/ PUBLIC HEALTH lIBRARY H”? 22 p, t2 REPORT ON ENVIRONMENTAL HEALTH PROBLEMS/x I HEARINGS SUBCOMMITTEE OF THE / COMMITTEE ON éLPPROPRIATIONSI L HOUSE OF REPRESENTATIVES EIGHTY—SIXTH CONGRESS SECOND SESSION ” SUBCOMMITTEE ON DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE. AND RELATED AGENCIES APPROPRIATIONS JOHN E. FOGARTY, Rhode Island, Chairman WINEmED K. BENTON. Indiana MELVIN R. LAIRD, Wisconsin FRED MARSHALL. Minnesota ELFORD A. CEDERBERG, Michigan Rosin M. Morris, Stat Assistant to Subcommittee __ ' Printed for the use of the Committee on Appropriations umv F311 I’m“? % Aurormm 4‘1. REPORT ON ENVIRONMENTAL HEALTH PROBLEMS HEARINGS BEFORE THE SUBOOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS HOUSE OF REPRESENTATIVES EIGHTY-SIXTH CONGRESS SECOND SESSION SUBCOMMITTEE ON DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE, AND RELATED AGENCIES APPROPRIATIONS JOHN E. FOGARTY, Rhode Island, Chairman WINFIELD K. DENTON, Indiana MELVIN R. LAIRD, Wisconsin FRED MARSHALL, Minnesota ELFORD A. CEDERBERG, Michigan ROBERT M. MOYER, Stafi Assistant to Subcommittee Printed for the use of the Committee on Apprqpriations SE UNITED STATES GOVERNMENT PRINTING OFFICE 52946 WASHINGTON : 1960 \‘ COMMITTEE ON APPROPRIATIONS _ I CLARENCE CANNON, Missouri, Chairman GEORGE H. MAHON, Texas HARRY R. SHEPPARD, California ALBERT THOMAS, Texas MICHAEL J. KIRWAN, Ohio W. F. NORRELL, Arkansas JAMIE L. WHITTEN, Mississippi ‘ GEORGE W. ANDREWS, Alabama JOHN J. ROONEY, New York J. VAUGHAN GARY, Virginia JOHN E. FOGARTY, Rhode Island ROBERT L. I". SIKES, Florida PRINCE H. PRESTON, Georgia OTTO E. PASSMAN, Louisiana LOUIS C. RABAUT, Michigan SIDNEY R. YATES, Illinois FRED MARSHALL, Minnesota JOHN J. RILEY, South Carolina JOE L. EVINS, Tennessee JOHN F. SHELLEY, California EDWARD P. BOLAND, Massachusetts DON MAGNUSON, Washington WILLIAM H. NATCHER, Kentucky DANIEL J. FLOOD, Pennsylvania WINFIELD K. DENTON, Indiana TOM STEED, Oklahoma HUGH Q. ALEXANDER, North Carolina ALFRED E. SANTANGELO, New York JOSEPH M. MONTOYA, New Mexico GEORGE E. SHIPLEY, Illinois . JOHN TABER, New York fl BEN F. JENSEN, Iowa H. CARL ANDERSEN, Minnesota WALT HORAN, Washington GORDON CANFIELD, New Jersey J IVOR D. FENTON, Pennsylvania GERALD R. FORD, JR.., Michigan HAROLD C. OSTER’I‘AG, New York FRANK T. BOW, Ohio CHARLES RAPER JONAS, North Carolina MELVIN R. LAIRD, Wisconsin ELFORD A. CEDERBERG, Michigan GLENARD P. LIPSCOMB, California \ JOHN J. RHODES, Arizona JOHN R. PILLION, New York PHIL WEAVER, Nebraska WILLIAM E. MINSHALL, Ohio KEITH THOMSON, Wyoming ROBERT H. MICHEL, Illinois SILVIO O. CONTE, Massachusetts ' KENNETH SPRANKLE, Clerk and Staff Director - II R/l/l #33 /%0 PUBLIC HEALTH 1.1mm H 1’ REPORT ON ENVIRONMENTAL HEALTH PROBLEMS TUESDAY, MARCH 8, 1960. WITNESSES DR. LEROY E. BURNEY, SURGEON GENERAL, PUBLIC HEALTH SERVICE ABEL WOLMAN, PROFESSOR OF SANITARY ENGINEERING, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD. DR. HERMAN HILLEBOE, COMMISSIONER OF HEALTH, NEW YORK STATE DEPARTMENT OF HEALTH, ALBANY, N.Y. DR. BOISFEUILLET JONES, VICE PRESIDENT AND ADMINISTRATOR OF HEALTH SERVICES, EMORY UNIVERSITY, ATLANTA, GA.- DR. NORTON NELSON, ASSOCIATE PROFESSOR OF INDUSTRIAL MED- ICINE, NEW YORK UNIVERSITY, NEW YORK CITY DR. ROLF ELIASSEN, PROFESSOR OF SANITARY ENGINEERING, MASSACHUSETTS INSTITUTE OF TECHNOLOGY, CAMBRIDGE, MASS. ' HERBERT BOSCH, PROFESSOR, SCHOOL OF PUBLIC HEALTH, UNI- VERSITY OF MINNESOTA, MINNEAPOLIS, MINN. DR. ROSS A. McFARLAND, PROFESSOR OF ENVIRONMENTAL HEALTH AND SAFETY, SCHOOL OF PUBLIC HEALTH, HARVARD UNIVERSITY, BOSTON, MASS. DR. JAMES L. WHITTENBERGER, HARVARD SCHOOL OF PUBLIC HEALTH, BOSTON, MASS. MILTON P. ADAMS, EXECUTIVE SECRETARY, MICHIGAN STATE WATER RESOURCES COMMISSION, LANSING, MICH. STATEMENT OF THE CHAIRMAN Mr. FOGARTY. The committee will come to order. Today we are holding a special hearing on the problems of environmental health. The committee over the past several years has become increasingly concerned about the environmental health situation and what is being done about it. We have questioned Witnesses exhaustively, but we feel that the picture is so involved and its complexities are mounting so swiftly that we do not have a clear understanding of the Whole situation. COMMITTEE REQUEST FOR STUDY AND REPORT Last year, the committee requested the Public Health Service to make a thorough study of environmental health problems and of the most efficient organization of facilities to meet these needs. We asked that the committee have an opportunity to study it before holding hearings on the 1961 budget. ~ (1) 914 ' 2 In making this request, the committee stated: Over the past several years a number of environmental factors affecting health have become increasingly significant. The development 'of industrial processes and industrial products has taken place at a rate so rapid that direct and indi- rect effects on the health of the worker, the user of the processed product, and the general environment have not been adequately evaluated. The considerably expanded use and diversity of sources of radioactive products is a technical development of particular significance to health. The continued growth of gigantic metropolitan complexes has created special problems related to com- municable disease, problems of mental health, and, to a certain extent, has made it increasingly difficult to deliver health services. Related to the growth of metropolitan areas and the expansion of industrial production are the in- creasing problems of air and water pollution and their effects on the health of the population, which are at present inadequately understood. COMIMENTS 0N REPORT The committee has received and reviewed the Public Health Serv- ice’s environmental health report. We are impressed with its analysis of Service programs and its description of the background of the host of health problems in the area of environment. We are disappointed, however, that it is most unspecific as to recommendations both for program expansion and for financing. In short, it does not give us what we need and what we hoped to get in order to act intelligently on the 1961 budget for environmental health activities. For this reason, we determined to hold this hearing and to ask a group of Federal and non-Federal authorities in the field to consider with us all of the problems, to help us define the appro- priate role of the Federal Government and an effective organizational \‘ structure to carry out that role. We realize this is a unique procedure for the committee, but the matter at hand is sufficiently urgent to war- rant unique action. Our expert witnesses this morning will be: Surgeon General Leroy E. Burney of the Public Health Service and a group of outstanding experts in the field from outside the Federal government. One thing came very clear to the committee in our critical unit-by- unit examination of Public Health Service programs. Too little is being done and too little is being planned to give the people of this country adequate protection against the increasing health hazards of our changing environment. The comprehensive report which the Surgeon General sent forward to the Congress documents that con- clusion. But in the 1961 budget proposals there is little more than token evidence of affirmative action. The administration from time to time views the situation with alarm, but refuses to admit that worry and concern without action will get us nowhere. We have got to know more about the health hazards of our environ- ment and we have got to do more to bring them under control. I am talking about the whole long list of environmental health problems—- pollution of air and of water by new and increasing quantities of chemicals, of the new and growing dangers of radioactivity, of occupa- tional health hazards, of the problems accompanying the develop- ment of large urban areas, of noise, of accidents. , DESIRABILITY OF ORGANIZATIONAL CHANGES The committee wonders whether some realinement of. responsibility within the Service might not help in giving greater viability to some 3 important but currently obscure programs and in bringing the whole environmental health field into a more closely knit area. I was interested, for example, in this statement on the subject which is con- tained in the report. 1. , To a large extent— the report reads— i the programs and activities developed by the Public Health Service for dealing with recognized environmental hazards are carried out each somewhat indepen- dent of the other, in response to specific urgencies. This has resulted in a loose grouping of related but independently treated problems, programs, and activities associated With the essential elements of our surroundings—the water we drink, the air we breathe, the food we eat, the shelter which protects us—or with action taken by man in pursuit of a fuller life—his occupation, recreation, transportation, social organization. The committee is glad to learn that the Public Health Service is now reviewing the present structure of all its governmental health pro- grams and activities toward the end of regrouping them into a balanced whole. Certainly, this type of organization would permit a more rapid and more effective assault on the environmental problems, among others, that are growing by leaps and bounds while the administration con- tinues to pursue its business-as-usual policy. It would be of consider- able help in getting us answers to the essential questions: What is the actual Size and extent of the environmental health problem? How far behind are we? What will it take to get it under control before it is too late ? FACTORS CONTRIBUTING TO THE PROBLEM Let’s take a quick look at some of the major elements of the task confronting us. When in the space of 50 years you more than double the population, concentrate two-thirds of it in urban communities, increase the num- ber of automotive vehicles from about 1,000 to 70 million, and multiply total industrial production by 900 percent, you are bound to have en- tirely new environmental problems. As a matter of simple arithmetic, that is what has happened in the United States. 'Some of the figures on our chemical environment are really astound- ing. My scientist friends tell me there are more than 500,000 distinct chemical compounds in use in industrial production today, while 20 years ago there were only a few hundred. In addition, they say, up- ward of 10,000 new compounds are being developed ’in laboratories each year, and a substantial number of these are put to use. These same scientists report equally astounding figures in other areas. They say, for example, that over 600 chemicals are added to the food we eat; that more than 600 million pounds of chemical pesticides are used annually in the United States, with significant amounts reach- ing our dining tables by route of fruits and vegetables. Even more startling figures they give me—unknown billions of tons of wastes are discharged each year into the rivers and streams which provide drink- ing water for most of the population. No one yet has collected national figures to give an estimate of the total tons of air pollutants, but the Los Angeles area alone reports that some 3,400,000 pounds of hydro- carbons are discharged into the atmosphere every day. 'Scientists also warn that all of us are affected to some extent by noise, vibration, speed, excessive light, high altitude flight, and other 4', physical stresses. And each time one reads the newspapers, new dangers and the self-destructive potentials of manmade sources of radiation seem to have increased and multiplied. RATE OF PROGRESS IN SOLVING PROBLEMS Our major concern is that we know so little and are doing even less about these environmental problems. Surely, what we are doing is being done far too slowly. In water pollution control, for example, where there is sufficient scientific information to make possible a good dent in the pollution problem, we are moving at a snail’s pace. The pollution of the interstate waters of the New York Harbor area is a disgrace to the richest nation on earth. Raw sewage, garbage, and in- dustrial wastes from stockyards and slaughterhouses continue to pol- lute the great Mississippi and Missouri. The Merrimac River, which runs between New Hampshire and Massachusetts, 'has been polluted for over a hundred years; and the Androscoggin in New Hampshire and Maine has been described as the most polluted river of its size in America. For at least 10 years it has been common knowledge that the Animas, one of the tributaries of the Colorado River, was con— taminated by radioactive wastes from uranium milling operations in the area. Yet it was only within the past few months that anything has been done about it. All of the areas I have outlined for you in this brief review merit, in our opinion, our greatest attention. We are looking to you experts for your suggestions and recommendations as to how we should pro- ceed from here, and in what direction we should move. We are well aware that for a variety of reasons, including possible limitations on personnel, we may not be able to move on all fronts simultaneously. If this should be the case, we want your help and counsel in deter- mining the areas of most pressing need and in planning for a coor- dinated all-out approach to the health problems arising from the en- vironment as fast as it is possible. SURGEON GENERAL’S REPORT ON ENVIIIONlVIENTAL HEALTH We will place the full text of the Surgeon General’s report in the record at this point. (The report referred to followsz) ENVIRONMENTAL HEALTH (The Surgeon General’s Report to the House Committee on Appropriations, Public Health Service, Department of Health, Education, and Welfare, . January 1960) SUMMARY Health activities designed to control biological agents of disease are so inter- woven with our everyday lives, our structure of Government services, and our economic systems, as to be taken for granted by the average citizen, although public health experts are aware that gaps still exist in the available controls of some of these biological hazards. In addition, over the past several decades, significant and growing nonbio- logical health hazards have arisen. Our increased use of materials and products is attended by increasing quantities of potentially toxic substances in the limited physical dimensions of man’s environment. The use of energy and the mechan- ization of processes and services produce additional hazards of noise, other .