer food supplies were

added to the environmental health agenda Much of

mod-ern environmental health policy and practice in the U.S has

roots in nineteenth century Europe, as will be subsequently

discussed

1.4.1 H istorical e nvironmental H azards

The struggle by humans to overcome environmental problems

is certainly not new Archaeological research has revealed

that some ancient civilizations developed ways to dispose of

human wastes and to provide water to their expanding cities

As described by the public health historian George Rosen [11], archaeologists have found ancient ruins where bathrooms, flushing toilets, and water gutters were present (Table  1.1), some dating to 2100 BCE The geographical diversity of these ruins is impressive—extending from northern India to the Incas in South America Notable is the presence of water supply systems developed by the two major early European cultures: Greek and Roman Both civilizations built elaborate systems of aqueducts and canals to bring water to the expand-ing cities of Athens and Rome, respectively

The environmental health resources listed in Table 1.1 illustrate humankind’s search for more healthful living condi-tions Such conditions, then and now, include living with an ample, potable supply of water to meet daily needs and for sanitary disposal of human wastes Maintaining these systems

of water supply and waste disposal are constant challenges to modern policymakers because of increases in human popula-tions and global climate change The former puts added pres-sure on water resources and sewage systems; the latter will change geographic patterns of rainfall and land use

1.4.2 n ecessities for s urvival

Humankind’s prosperity over the ages can be attributed to many factors, but surely meeting basic human survival needs must be the foremost factor For human life to exist there must

be healthful air, potable water, and secure food Absence of any of these three is a death sentence Another survival need

is the sanitary disposal of human wastes, since improper agement connotes disease and illness Moreover, the envi-ronment must be sustainable if survival is to continue The following sections overview the evolution of humankind’s means to address these five basic survival challenges, pre-sented in order of their likely historic development

man-1.4.2.1 Sanitary Waste Management

There is, of course, no precise date in antiquity that cates humankind’s awakening to the health hazards of their environment But there were certainly environmental

demar-All successful politics must

include discussion,

nego-tiation, and, ultimately,

compromise

TABLE 1.1

Environmental Health Resources before the Common Era

India: Indus Valley and Punjab 2100 BCE Bathrooms and drains found in excavated buildings

Egypt: Middle Kingdom 2100–1700 BCE Water gutters found in excavated city

Source: Rosen, G., A History of Public Health: Expanded Edition, The Johns Hopkins University Press, Baltimore,

MD, 1993.

BCE, before Common Era.

challenges faced by cave dwellers and other prehistoric

peo-ples Carnivorous animals, natural disasters, and emerging

human diseases all surely took their toll on our earliest

ances-tors However, one could postulate that diseases produced by

unsanitary environmental practices and humankind’s

man-agement of them could be called our first environmental health

experience More specifically, improved sanitation

manage-ment of human wastes was a most important environmanage-mental

health advancement as encampments grew into villages and

then into cities Too often human wastes were deposited into

the residential environment, contaminating drinking water

supplies Cholera and dysentery were grievous outcomes of

consumption of impure water

Attempts to improve basic sanitation practices began

during the middle ages in Europe In the early middle ages,

sanitary household practices were primitive to say the least

According to one source [11], “In much of medieval Europe,

sanitation legislation consisted of an ordinance requiring

homeowners to shout, ‘Look out below!’ three times before

dumping a full chamber pot into the street.” Because many

houses were multistoried, dumping chamber pots literally

caused a rain of human wastes on persons on the streets

below There the waste lay until rain washed it away to be

deposited in lower lying areas or waterways Later, larger

cit-ies began building sewers and reducing human wastes left on

streets Practices in China probably preceded anything done

elsewhere For instance, in rural China, “night wastes” have

for centuries been routinely collected and used as fertilizer

for crops and land, resulting in top soil thickness measured in

feet, not inches as in the U.S As to the earliest environmental

health intervention, some public health historians might

attri-bute that to John Snow’s removal of a pump handle in London,

thereby preventing public access to a community water well

contaminated with fecal coliform bacteria, which Snow

asso-ciated with an ongoing cholera epidemic [12]