\, 5 physical forces, and accidents. The diverse and growing beneficial uses of nu- clear energy are producing a whole new spectrum of hazards to health, both for present and for succeeding generations. While the biological hazard in the environment normally assaults the individ- ual in discrete and separate instances, the chemical and physical hazards come more often in intermittent or continuous doses through a variety of vehicles. It is the total and cumulative exposure of the individual to ionizing radiations that is important no matter how the separate components reach him. Of no less concern is the total exposure to chemical toxicants through air, water, and food. Social factors also contribute new hazards to the environment. Increasing ' urbanization, the growth and coalescence of large metropolitan complexes, and new patterns of living compound the sources of environmental hazards and concentrate the people affected by them. Growing public concern about air and water pollution, food additives and toxic residues, and radiation exposure has, in some cases, led to demands for con- trol actions for which scientific rationale does not now exist. To a large extent, the programs and activities developed by the Public Health . Service for dealing with recognized environmental hazards are carried out each somewhat independent of the other, in response to specific urgencies. This has resulted in a loose grouping of related, but independently treated problems, programs, and activities associated with the essential elements of our surround- ings—the water we drink, the air we breathe, the food we eat, the shelter which protects us—-or with action taken by man in pursuit of a fuller lifLL-his occupation, recreation, transportation, social organization. But the many complex interrelationships among these problems have become increasingly apparent, and it is imperative that they be considered as parts of a whole. Awareness of such interrelationships is essential to an orderly and efficient development of programs to meet present and future hazards in the environment. For the most part, official responsibility in the United States for environmental health services and activities properly rests with the level of government closest to the people which is capable of performing the function. Thus the local com- . munity, supplemented and aided by the State when necessary, is the first line of defense. The Federal Government, in turn, exercises certain interstate func- tions and assists the States by financial grants-in-aid, technical assistance, re- search, and training of personnel. The role of industry in the control of environ- mental health hazards is increasing. Among agencies of the Federal Government and of the Nation, the Public Health Service is unique in the number and scope of its responsibilities in the field of environmental health. Such activities are carried en in all three of its operating bureaus, but primarily in the Bureau of State Services. The admin- istration of these activities now presents a number of organizational problems with respect to interagency and internal coordination, staffing, laboratory fa- cilities, and appropriations structure. Over the next decade, social and economic forces will increase the potential of environmental health hazards. The challenge to public health is to make comprehensive assessment of the interacting effects of these hazard: and to apply preventive measures and controls to eliminate or minimize their damage. There will be major growth in expenditures by State and local governments and by industry for facility construction and operation, and for other controls. The Public Health Service is faced particularly with the need for an expanded pro- gram of research, training, and technicalservices. The need for a high level organizational unit to carry out the environmental health mission of the Public Health Service is apparent. Within such a unit, there must be strong professional leadership, an integration of biomedical and engineering activities, and as close a relationship as possible between operational and investigatory groups. In addition to an expanded intramural research program, there should be an extensive extramural program. All of the working mechanisms of the Public Health Service—direct operations, grants, contracts— must be available for all of the environmental health programs. Establishmentof environmental health as the theme of a major organiza- tional unit poses difficult questions with respect to the assignment of precise functions and the relationship of such a unit to other parts of the Public Health Service. The growing functions of the Service in other important areas of activity require a comprehensive organizational examination. Final recom- 6 mendations on the administrative structure of an environmental health unit will be made upon the completion in the late spring of a report on the overall missions and organization of the Public Health Service. BACKGROUND In June 1958‘, a panel of consultants on medical research and education to the Secretary of Health, Education, and Welfare, under the chairmanship of Dr. Stanhope Bayne-Jones, reported the need for additional research on such environmental health problems as radiation injury, harmful chemical processes, accidents, communicable diseases, and increasing air and water pollution.» In the same month, the National Advisory Health Council called attention to the constantly changing pattern of problems in the field of environmental health and stated “to provide the necessary leadership in the effective expansion of the total national effort, the Public Health Service should devote greater re- sources to research and education in this field.” The Committee on Appropriations of the House of Representatives, in its April 1959 report on the fiscal year 1960 appropriations to the Public Health Service, stated the following: “Over the past several years a number of environmental factors affecting health have become increasingly significant. The development of industrial processes and industrial products has taken place at a rate so rapid that direct and indirect effects on the health of the worker, the user of the processed product, and the general environment have not been adequately evaluated. The consider- ably expanded use and diversity of sources of radioactive products is a technical development of particular significance to health. The continued growth of gigantic metropolitan complexes has created special problems related to com- municable diseases, problems of mental health, and, to certain extent, has made it increasingly diificult to deliver health services. Related to the growth of metropolitan areas and the expansion of industrial production are the in- creasing problems of air and water pollution and their effects on the health of the population, which are at present inadequately understood. “The U.S. Public Health Service is now doing work in this general field under several different appropriations, and in several different organizational units. These are identified in various parts of the budget as radiological health, sanitary engineering, accident prevention, some aspects of mental health, control of com- municable diseases, occupational health, etc. The committee believes that this is a field where problems are almost inevitably going to increase and that a very thorough study to determine the most eflicient organization of our public health and medical research resources to cope with these problems is overdue. “In view of the above, the committee requests that the Public Health Service make a thorough study of the environmental health problems and the most effi- cient organization of our facilities to meet these needs, and have a report pre- pared for submission to the committee by January 1, 1960, so that the committee may have an opportunity to study it before holding hearings on the 1961 budget.” That report states the position of environmental health briefly and clearly. The Public Health Service welcomes evidence such as the foregoing as con- firmation of its own convictions regarding the multiplying and far-reaching effects of new and complex problems in the field of environmental health, and the immediate need for their identification and control. It is not being overdramatic to suggest that threats from our environment, actual and potential, cannot only generate wholly undesirable effects on the health and well-being of isolated individuals, but under certain circumstances could affect large segments of our population and conceivably threaten the very existence of our Nation. Recognizing that this is therefore not a subject to be lightly considered by any- one, for some years the Public Health Service has been actively concerned with the seriousness of this major problem. The Service consequently is pleased to have this request from the committee, and to comply with it as effectively as possible, invited the advice of a special panel of consultants made up of three members of the Committee on Environmental Health of the National Advisory Health Council, members of the Public Health Service advisory committees con- cerned with specific aspects of environmental health, a State health officer, and the health officer of a large metropolitan area. Specifically, this special com- mittee was made up of the following distinguished members: ‘1. 7. Boisfeuillet Jones, chairman,1 vice president and administrator of health services, Emory University, Atlanta, Ga. Herbert R. Domke, M.D., director, Allegheny County Health Department, Pitts- urgh, Pa. Harold B. Gotaas, Sc. D.,1 dean, Technological Institute, Northwestern University, Evanston, Ill. Roscoe P. Kandle, M.D., State commissioner of health, New Jersey Department of Health, Trenton, N .J . Louis C. McCabe, Ph. D., president. Resources Research, Inc., Washington, DC. Ross A. McFarland, Ph. D., professor of environmental health and safety, School of Public Health, Harvard University, Boston, Mass. Lemuel C. McGee, M.D., medical director, Hercules Powder 00., Delaware Trust Building, Wilmington, Del. Malcolm H. Merrill, M.D.,1 director, California State Department of Public Health, Berkeley, Calif. Russell H. Morgan, M.D., professor of radiology, The Johns Hopkins University, Baltimore, Md. B. A. Poole, director, Bureau of Environmental Sanitation, Indiana State Board of Health, Indianapolis, Ind. The Service is grateful for the advice of that committee in the preparation of the following report. SCOPE OF ENVIRONMENTAL HEALTH PERSPECTIVE In the United States, environmental health activities have contributed to vir- tual banishment of many oncedreaded epidemic diseases such as typhoid fever, cholera, malaria, yellow fever, and endemic typhus. In lesser degree, the in- cidence of the dysenteries and other filth-borne diseases has been greatly re- duced by environmental controls. Originally, these environmental controls developed as a result of social dissatisfaction with urban sanitary conditions following the industrial revolution. At first, the methods used were largely empirical, but improved knowledge of specific disease etiology and sanitation technology gradually established bases for more scientific and efifective pro- cedures. ‘ Environmental health activities designed to control biological agents of dis- ease now have been so interwoven with our everyday lives, our structure of. Government services, and our economic system as to be taken for granted by the average citizen. He accepts with but little thought the refrigeration and other food sanitation practices of his home and commerce, and the pasteuriza- tion of his milk; and assumes there are no problems in the purification and de- livery of his water and the disposal of his garbage and sewage. Gaps still exist, however, in the available controls of biological hazards in the environment. Incomplete knowledge of infectious hepatitis, the encephalitides, poliomyelitis, and similar diseases, and many fungus diseases, for example, has limited the development of environmental controls for them. In addition, over the past several decades significant and growing nonbiological health hazards in the environment have arisen. Our increased use of materials and products is attended by increasing quantities of potentially toxic substances in our environ- ment of limited physical dimensions. The uses of energy, accompanied by mech- anization of processes and services, produce additional hazards of noise, other physical forces, and accidents. The diverse and growing beneficial uses of nu- clear energy, potentially of enormous benefit, are producing a Whole new spec- trum of hazards to health for present and succeeding generations. While the biological health hazard normally assaults the individual in dis- crete and separate instances, the chemical and physical hazards come more often in intermittent or continuous doses, Which reach him in a variety of ways. It is the total and cumulative exposure of the individual to ionizing radiations which is now recognized to be important, no matter how the separate components reach him. Of no less concern is the total exposure to chemical toxicants, portions of which reach the individual separately through air, water, and food. Social factors in the environment are contributing to the newer environmental health hazards. Increasing urbanization, the growth and coalescence of large metropolitan complexes, and new patterns of living compound the sources of environmental hazards and concentrate the people affected by them. Reactions 1 Subcommittee on Environmental Health of the National Advisory Health Council. 8 between hazards and peopleare thus multiplied, and controls, to be eflective, must be correspondingly more efficient. The magnitude of our newer environmental health hazards is expanding at more than a linear rate. Acceleration arises from both population growth and technological advance. One of the most significant new elements in man’s eco- nomic thinking is that the rate of economic growth can be accelerated by planned research and development. Accordingly, our expenditures for industrial re- search and development have been expanding impressively over the past decade. By comparison, expansion in research activities on the attendant health hazards has been substantially less. Growing public concern about air and water pollution, food additives and toxic residues, and radiation exposure has, in some cases, led to pressures or demands for control actions for which rational scientific and technological pro- cedures do not now exist. To a large extent, the programs and activities for dealing with recognized environmental health problems have been developed and carried out each some- what independent of the other, in response to a specific urgency. This has re- sulted in a loose grouping of related, but unilaterally treated problems, programs, and activities associated with the essential elements of our surroundings—the water we drink, the air we breathe, the food we eat, the shelter which protects us—or with action taken by man in pursuit of a fuller life—his occupation, rec- reation, transportation, social organization. Too often the important interre- lated biological and social implications have not been given adequate attention. The “total dose” of toxicants to individuals cannot be controlled if the several programs concerned with various segments of the environment remain uncoor- dinated. The danger of correcting one problem only to create or intensify an- other can be reduced only by recognizing the environment as a whole and the interrelationships of its several parts. A unifying concept is needed if the ap- proach to specific problems is to be most effective. COMPONENTS OF THE ENVIRONMENT The health status of an individual, a community, or a nation is determined by. the interplay and integration of two ecological universes: the internal environ- ment of man himself; the external environment of the world as it affects him. Changes in either of these or in the relationship between them can affect the health of the individual or the entire community. As it is with the individual, so it is with the community; health is not static or absolute, but rather a never- ending adaptation to changing environment. In the life of an individual, the external and internal environments merge. For purposes of carrying on research and control programs, however, attention can be concentrated on one or othe other of these two environments. This report is focused on those aspects of the environment that are primarily external. Such personal health services as immunization, diagnosis of disease; medical, nursing, and dental care; and hospitalization are excluded. In considering the external environment, three major areas of health con- cern are recognized: 1. The biological component, including the living things of the plant and animal kingdoms——ranging from the food upon which life depends to those micro-organisms responsible for disease. 2. The physical component, encompassing the nonliving things and phys- ical forces affecting man—such as water, air, food, chemicals, heat, light, and other radiations. 3. The social component including a complex interplay of factors and con- ditionswcultural values, customs, attitudes, and mores: economic status: social and political organization; and ability to support facilities and services. ‘ These components are closely interrelated. Some products, such as insecti- cides. control certain biological hazards, but in turn create new physical threats to man through their potential toxicity. Hazards from the physical environ- ment may be greatly altered by biological activity, as for example, the concen- tration of waterborne radionuclides in micro~organisms and fish. Many problems in the physical and biological environment stem from the social environment. The difficulties of controlling water pollution are intensified by the multiplicity of political subdivisions, with different financial structures and philosophies of public responsibility, which must participate in such programs. The fact that many persons prefer to drive their automobiles to work contributes to the smog problem by increasing the number of vehicles on the road. 9 Man adapts to some aspects of this complex external environment. Other aspects he changes to meet his needs. In changing the environment for one pur: pose, hOWever, he may knowingly or unknowingly create new hazards to his health. Technological advances have reduced some health hazards, intensified others, and introduced some entirely new ones. Many of these, man cannot adapt to. His only recourse is to control his environment. ENVIRONMENTAL HEALTH PROBLEMS Environmental health problems have been approached in several ways. In general, control programs have been organized along one of three axes—(1) the hazard, (2) the vehicle by which the hazard is transmitted, or (3) the partic- ular population groups affected. Examples will serve to give background for a discussion of present and future needs, and to indicate the extent to which the problems are interrelated. The hazard Among physical hazards, chemicals are of, increasing importance. New chem- icals, many of them with toxic properties or capabilities, are being produced, marketed, and put into use at a rapid rate. These include plastics, plasticizers, additives to fuels and foods, pesticides, detergents, abrasives. In the phenomenal growth of all industry during the last two decades, that of the chemical indus- try has been dramatic. It is estimated that 400—500 totally new chemicals are put into use each year. With many of these products, new waste byproducts are created which must be disposed of. Although many commonly used chemicals are checked for toxicity, much is still unknown about their long-term potential hazards. The total dose of chem- icals absorbed by man through numerous channels in minute and diluted amounts over his lifetime may be damaging his health. Positive evidence with re- spect to the limits of tolerance is difficult to establish because of the long-term nature of the problem. There are many substances Which must be viewed with suspicion until evidence of harmlessness is available. In view of the rapid expansion that is forecast for the industrial use of nuclear energy2 and the increase in the use of X-rays and other sources of radiation, knowledge of the effects of low-level radiation exposure is grossly inadequate. Professional competence and public understanding regarding health protection from overexposure to radiation must be developed. Scientific evalua- tion of the long—term effects of radiation is essential. Safe and more 'efliclent means of disposing of unwanted radioactive wastes will have to be developed. Methods of using nuclear energy must be assessed in relation to health hazards created. In addition to chemicals and nuclear energy, other physical factors such as sound, light, temperature, speed, and pressure aifect human health. Some of these are discussed later in relation to housing and occupational health. While great gains have been made in controlling biological hazards, many problems remain. The current problem of staphylococcus contamination in hos- pitals is a case in point. The control of viruses is a continuing problem. Bac terial mutations are creating new problems in identification and control. ' Many facets of the social environment bear on health. Accidents, for ex- ample, are often related as much to social-psychological phenomena as to phys- ical hazards. The prestige of driving more powerful cars and reckless driving are forces to be reckoned with in the prevention of accidents. Hazards to emotional health are often created in today’s complex social set- tings which emphasize diverse value factors and status symbols: social class, superdrives for success, pressures for conformity. Despite the many accomplishments and benefits of public housing and slum clearance, there often remain health problems which are largely social in origin. Serious strains on health have been created by separation from friends and neighbors, by dlsruptiou of community services and facilities, and by economic burdens imposed by higher rents. The vehicles of transmittal Water and air, food and milk, solid wastes, insects and rodents, and shelter, are among the channels through which man’s health may be endangered. Con- 2Bruce Prentice vice president of the General Nuclear Com, has estimated that by 19 0, 65 pe cent of llhew powerpl nt construction will be nuclear‘energyp ht . Other sgmates, t ough dfierlng numericalghlup off the conclusion that the hue ear industry a on the threshold or extremely ram xpahs do. 10 trols directed at these vehicles may eliminate or reduce not only known hazards, but unknown or little understood ones as well. - Pollution of the environment can be undesirable for reasons other than health. Polluted waters are esthetically objectionable; unfit for fish and wildlife; or unpleasant for swimming, boating, and other recreational purposes. Smoke and fumes were recognized as inconveniences and nuisances long before they aroused concern as to their disease-producing eifects. In addition to the health con- cern, injury to agricultural crops and livestock, damage to and deterioration of property, and hazards to air and. ground transportation are reasons enough for preventing or abating air pollution. Demands made on our limited water supply are presenting increasing and in some areas critical problems. As sewage outlets and intakes are wedged closer together and as reuse of water increases, heavier demands are placed on both sewage treatment and water purification. Of particular importance in water resource management is the development of safe and eifective means of disposing of radioactive and chemical wastes of large volume and increasing complexity. Water resource planning, storage, impoundment, treatment, and control of levels of fluorides and other chemicals are environmental problems of high priority today. Like water, air has a limited capacity for purifying itself. Increasing pollu- tion comes from such chemical substances as sulfur dioxide; from smoke and dusts of both industrial and nonindustrial origin: from radiatiOn fallout. Physi- cal and chemical reactions which occur among pollutants in the atmosphere may increase or decrease their potential