In more modern times, the U.S has enacted federal statutes

that control the levels of contaminants that can be released

into water supplies and for management of human wastes

These are described in Chapters 9 and 12

1.4.2.2 Potable Water

Water quality was, and remains, an environmental health

problem of great concern to many human populations Over

time, exposure to human wastes found in water gradually

decreased by moving latrines, public toilets, and isolated

priv-ies away from such water supplpriv-ies as wells, springs, lakes,

and flowing streams Some of these changes occurred when

armies formed themselves into encampments Military

lead-ers knew the health importance of constructing latrines and

requiring their use by troops As a consequence, one can

imagine troops returning to small villages with some

experi-ence on how to better manage the disposal of human wastes

In the U.S., as migration of immigrants increased in

num-bers, villages and cities sought better ways to protect their

water supplies In contrast, persons who lived on farms and

in rural areas had to depend on wells, springs, and surface

waters as sources of drinking water For both urban and rural

dwellers, avoidance of biologically contaminated water tainly was of concern, but without the population knowing how to protect themselves Indeed, as discussed in Chapter 9, sanitary practices and water contamination first came within the province of public health authorities in the early part of the twentieth century Local sanitation authorities became involved with construction of sanitary sewers and location

cer-of waste facilities The emergence cer-of city and county health departments occurred in the twentieth century Sanitarians soon became integral members of local health departments

1.4.2.3 Healthful Air Quality

As cities grew in size and complexity, air pollution resulting from burning coal for industrial purposes and for home heat-ing became another environmental problem In Europe and the U.S., coal burning created huge amounts of carbonaceous particulates that darkened the environment, fouled the air, and lowered the quality of life The consequences of air pollu-tion on environmental quality and public health are described

in Chapter 8 Suffice it to say here that death to residents of Donora, Pennsylvania, in 1948 and London, England, in 1952 from exposure to episodes of highly polluted air had a major influence on enactment of U.S federal clean air legislation In more recent times, emissions from industrial plants and from motor vehicles powered by internal combustion engines have become of public health concern, as described in Chapter 8, where other adverse public health effects of air contaminants are discussed

1.4.2.4 Food Security

Food, of course, is vital for human survival In Colonial America and well into the twentieth century, food was pro-duced by farmers and ranchers In villages and cities, food was purchased at local markets and prepared at home for consumption Foodborne illness was primarily the responsi-bility of those who prepared food As the U.S passed from

an agrarian society into an industrial economy, food was increasingly produced by large agricultural enterprises, and imported supplies of food increased in volume and variety As food sources became less familiar to consumers, food safety concerns increased

Perishable food was a special problem for consumers Methods were developed for canning vegetables, fruits, and some meat products Canning involved placing cooked food into sterile, sealed containers, a process that killed microor-ganisms, thereby lessening the possibility of food poisoning Other preservation methods included sun drying of some foods and the use of preservatives such as salt and the smoke from wood fires These methods reduced the amount of moisture in the treated foods and thereby inhibited the growth of micro-organisms But technological breakthrough needed to occur before perishable foods could be stored in large quantities for appreciable lengths of time The invention of refrigeration equipment and its widespread distribution were responsible for increasing food safety Beginning in the 1930s, perishable food could now be shipped in refrigerated trucks, stored in refrigerated warehouses, and sold to stores and restaurants for