for producing adverse health or other effects. In some geographic areas, chronic bronchitis is becoming an increasingly fre- quent cause of disability; the rate of occurrence seems to be related to climate and to pollution of the air. Evidence is mounting that other disease entities, such as lung cancer and emphysema, also may be related to air pollution. Today, the modern supermarket and frozen food locker permit 'the use of a wide variety of foods, with resultant nutritional benefits. But modern methods of growing and processing foods introduce new hazards of pesticide spray resid— uals, preservatives and other food additives, and even contaminants related to packaging, which require attention for control. Collection and sanitary disposal of such solid wastes as trash, garbage, chemi- cals, and radioactive materials are basic to sound community environmental health programs. Approximately three-fourths of all communities of over 1,000 population are using open dumps or other unsatisfactory methods of solid waste disposal which contribute to air and water pollution, disease vector propagation, odor, and unsightliness. - Insect and rodent control, which affects comfort as well as health, has become increasingly important as the population shifts and grows. The recent outbreak of mosquito-borne encephalitis in New Jersey is an example of the continuing threat of such vectors. Important from a health standpoint in housing are such features as safety, temperature, ventilation, light, space, noise, water supply, and waste disposal. In addition, attitudes and motivations of people in relation to their housing are important, to both physical and mental health. The population group The third approach to environmental health problems has been that of dealing with threats to particular population groups such as industrial and agricultural workers, travelers, and people on vacation. Some of the environmental health hazards that affect the general population are intensified in particular types of occupations; others are occupational in origin. Depending on the particular occupational setting, attention may have to be given to water supply, ventilation, waste disposal, light, temperature, noise and the proper handling of toxic materials. Some especially hazardous occupations are of particular health concern. For example, the high level of exposure of the occupational group engaged in the formulation and use of pesticides accentuates the need for protective measures. The large field of service activities (laboratories, laundries, cleaning establish- ments, repair plants, etc.) where use of dangerous products is concentrated, also calls for special attention. There are strong indications that unrecognized occupational factors may con- tribute to the etiology or the aggravation of diseases now considered solely degenerative in origin. Social conditions and strains in the occupational climate have definite bearing on mental and emotional health. 11 Many health problems arise from the mass movement of people. With air routes enmeshing the earth, rapidity of travel is a significant factor in the transmission of disease. The increase in number of persons, as well as the speed and complexity of modern travel, create problems of vehicle safety and highway design and also involve sanitation of drinking water and food service; waste disposal; air pollution; transmission of animal and plant hazards from place to place. Less well understood, but pressing for consideration, are the health implications of noise, speed, pressure, crowding, and associated tensions. The roar of the jet takeofl is a dramatic symbol of the new hazards inherent in rapid transportation. As the workweek has been shortened, the ways in which people spend their leisure time have become more important. Each type of recreational activity has its own benefits and its own hazards. The increased popularity of boating and water skiing has sharply increased water accidents. The growing number of people visiting remote park areas has resulted in the exposure of larger susceptible populations to arthropod vectors and animal reservoirs of encephalitis, Rocky Mountain spotted fever, tick fever, tularemia, and plague. In community planning, requirements for recreation areas and their relation- ship to community living as a whole are matters of concern to health personnel. For example the use of domestic water supply reservoirs for fishing and other recreational purposes is feasible if the public is Willing to pay the price of necessary protection. Thus, the interplay of several elements of environmental health is demonstrated once more. NEED FOR BROAD APPROACH Separate approaches to specific problems have had great practical value. They have provided effective mechanisms for getting at critical phases of important problems. By dramatizing particular segments of problems, it has been possible to enlist public support for corrective action in relation to specifically defined situations. Many noteworthy achievements have resulted. But the many and complex interrelationships among those problems have be- come increasingly apparent, and it is obvious that they must be considered as parts of a whole. Awareness of such interrelationships is essential to an orderly development of efficient programs to meet present and future environ- mental health problems. To achieve a “total view,” there must be an integration of research and con- trol methods. The knowledge and skills of many professional disciplines and specialties—physicians, engineers, physicists, chemists, educators, statisticians among them—must be further coordinated in seeking scientifically sound an- swers to the many challenging questions in the field of environmental health. Towicology and epidemiology The methods of toxicology and epidemiology are essential and basic in dealing broadly with the newer environmental health problems. The task of toxicology is to explore and identify the biological implications of harmful and potentially harmful substances. Increasingly, the same chemical toxicants can reach the population through air, water, and food. Furthermore, the toxic eifects of cer- tain chemicals are multiplied many times by the simultaneous presence of an- other substanCFthe synergistic effect. Long associated with the conquest of communicable disease, the epidemiologi- cal method is equally useful for identifying industrial waste, its category, source, and degree of potential danger to a community, or for determining the causes of accidents. Systems analysis or operations research facilitates bringing together the bio- logical, engineering, and social aspects of the overall problem. Extension of the epidemiologic process to the wider concept of operations research or systems analysis is much needed in the environmental health field. Such a tool provides a mechanism for dealing with the total problem, focusing attention on those components which overall examination has revealed to have critical importance, and assisting in both the planning and operational phases of activities having implications for environmental health. Metropolitan area problems The growth of metropolitan areas has intensified the environmental health problems of urban groups, while introducing new complications in the control of hazards. Because of the size and variety of their populations, metropolitan 12 areas have llhpl‘ecedented problems of water supply, water and air pollution, housing, transportation, recreation, food supply, occupational health, and social and economic stress. These problems demand coordinated, areawide considera- tion, a difficult task for separate and relatively autonomous political entities. To date, city planners in dealing with urban growth have largely concentrated on the problems of land use, transportation, water supp‘v, and waste disposal— the pro lems concerning which the most extensive knowledge is available. Even in these areas only limited progress has been ’made toward an areawide ap- proach. Environmental health problems associated with the rapid growth of suburban residential areas and the decline of the central city call for increasing consideration in community planning. 1, ENVIRONMENTAL HEALTH ACTIVITIES TODAY Today, the same social and economic forces that are producing changes in our environmental health problems are also modifying the form and size of govern- ment and private organizations that must deal with such problems. An increas- ing number of Federal agencies has become involved in environmental health ac- tivities. Relationships between the Public Health Service and State and local governments are assuming new directions. Technological changes and increased movement of industrial products across State borders have created growing pres- sures for direct industry relationships with the Federal Government on health matters. Thus, in the environmental health programs of the Public Health Service, and particularly the newer oneS, new relationships among oflicial and private organizations are emerging in response to program needs. FEDERAL INTERAGENCY RELATIONSHIP Environmental health hazards are closely related to the development and use of natural resources, transportation, and economic activities with which many Federal agencies are concerned. Health programs must be developed with con- sideration of related activities of Federal Government. Accordingly the need for the Public Health Service to collaborate with other Federal agencies in co- ordinating health and other interests in areas of mutual concern has increased. One example of collaborative action is the use by the Public Health Service of meteorologists employed by the Weather Bureau for research and technical advice on air pollution. By such cooperative arrangement, highly specialized scientific competence of one agency is made available to complement the basic staff of another. As the demand for a wider variety of highly specialized scien- tists increases, their joint use becomes more essential.‘ Another example is the agreement between the Department of Health, Edu- cation, and Welfare and the Department of the Army on water-resource planning and development. Under existing legislation, the Army Corps of Engineers and the Bureau of Reclamation of the Department of the Interior are authorized to include in multiple—purpose reservoir projects water-storage capacity for mu- nicipal and industrial use. The agreement requires the Public Health Service to determine present and future water-supply needs and the economic value. A close working relationship exists between the Public Health Service and the Food and Dru;r Administration in stabilization of the quality of foods and drugs; the Fish and Wildlife Service in detection and elimination of stream—pollution hazards; and the National Park Service in provision of safe water and sanitary camp facilities in national parks. The Public Health Service’s relationship with the Office of Civilian and Defense Mobilization for emergency planning for natural and war-caused disaster is an- other interagency working arrangement. Since it is the “total dose” of toxic substances which is important in chronic exposure, it is essential that there be consistency in standards imposed by the several agencies dealing with different aspects of the same problem. Thus, a Federal Radiation Council has been established to advise the President on radia- tion health matters, particularly in relation to guidance for Federal agencies on radiation protection criteria. The Public Health Service’s work in radiation health necessarily involves frequent collaboration with the Atomic Energy Commission. 