Fundamentals of Environmental Health Policymaking

placement in freezers and other refrigerated equipment The

public’s health was improved by this technology However, as

will be discussed in Chapter 10, food safety and security

con-cerns remain a major public health problem, given the large

number of foodborne illnesses that occur annually in the U.S

and globally

1.4.2.5 Sustainable Environment

Having access to adequate sources of air, water, food, and

methods of waste disposal is necessary for survival, but access

itself does not guarantee long-term survival if the access is not

sustainable Sustainability is the ability to continue a defined

behavior indefinitely In this instance, the defined behavior is

survival Consider the defined behavior of animals that rely

on only one source of food If the sole food source

disap-pears, so must those that depend on its availability The giant

panda, whose sole food source is bamboo, and koala, whose

only food source is eucalyptus trees, can exist only as long as

the sustainability of sources of bamboo and eucalyptus trees,

respectively Humankind’s survival ultimately also relies on

a sustainable environment Herman Daly, one of the early

pioneers of ecological sustainability, looked at the problem

from the perspective of maintenance of natural capital He

proposed in 1990 that:

1 For renewable resources, the rate of harvest should

not exceed the rate of regeneration (sustainable

yield);

2 [For pollution] The rates of waste generation from

projects should not exceed the assimilative capacity

of the environment (sustainable waste disposal); and

3 For nonrenewable resources the depletion of the

nonrenewable resources should require

compa-rable development of renewable substitutes for that

resource [13]

Daly’s list gives emphasis to the importance of humankind’s

management of both resources as well as waste disposal

Chapter 2 will discuss sustainable development, a policy with

a focus different from that of sustainable environment

1.4.3 euroPean roots

Modern environmental health systems and practices in the

U.S generally derive from those developed in mid-

nineteenth-century Europe, although this attribution may wrongly be

based on of our lack of knowledge about conditions in other

parts of the world The evaluation of public health

aware-ness and the sanitary movement in Europe in the early to

mid-1800s had common roots: industrialization, unsafe and

unhealthful working conditions, inadequate sanitation in

crowded cities, and persons of vision who were committed

to improving the public’s health These conditions were most

evident in England, France, and Germany

One source asserts that the devastating bubonic plague

(also called the Black Death) that ravaged the globe during the

mid-fourteenth century gave rise to the initial development of

public health [14] He notes, “The Black Death also played a major role in the birth of public health One early innovation

in the field was the municipal health board, such as those in Florence and Venice established in 1348 to oversee sanita-tion and the burial of the dead Later the boards would grow more sophisticated In 1377 Venice established the first pub-lic quarantine in its Adriatic colony of Ragusa (modern day Dubrovnik).” It is interesting to note that to some extent what

we now call public health has some of its roots in kind’s struggle with a notorious pandemic plague

human-In early nineteenth century England, the enclosure of mon lands had the deleterious social consequence of creat-ing huge numbers of rural poor Their numbers exceeded the capacity of the country’s existing relief system for the poor These newly impoverished families migrated to the nascent emerging industrial cities, where work, often hazardous and exploitive of children, was available [11] Whole families were often crammed into dank basements and cellars, with inad-equate or nonexistent sanitary facilities

com-As workplace and community living conditions in England continued to worsen, social and health reformers emerged Principal among them was Edwin Chadwick The New Poor Law Act of 1834 created a new labor market, facilitating the immigration of the rural laboring poor into the harsh real-ity of urban factory work [11] Chadwick had been a primary author of the 1834 act Later, in 1842, he and colleagues pub-

lished the influential Report on the Sanitary Conditions of the

Labouring Population of Great Britain The report became the seminal work that reformed public health in England Chadwick and others were convinced that prevention of epi-demic disease, e.g., cholera, was less costly to the English economy than treating the consequences of unabated disease The English model of disease prevention through improved living conditions and sanitary reforms found favor in France and Germany and later also influenced public health policy

Commencing in 1841, with the passage of labor legislation regulating child labor in factories, a body of law and senti-ment gradually emerged in support of a public health system

in France The outstanding figure in the French public health movement was Louis René Villermé, known for his study of textile workers’ health, who aroused public opinion about haz-ardous workplace conditions [11] Earlier, in 1828, Villermé had published a report showing that mortality and morbidity rates were closely related to living conditions across social classes Later, in 1848, a French law created a network of local