13 PHS RELATIONSHIP \VITH STATE AND LOCAL GOVERNMENTS For the most part, official responsibility in the United States for environmental health services and activities properly rests with the level of government closest to the people which is capable of performing the function. Thus the local com— munity, supplemented and aided by the State~ when necessary, is the first line of defense. The Federal Government, in turn, exercises certain interstate func- tions and assists the States by financial grants—in-aid, technical assistance, re- search, and training of personnel. The Federal role is particularly significant in stimulating action with respect to new problems. With the growing importance of environmental health problems in metro- politan areas, it has become essential that the Public Health Service exercise strong leadership in helping to deal with these problems. Metropolitan areas, one-fourth of which already are interstate in character, are more than collec- tions of local governmental jurisdictions clustered around a central city. They are complex social and economic entities produced by the many forces that have led people more and more to live and work in large urban areas. The Public Health Service has been callednpon increasingly to assist in de- veloping program mechanisms that specifically recognize the health needs of the metropolitan areas and in helping to devise with the States new forms (if organization appropriate to the needs of such areas. A special ad hoc advisory group, consisting of representatives from local and State governments and vol- untary organizations, recently recommended that the Service, in cooperation with other governmental agencies concerned with programs affecting urbanized areas, increase its activities to assist through research, demonstrations, and training in solving environmental health problems in those areas. PHS RELATIONSHIPS WITH INDUSTRY ,Industry long has played an important role in improvement of environmental health by producing those things which have given us a steadily rising standard of living. At the same time, the increasing volume and variety of waste prod- ucts created by today’s industrial economy and the increasingly common use of toxic products have contributed to environmental health problems. Distribution of industrial-waste materials and of potentially toxic products often crosses State lines. Therefore, a closer relationship is being established between the Public Health Service and industry with respect to broad standards which apply throughout the country. Recently a trend toward joint Federal—industrial development of control measures has been evident. The petroleum, automobile, chemical, and food in- dustries haVe taken active steps toward self-control of the hazards Created by their products and processes, both through trade association and individual large companies. The Federal Government has participated in these programs. These relationships and acceptance of responsibilities are still evolving. Al- though all segments of industry now recognize some responsibility, thereis still a considerable difference from one industry to another in the extent of responsibility which is accepted for health and conservation of resources. PRESENT PROGRAMS IN THE PUBLIC HEALTH SERVICE Current environmental health activities in the Public Health Service present a picture of gradual change superimposed upon previously existing programs which were oriented toward the control of biological health hazards. These re- cent changes in programs are of two general types: (1) those concerned with relationships with other organizations and (2) those concerned with program substance and organization. The role of the Public Health Service in relation to other official organiza- « tions has developed within the framework of traditional Federal—State health agency relationships. In recent years, as previously noted, there has been a growing tendency toward more and broader relationships with other ofiicial agencies and private organizations. New environmental health programs initiated by the Service to deal with the ',changing needs of society have included programs concerned with accident pre- vention, radiological health, and air pollution. In addition, the water—pollution program has been reinvigorated under the stimulus of new legislation. These 14 newer programs have been characterized by broad organizational relationships, by use of multiple program mechanisms (direct operations, grants, contracts), and by a broad multidisciplinary approach, using personnel trained in medi- cine; the biological, physical, and social sciences; and engineering. Environmental health activities are carried on in all three of the Service’s operating bureaus. ' Bureau of M edtcwl Services In the Bureau of Medical Services, three divisions have some activities in the environmental health field: Foreign Quarantine, Indian Health, and Hospital and Medical Facilities. Environmental health activities of the Division of For- eign Quarantine—which are a relatively minor portion of the total program of that Division—are concerned with inspection of vessels and aircraft arriving in the United States from a foreign country. These activities are designed to pre- vent the introduction, transmission, or spread of communicable diseases from abroad caused or transmitted by rodents, insects, or other vermin infestation; contaminated water or food; or any other unsanitary condition. This surveil- lance is a legal responsibility of the Service, similar to that carried on with re- spect to interstate common carriers. The two programs are currently coordi- nated to the extent of some common use of personnel. The Division of Indian Health operates an integrated public health and medi- cal care program, With the objective of raising the health status of Indian and Alaskan native beneficiaries to a level which will compare favorably with that of the general population. Most illness and a fifth of the deaths among Indians are due to! infectious diseases which can be prevented by proven control meas- ures. Public Law 86—121, signed in July 1959, permits the Public Health Serv- ice, in cooperation with the Indians, to construct, improve, extend sanitation fa- cilities, including domestic and community water supplies, drainage facilities, and sewage-disposal facilities for Indian homes and communities. Ths is a di- rect construction program carried on by the Division of Indian Health. The Division of Hospital and Medical Facilities is responsible for administra‘ tion of the Hill-Burton hospital and medical facility planning and construction program. Although the basic objective of this program is to provide facilities for personal health services, the Division of Hospital and Medical Facilities through its activities in relation to hospital construction and equipment stand- ards makes a significant contribution to the improved environmental conditions ofrfacilities receiving Federal aid. National Institutes of Health The National Institutes of Health focus their major attention on the advance- ment of knowledge and understanding of the fundamental biological and psycho- logical processes. While much of this activity is oriented to the internal biolog- ical environment of man, a substantial fraction of these investigations centers on factors in the external environment and their effects on health. Because of the categorical organization of the National Institutes of Health, with its focus primarily on disease entities, research concerning environmental influences tends to be concentrated on specific disease "problems. Thus, its activities in the area of environmental health cannot always be separately and clearly identified. The research program of the National Institutes of Health is divided into two parts: intramural research conducted by NIH staff in Bethesda and a number of field stations and the extramural program of grants to non-Federal scientists working in universities, medical schools, hospitals, health departments, and other institutions and agencies in support of their research projects and research training activities. Intramural research related to environmental health is conducted by each of the seven Institutes and the Division of Biologics Standards. Illustrations of topics under study include the effects of naturally occurring fluorides on dental decay, environmental agents—physical, chemical, and biological—as causative factors or useful in the treatment of cancer; environmental influences contrib- uting to heart disease, the nutritional diseases, radiation biology; the relation of socially isolated living conditions or of environmental stress to mental dis- order; vectors affecting the occurrence and spread of communicable diseases; and studies of germ-free environment. Most of these intramural studies relate fairly directly to the cause, aggravation, or amelioration of one or another spe- cific and identifiable disease process. Substantially more research in which the study of environmental influences plays a conspicuous role is supported by means of extramural grants-in-aid. 15 Among the seven Institutes and the Division of General Medical Sciences award- ing such grants-in-aid, an estimated $6 million was devoted in 1959 to studies of environmental factors in health and disease. Of this amount about $4,500,000 can be readily identified as supporting research on air pollution, water supply, sewage and industrial wastes, toxicology, occupational medicine, accident preven- tion, food sanitation, and insect and rodent control. The Division of General Medical Sciences currently provides the major portion of Public Health Service grant support for research in the environmental health field. In 1959 grants devoted specifically to air and water pollution, accident prevention, occupational medicine, and toxicology, amounted to approximately $3 million and constituted about 20 percent of the Division of General Medical Sciences research grant funds. These funds were augmented by $737,000 con- tained in the Bureau of State Services appropriation for the support of air and water pollution research projects. An additional sum of about $500,000 was devoted to grants having broader relevance to environmental health on such topics as the effects of housing standards on health, evaluations of the effective- ness of public health methods in dealing with environmental hazards, and the development of improved methodology in epidemiologic and biometric research. Proposals for the support of research training in the field of environmental health by the Division of General Medical Sciences are currently under consideration. The next largest program emphasis on environmental health is given by the National Institute of Allergy and Infectious Diseases. The NIAID program includes grants for studies on the causes and prevention of parasitic and in- fectious diseases and their vectors, as well as grants for the study of environ- , mental allergens, including control measures. Environmental health studies constitute about 20 percent of the Institute’s total program ($2 million for environmental health projects in 1959 out of a total of $10 million). The National Cancer Institute, the National Heart Institute, the National Institute of Arthritis and Metabolic Diseases, the National Institute of Dental Research, and the National Institute of Neurological Diseases and Blindness all provide support to scientists studying the biological effects of environmental chemicals and radiations, and the effect of diet, geographic, climatic, and a wide variety of other environmental influences on the conditions and diseases with which these Institutes are concerned. The National Institute of Mental Health is also greatly concerned with environmental factors in health, particu- larly those of a psychological and sociologic nature; it has provided support for studies of the effect of community size on the emotional well-being of children, studies of the emotional disruption occurring when a whole community is forced to move and relocate, studies of urbanization and urban stress, and the emotional problems associated with migrant labor. Under the health research facilities (construction) program, the Division of Research Grants has provided grant support (during the fiscal years 1957—59) for the construction of research facilities in the environmental health field in the amount of approximately $2 million. Bureau of State Services Most of the Service’s environmental health activities are within the Bureau of State Services. Approximately $13 million in direct operating funds and $52 million in grant funds are budgeted for the Bureau’s identified environ- mental health functions during fiscal year 1960. Only a minor portion of the BSS environmental health activities is concerned with direct and exclusive Federal responsibilities. Enforcement of the sanitary requirements of the interstate quarantine regulations ($685,000 in fiscal year 1960) and enforcement of abatement of pollution of interstate waters ($411,500 in fiscal year 1960) are illustrations of direct activities. The major portion of the Bureau’s environmental health activities is concerned with: research; the provision of technical assistance—including training—to other Federal agencies, State and local governments, and other organizations; administration of grants- in-aid; and basic data collection and evaluation. Categorical and general grants from the Bureau of State Services provide sup- port for environmental health services of official State and local agencies. Cate- gorical grants are available for construction of municipal waste treatment works ($45 million in fiscal year 1960) and for development and support of water pollu- tion control programs by State and interstate agencies ($3 million in fiscal year 1960). The air pollution program is unique among the Bureau’s environmental 52946—60—2 16 health activities in that it schedules grants to public and private organiza- tions for individual research, training, and demenstration projects ($590,000 in fiscal year 1960). No categorical grant support is available from other BSS en- vironmental health programs, but unspecified amounts are available for this purpose from grants to the States for general health purposes and from the grants and traineeships available for university training of public health per- sonnel. In the Bureau of State Services, the primary responsibilities for program opera- tions are decentralized to the several divisions. A profile of the general respon- sibilities of each division carrying on environmental health activities is given here. The Division of Engineering Services is responsible for enforcing engineering and sanitation aspects of the interstate quarantine regulations pertaining to interstate carriers (trains, planes, buses, and vessels, including their sources of water, milk, and food) and for the research and technical activities relating to milk, shellfish, and other foods, household water supplies, sewage disposal sys- tems, bathing places, plumbing, recreational areas, schools, and other institutions. This Division is also responsible for the engineering aspects of :the air pollution program. The Robert A. Taft Sanitary Engineering Center in Cincinnati, Ohio, is a part of this Division. It provides, for this and other divisions, a central facility for research, specialized technical assistance, and short-term technical training in air and water pollution control, milk and food sanitation, and other environmental health specialties. The Division of Water Supply and Pollution Control is responsible for admin— istering the Federal Water Pollution Control Act. It is concerned with nation- wide water resource planning as related to public water supplies, and the water pollution aspects of recreational, agricultural, industrial, and other water uses. This Division is also responsible for assistance in the development of State and interstate water pollution abatement programs and for enforcement of pollution abatement of interstate waters. It also carries on the construction grants program, assisting municipalities to build sewage treatment plants, and is responsible for a broad program of research and technical assistance in the water pollution and water supply fields. The Division of Radiological Health carries the Service’s responsibility for the development of a national program for the prevention and control of radio- logical hazards to health. This includes assistance to State and local health au- thorities in the development and administration of their radiological health pro- grams; research in and development of public health measures for reducing exposure from X-ray, nuclear reactor wastes and other radiation sources; research to obtain epidemiological data concerning long-term effects of radia- tion on humans; monitoring of weapons testing; evaluation \of radiation levels in air, water, and milk (in cooperation with Division of Engineering Services) ; and extensive activities in the training of health personnel in various aspects of radiological health. The Communicable Disease Center in Atlanta, Ga. (which functions as a division) is concerned with investigations of the relationship of the environ- ment to the transmission and control of communicable diseases. The center carries out extensive investigations, field studies, and laboratory research, and coordinates advancements in knowledge from many sources in order to develop practical techniques that will assist the States in planning and executing their own communicable disease control programs. Evaluation of the health hazards associated with the use of economic poisons continues to be important as the use of pesticides in public health and agriculture increases, both in tonnage and in variety of chemicals used. Demonstrations are carried out to illustrate the effectiveness of such activities as insect and rodent control and other problems pertaining to the environmental control of disease. The center assists also in maintaining the proficiency of personnel in State and local health departments by conducting annually a series of short courses in the diagnosis of communicable disease, the environmental control of communicable disease, and the epidemio- logy and control of food-borne and vector-borne diseases. Environmental health plays an important part in three programs of the Division of Special Health Services. These programs are accident prevention, air pollution medical program, and: occupational health. Major elements of the, accident prevention program are research and investigations in the epidemio- logic, medical, personal, and behavioral aspects of accident prevention; consulta- tion in the improvement of housing design for the prevention of home accidents; or assistance to State and local authorities in the development of accident pre- vention activities; and maintenance of a national clearinghouse of information » for poison control centers. The air pollution medical program is concerned with laboratory and commun- ity studies of the physiolOgical effects of air pollution on man, and the extension of technical assistance and training to apply research findings in operational programs. To help safeguard American workers against a growing variety of occupa- tional health hazards, the occupational health program through its field head- quarters in Cincinnati, Ohio, conducts field studies and laboratory research, and provides technical assistance and training. In the Division of General Health Services the Arctic Health Research Center conducts a wide range of studies and investigations of problems asso- ciated with life in low-temperature areas. Emphasis is placed on factors and conditions which affect health and impede or prevent the development of popu- lous communities in the Arctic environment. These studies are directed to the health problems associated with water supply, waste disposal, and disease con- trol which are unique to low-temperature areas. Grants to States for extension and improvement of general public health services are also administered by the Division of General Health Services. Substantial portions of these funds go to support and develop State and local environmental health activities. Public health traineeships, awarded by the Division, are available to all types of personnel in State and local public health work. Still other functions of the Division of General Health Services having environmental health components are school health activities and activities aimed at better health services for residents of rural areas, including agricultural migrants. ’ Environmental health interest of the Division of Dental Public Health centers in the fluoride content of drinking water, and the use of more eflicient and eco- nomical methods, processes, and equipment for fluoridation and defluoridation of public and private water supplies. IThe DivisiOn of Health Mobilization is responsible for preparing plans and developing programs for meeting the emergency health needs of civil defense and major natural disasters. 0f paramount concern are such environmental health problems as external radiation exposure; contamination of air, water, and food from radioactive material fallout; disruption of community water sys- tems; loss of sewage, garbage, and rubbish disposal systems; loss of heat and light; and contamination of food and milk. Perhaps the most critical is the problem of providing emergency water supplies. PROBLEMS OF CURRENT PHS ORGANIZATION The main organizational problems in the administration of Public Health Service programs in the field of environmental health are those inherent in a program fragmented to the degree demonstrated in the preceding review. Some areas requiring special concern are those of coordination, staffing, laboratory facilities, and appropriations structure. The current assignment of responsibilities to the various organizational units makes possible only very limited coordination of activities related to common problems. The limited toxicological services of the Bureau of State Services are concent'ated in the Division of Special Health Services and the Technology Branch of CDC and available only for the programs of those organizational units. Engineering and physical sciences competencies are largely concentrated in the Divisions of Engineering Services and of Water Supply and Pollution Control. The newer environmental health programs in air pollution control, radiological health, and accident prevention are staffed on an interdisciplinary basis to take account of both the biological and the engineering aspects of those complex prob- lems. This type of staffing is not the pattern for such older environmental health programs as milk and food sanitation, general engineering, water supply, and water pollution control. The latter programs generally do not include those professional disciplines needed for assessment of physiological and toxicological effects and etiologic relationships. None of the programs is staffed to explore in any depth the sociopsychological factors which are interwoven with the more apparent physical and biological elements. With the rapid expansion of environmental health programs in the Public Health Service, the pressure on existing research and training facilities has 18 become severe. For example, the Sanitary Engineering Center now is greatly overcrowded and lacks the toxicological and biological facilities necessary to round out its research capacities. The Occupational Health Field Headquar- ters is located in makeshift space which does not meet the requirements of the present program. Recent changes in the appropriations structure for environmental health activ- ities in the Public Health Service have efiected a partial consolidation of the items relating to these programs. Within the Bureau of State Services, however, environmental health programs still are financed from four difierent appropria- tions: assistance to States, general; communicable disease activities (including Arctic health research) ; environmental health activities; and grants for waste treatment works. In addition, sums for environmental health activities are in- cluded in various appropriations for the National Institutes of Health and the Bureau of Medical Services. ENVIRONMENTAL HEALTH NEEDS FOR THE FUTURE During the next few years our society will undergo further changes profoundly influencing environmental health practices and problems. In the following pages We discuss only the short-range 10-year prospects. . But those who have looked farther ahead see additional and even more rapid growth of problems and needs. The challenge of the next decade is to make a comprehensive assessment of the interrelated, interacting effects of the major environmental health hazards and to develop preventive measures and controls to eliminate or minimize their damage. GENERAL SETTING The scope of environmental health programs in the future will be influenced by the growth of population, scientific accomplishments, an expanding and chang- ing economy, and changing patterns of living. The marked population growth of recent years is expected to continue and even accelerate in the next decade. During the 1930’s total population increased by 9 million, during the forties by 20 million, and during the fifties by 28 million. Growth in the next decade is estimated at 33 million, to a total of 214 million in 1970: Year : Total population 1930 ______ 123, 188, 000 1940 132, 122, 000 1950 151, 683, 000 1960 180, 126. 000 1970 213, 810, 000 Concentration of population growth in cities and their suburbs (chart '1) will increase the number of metropolitan areas crossing State as well as local government boundaries. With a third of the Nation’s population expected to be concentrated in 10 supercities by the end of this century, the need for develop- ing governmental mechanisms to function eflectively in relation to these socio- political complexes will become increasingly imperative. 19 CHART 1.—POPULATION IN THE UNITED STATES AND IN STANDARD METROPOLITAN AREAS : 1900—1959 AND PROJECTIONS TO 1970 Kimono 2&0 - 22° ' Total population using ,’ Series II estimates * 180~ / n+0 _ , 661 Population in standard I metropolitan areas on ’ 60* basis or we umtiona O l l J J I I I 1900 1920 19% 1960 1970 *These estimates assume that 1955—57 fertility continues to 1970. Sources: Bogue, Donald J ., “Population Growth in Standard Metropolitan Areas 1900—1950," Housing and Home Finance Agenc ; Government Printing Oflice, Washington, 1953. Bureau of the Census. “Current Populat on Reports.” “Population Characteristics,” 1). 20, No. 71, and “Population Estimates,” p. 25, Nos. 187 and 207. A more than proportionate increase in the old— and young-age groups of the population will have a direct bearing on planning for housing, recreation, trans- portation, and other aspects of community living. The national economy is growing even more rapidly than the population. There are indications that in the next 10 years the gross national product will increase by two-thirds, bringing expanded industrial activity, more purchasing power, and higher levels of living (chart 2). Gross national product 1958 dollars 1958 dollars Year : (billions) Year—Continued (billions) 1950 __________________________ 352 1965_____-____.___________1__ 633 1959 __________________________ 451 1970 _________________________ 790 Electric power production is expected to nearly double in the next 10 years. 20 Electric power production Billions of Year : kilowatt-hours 1950 389 1960 300 1970 1, 400 The total energy consumption from all sources should increase approximately one-third (chart 3) to a total equivalent of around 220 kilowatt-hours per person per day. It is expected that steel production, an indicator of industrial development of many kinds, will increase substantially. Steel production 1 Millions Year : ‘ of tons 1950 ‘ 97 1960 142 1970 , 165 1 Steel, Sept. 15, 1958, p. 149. CHART 2.—-Gnoss NATIONAL PRODUCT, TOTAL AND PER .CAPITA (1958 PRICES): 1900—1957 AND PROJECTIONS TO 1970 (LOGARITHMIC SCALE USED To SHOW RATE OF GROWTH) 31mm of dollars noun" pot noggin 1,00% 1 ' ' 5’ P ”" r I u /’ .. ’1 ‘ - // t: ' Slam ‘ .«”' ‘ y- capital. 1 190/ J 1:000 - 4 .q - 1 b c l. -1 * a 10 J I 1 100 l [— JO .900 1910 1920 1930 191w 1.950 1960 1970 Source: National Planning Association. “National Economic Projections. 1962-65. 1970." 1969, pp. 8. 148. L \ ' l P ' I .’ l ‘ I Trillion B. T. U. CHART 3 60,000 _ Estimand PRODUCTION OF / MINERAL - ENERGY . FUELS AND - E NE R G Y F ROM WATERP-OWER 5°‘°°° ' / 40,900 — ' . Source: Minemls Yrbk. « / Fuels. Vol. l|.,\p. 2. Dept. of Interior, / Bur. Mines lnfonmflon ... N cm. No. 7754. 1957, 30,000 ' :H / 20,000 -— " . \ - / / -- — Tami Energy / " \ x f \ \-"' —- - -— Bituminous Coal fl / \ / / M". ‘4 a. Lignm 10.000 *- - / x... / "nun-u. Petroleum “MOI / / "‘0"- / crude) / .....n-o.-qglu".. / - ----- Anthracite My.” / -—- --- Nafwal Gas __ . —-_;.:-“’-'—. - ~ ~ -/.:.‘_.~r.’.'—/A,4-=-:-—~ Waterpower 0 -.-_ —-. ; . . x ‘ 1 - I 1 I 1900 '5 '10 '15 '20 '25 '3 ’35 '40 '45 ’50 '55 '60 '65 '70 22 ( Automobiles and trucks on the roads will increase by an estimated 20 million chart 4) : Automobiles and trucks registered Year : 1950 40 1960 70 1970 90 Chemical industries are expected to experience increasing production of such items as plastics, synthetic fibers, paints, and pesticides (chart 5). Economic development is a prime beneficiary of the successful results of na- tional expenditures on research and development. Since 1945 such expenditures have increased from $1.5 billion annually to approximately $12.5 billion, with further growth in prospect to perhaps $30 billion in 1970 (chart 6). Changing social forces—among them the mobility and urbanization of popu- lation, its distribution by cultural and socioeconomic groups, the increasing auto- mation of industry, the increasing amounts of leisure time—are creating new social problems and intensifying old ones. \ The trend toward organization of many phases of man’s life into bigger and bigger units will require new methods of health protection. Increasingly in- dividuals tend to depend on organized efforts to protect them from the adverse aspects of their total external environment. These are a few of the general developments that will change man’s environ- ment. Health needs related to particular phases of the environment must be viewed against this constantly changing background. CHART 4 Millions of Vehicles 0—90 PRIVATELY OWNED MOTOR VEHICLES IN U.S. I A g l 7.0 sammmam _ Y n j —.. ; I l 60 V I E 9 so I <2 3 : : w ‘ I Q Q U Q I u 5 3° C) " I ‘ 2° l V i 1 i 10 I i i ' 1 . 19207 '25 ”"30 "7'35 '40 '43 "so '55 ‘60 7 '65 ' '70 CHART 5 GROWTH OF THE CHEMICAL lNDUSTRY I950 - L975 1975 L942. Production pf Selected Synthetic: (in million: of pounds) 1950 I 1955' I 1960* I 1965' I 1970' I 1975‘- Plastics 2,151 3,739 4,300 6,450 8,600 10,500 Surface-acHVC agents 676 1,153 2,000 2,500 3,000 3,500 ' AMI-knock agents 350 700 1,000 1,250' 1,500 1,750 Minted on but: of five-tom increase over 1950 in 195. Source: no chance]. mum-y Ml but. and edition,'l957. T75 moo— 82 383 1.8 5.3. 3 22:3. 5 «otmtdica P5331... .l ...l 22:52..“0 I . I _u*0h 3.1:. 60:61.3“. 00:38 .2322 .3... .82 €950.38 .w 50E :0 25 3 5033. .6958 71:2 mo 00.50» T: on I mwow mmxfihazmmxm h2w2a04w>wo d IU¢ Mr. DENTON. Didn’t the Public Health Service conduct a campaign for smoke abatement? ‘ 190 Dr. PRICE. The actual work in smoke abatement has been done largely for other reasons than health. This has been one element of it, but this has been by and large an activity of communities to reduce a nuisance and cut down on the amount of dirt and filth and house- hold tasks and they have done it for those reasons as much or more than they have for health reasons in the past. Mr. DENTON. I think that is all. Mr. FOGARTY. Dr. Shannon, as Director of the National Institutes of Health and a person with a really excellent background in the whole field of research, I am sure you could make a real contribution to this hearing. We will be glad to hear whatever you might wish to add to what has already been said on this general problem. STATEMENT OF DR. JAMES SHANNON Dr. SHANNON. Mr. Chairman, I am pleased to have an opportunity to comment on environmental health in the light of the discussions, as I understand them, that took place yesterday and those that I have heard this morning. We have been deeply concerned with the broad problems of en— vironmental health at the National Institutes of Health and have developed a basic philosophy or basic attitude toward them based upon certain historical considerations and certain technical knowledge of the present—day environmental health problems. If I may, Mr. Fogarty, I would like to sketch in some of this background. Mr. FOGARTY. Go right ahead. Dr. SHANNON. Those who are primarily concerned with the de— ‘ velopment of new knowledge, whether it be in the physical world or the biological world, seek to isolate what are the primary challenges in the field of their responsibility—in this case, health. In looking back at the development of health knowledge in this country during the past 60 years, there are three broad areas that I think are most interesting. INFECTION In the period of 1900—35 the primary challenge to health was infec— tion. The program that addressed itself to this challenge had to do with the study of the agents of infection, the reaction of individuals to those agents (that is, to the viruses or the bacteria), the under- standing of the chain of transmission (how the infectious diseases were passed from one individual to another), and so on. I have in mind such classical examples as typhoid or the diarrheal diseases, which were subjected to very careful study leading into a broad research pro- gram including what I would call an environmental approach as well as an individual approach. HISTORY OF ENVIRONDIENTAL APPROACH TO HEALTH PROBLEMS The environmental approach, which was so important in advancing the health of this Nation over that period of time, had to do with the development of an understanding of the general concepts of hygiene. This included, for example, the need to rovide a technology by which pure water supplies could be provide and certain protec- tive measures established relative to our food supply and milk supply. 191 Thus, when one discusses environmental health in the context of 1900 to 1935, it is related to interrupting the transmission of disease due to infectious or transmittal agents. The individual approach to health problems at that time was char— acterized by an attempt to understand diseases as such, to develop ways and means by which individuals as individuals could be immu- nized against them or treated for them. In 1935, with the development of the first really active, widely usable antibacterial—sulfanilamide—we came into a 15-year period of transition. In this period, we have seen a whole array of new anti— bacterials. We have seen the virtual conquest of many infectious dis- eases in terms of fatal illness, although they remain an important cause of disablement. At the same time, we have seen chronic illness become recognized for the first time as the primary challenge to health. ‘ We moved over, then, in this 15-year period, to completely new chal- lenges. As a result of these challenges, there were changes in research programs and very broad changes in health practice. The changes in health practice, by both public and private agencies, began increas- ingly to encompass some of the needs of individuals, just as in the previous quarter of a century they had encompassed some of the needs of communities as communities. During the 10 years since 1950, we have seen a very broad expan- sion in medical research. This has provided new information which permits us to move forward in terms of the conquest of individual dis- eases, and has also given us an opportunity again to assess what con- ‘ stitute the major threats to health today. MAJOR THREATS TO HEALTH I would say that beyond any doubt there are,two major threats, each approachable by quite different means. The primary threat to the individual, or the one most generally recognized, continues to be chronic illness as such. Wehave come to an appreciation that chronic illnesses without doubt have a very broad genetic background requir- ing a much more thorough understanding of human biology, of bio- chemistry, of pharmacology, of the physiology of our individual sys- tems that go to make up the total man.- And I think that in no small measure we have begun to mount a varied program that hopefully will, in time, give us the answers to these problems. A second major threat to health today lies in the fact that the prob- lems of our environment have returned again to new significance, as important as the environmental problems from 1900 to 1935, but quite different. These problems now arise out of the advances of agricultural tech- nology, of our industrial practices, and of housing demands resulting from urbanization and our growing population—advances which in turn reflect a rapidly changing social and economic pattern. It is now appreciated that a progressive attack along a broad front on chronic illness per se will satisfy only a part of the total health prob- lem. Unless, subsequent to their definition, we address ourselves to the problems of our environment in this age of chemistry, we shall suffer from the very advances we are making. I would like to men- 52946—60—13 192 tion a few illustrations of the impact of modern technology on our day—to—day life. The widespread use in the agricultural industry of pesticides and other economic poisons is essential in food production. An increas— ing food supply is even more essential today as our mortality line de- creases and our population increases. We must have more productive agriculture, which means we must have increased technology in agri- culture. The industrial processes that we use today permit synthesis of man of the plastics as substitutes for what heretofore were natural pro acts. I have in mind here such substitutes as the synthetics now used in place of wood and metal products. These were characterized in Germany from 1935 to 1945 as ersatz material; they were developed because of an inability to import the natural material. In this country the development of ersatz material has far out- stripped the industries which they in part replaced. This is as a result of a new type of industrial chemistry that has impact on the eople that produce the products, the environmental area which may e af- fected by industrial wastes disposal, and the individuals who utilize the end products in their homes. EFFECT OF INCREASED DEMANDS FOR ENERGY From a somewhat different standpoint in the modern technological or industrial revolution—and this is a true industrial revolution, I be- lieve—if one adds up the energy requirements of this country—not so much the industrial plant, but our total consumption of indust for all urposes—I would guess we are going up, perhaps even dou ling within every few years, rather than the slow increase that character- ized development of our economy in the early part of the century. The increasing energy requirement of the country may be a pretty cold figure, but it is a figure with fantastic health implications, be- cause energy is not purchasable without there being, as an indirect disadvantage, the development of an industrial and public health hazard. I think we have probably, as Mr. Hollis pointed out, im- pounded most of the water that is going to be impounded in this coun- try for the simple provision of power through water. It means that our power requirements, as they go forward in the future, will be either from nuclear energy or from the burning of gases, the burning of oil, or the burning of coal. In, any of these categories, any in— crease in the amount of energy produced and utilized will increase the hazards of noxious gases, specific or general, which are developed incidental to the production of energy. If one plots the rate of in- crease of energy over the coming 40 or 50 years, I think you will ap- preciate this will come to fantastic levels. - At the present time we do not even know, other than in very gen- eral terms, what hazards the products of combustion of these materials roduce. p Mr. Denton asked about soft coal versus gas and oil, and Dr. Price very rightly said We can’t compare them because we don’t have the knowledge that permits the comparison of the hazard from the use of one to the hazard from the use of the other. 193 It would seem to me, then, that we must face up to the situation as we perceive it in 1960—a situation that has evolved parallel with the evolution of chronic illness as a major threat to our health both as a nation and as individuals contained within a community of na— tions. It would appear to me that a responsible program can only have leadershi from the Federal Government and should be of an order of magnitude commensurate with the threat. If the threat is great, then the program should have strong impetus. To develop such a program as this in an area only recently perceived as a major prob- lem requires bringing together elements of basic education and higher educatlon; a program for recruitment of individuals into new fields by providing adequate incentives; the provision of resources Where these individuals can be put to productive work; and the provision for the widespread application of their results. This is of course not the responsibility of the Federal Government alone. But unless lead- ership comes from the Federal Government, it is unlikely that there can be a unifying program that will meet the health need. FEDERAL-STATE-LOCAL RESPONSIBILITIES I feel that the States do not have the resources to mount a program in proportion to the need, although I do feel that given leadership, they will participate effectively in the program. I think the complex of official agencies is such that cities, too, will accept responsibility for very major segments of this program. But the total program must be a national one. What is required now is provision for an aug- mented program in the future by acknowledging the role to be played by official agencies on the Federal, State, and local level, by univer- sity groups, and by industrial groups. Accompanyinor this, there must be a broad educational program. I did not hear this mentioned specifically this morning, but I think such educational activity should certainly be provided in the overall program—an educational pro- gram not aimed at scientists, but at industry, at institutions of higher learning, and at oflicial agencies. EDUCATIONAL PROGRAM Mr. FOGARTY. What kind of a program? Dr. SHANNON. A straightforward, educational program using all the educational aids available. Mr. FOGARTY. I see. Dr. SHANNON. With the many groups involved, there might be a tendency for this program to continue to differentiate further, to be- come more and more fragmented, since one group may be concerned with water and compete with the group concerned with air for rela- tive support of their program. This is a very serious hazard, since one program should not be put above the other. They are, in fact, parts of a single program. ‘ I would think that were the Public Health Service designated as the instrument of Government, charged with the solution of the broad environmental health problem—a problem that continues to be ac- , cented by the complexities of our modern life—there should be pro- vided in the Service a fOCus that could be fully responsive to the needs of the people that could define objectives and determine how 194 these objectives could best be met, that could bring together the various groups and interests that must be involved. The Public Health Service can do this only if it is given the opportunity to mount a very broad and very significant program. - IMPORTANCE OF EDUCATIONAL CENTERS In terms of mounting such a rogram, as has been pointed out this morning, we are in an area of s ortage in all fields of science. This new area has to compete with areas of science that are better estab- lished. This means that if the program is to get underway in a reasonably short period of time, there must be provision for certain focuses of interest outside of the Federal Government that will serve as satellite points to stimulate the recruitment and training of person— nel and to provide other resources for research. This is why I think that Dr. Price’s proposal—that of centering a sizable part of this new program, should it come into being, in very broad comprehensive university centers, where the total resources of the university can be brought to bear on the problem from its undergraduate right through its graduate training work and on through the doing of research—is an excellent one. Mr. Fogarty, I don’t think this can be done rapidly. I think this will be very costly. I suspect that if the job is well done, Dr. Price’s figure that he mentioned this morning is undoubtedly a conservative estimate, but I would say that the field of environmental health re— quires as serious and as broad attention by the Federal Government as does the other area of threat to our health; namely, chronic illness. NEED FOR AROUSING PUBLIC INTEREST Mr. FOGARTY. I mentioned some of these problems at lunch today and we began discussing the problems of underground shelters in the case of atomic attack. There are many people right in Congress who have spent days and monthsin hearings and they have had some of the best experts in the country testify, but very few people seem to get excited about it. Even though I was told today that in the kind of war that we might expect, if we did not have underground shelters, 50 million people might be killed; and if we had under- ground shelters, 5 million people might be killed. That means, as I understand it, a saving of about 45 million lives if we had under- ground shelters in case of this kind of a war. But people don’t seem to be very concerned and the same applies in this field. If we do not move ahead on this problem of environmental health, what will be some of the consequences? CONSEQUENCES OF INATTENTION TO EN VIRONMIENTAL HEALTH PROBLEMS Dr. SHANNON. I think the ultimate consequence of lack of atten- tion to these things would certainly be an increase in disability or a lowering in the rate at which disability is presently being reduced. This might be manifest, for example, in a higher attack rate. of can- cer, a higher attack rate of cardiovascular and pulmonary disease, a higher attack rate of those disabling conditions that are meldental to smogs, and so on. 195 I would not be surprised to find that many of the factors concerned with acceleration or deceleration of chronic illnesses will be found in retrospect to have been profoundly influenced by currently unknown factors in our environment. Let me give you a very good example of what I mean. This is not a prediction or an estimate of what may happen. But I recall, Mr. Fogarty, when we first went into a re- search program on ‘ atherosclerosis in a sizable accelerated way in about 1951 or 1952, I believe it was either you or Mr. Lanham—who died a couple of years ago—who asked this question: If this disease develops or begins to develop when one is in his thirties and doesn’t start to kill until the midfifties or sixties, how can you combat it With the approach of medicine? I said at that time that I could foresee the possibility of handling such chronic illnesses through the addition of specific chemical sub- stances to the food. These substances, I said, would be in the nature of perhaps not vitamins as such, but have a vitamin-like action; and I felt that, having demonstrated beneficial results over a long period of time, they would be as important to the development of sound health in the individual. . There is reason to believe, from the way knowledge in this field has evolved, that this was not a rash expectation. We do not have the substances now; we may never have them; but this is still a possibility. Returning to environmental health, I would point out that when we turn out, as we are now, a large number of wholly new organic chemicals each year—when we spew out of our smoke stacks an in- finite number of chemical compounds of a wide variety, we are in fact taking into our bodies a sizable number of discrete chemical entities that must have some biological effect. It could be that they would be beneficial, but the likelihood is that they are not. It is not possible with any precision to say what would be the benefit of removing the hazard that is contained in the exhaust of smoke stacks, the exhausts of automobiles, or the burning of rubbish, and things of this sort. It might conceivably have an effect on some of our genetic diseases— multiple sclerosis and the like—or even on the evolution of some dis- eases of obscure origin, such as rheumatoid arthritis. The only thing We can be sure of is that it Would at least reduce the risk of certain cancers, of cardiopulmonary and cardiovascular disease, and of certain of our skin ailments, as well as making life more pleasant. In a specific area, there are many examples where sound indus— trial toxicology has resulted in changes that have been for the better- ment of the workers. I have in mind, the felt industry, with actions based on recognition of the fact that chromates are implicated in can— cer causation; the removal by the dye industry of certain dyestuffs, based on appreciation that they have a specific capability of producing cancer; and in the more conventional type mechanical operation— there have been a whole host of industrial safety measures and de- vices that have come into being as a result of the efforts of employee groups as well as corporate groups. There has been a s1zable advance in the mechanical aspects of how an industry does business. There has been relatively little in the way of advance along chemical lines, and this is an insidious threat to health and to life itself. If one wants to take the many individual items, he can point out the goals to be achieved. They are many 196 and they are discrete. In the aggregate, I think they are so important that we can no longer treat them as an ancillary part of medical re- search that is primarily focused on alleviation of death and disability due to chronic illness. Environmental health problems have reached the stage of first order of importance, where they should be addressed as broad problems for their own sake. I think I have touched the high points. Mr. FOGARTY. Thank you very much, Dr. Shannon. Mr. Hollis, do you have anything you would like to add? Mr. HOLLIS. Thank you very much, Mr. F ogarty. From an engi- neering point of view there is certainly no question that the byproduct waste from this upsurge in population and technology is contaminat- ing the environment and contaminating it in an increasing and chang- ing way. This affects the water we drink, the air we breathe, and the food we eat. MEANS OF INCREASING PUBLIC AWARENESS OF PROBLEM Mr. FOGARTY. How do we get this to the people? How do we make them understand that the problem is there? Mr. HOLLIS. I think the best ways to get the public to understand it, Mr. Chairman, is, first, for us to understand it ourselves. We must understand exactly what these impacts are, especially the health effects. We will then be able, I think, to put it before the people in a manner that they can understand. For example, in very recent weeks there have been two or three articles in the lay press on drinking water Mr. FOGARTY. Very disturbing articles. Mr. HOLLIS. I think the public reaction to them is a clear indica— tion of the deep interest and awareness and concern of the people about this problem. Again, we haven’t yet worked out the problems clearly enough to get the‘full import across to the people so that it will be generally understood. Many of the difliculties ahead are be- coming apparent. For example, We know the continual buildup in water pollution and in air pollution, the impacts of accidents and other stresses of modern living do need more attention. The tradi- tional problem of germ pollution, germ contamination, is going to in- crease with the greater concentrations of people, but for the most part we understand this; we have the methodology of approaching it, we have the machinery to apply controls and we are confident we can meet this need—can meet the increase in problem without undue difficulties. It will take more resources. It is these newer problems, the chemi- cal contaminants that Dr. Shannon referred to that we do not fully understand. Their health effects are much more subtle and long range and much more difficult to pinpoint and work out. RATE BY WHICH PROBLEBIS INCREASE As was pointed out earlier, there will be combinations and com- posites and synergisms of all of this that will affect us. The point I would like to emphasize, Mr. Chairman, is that all of these ingredi- ents that are influencing and contributing to the problem we are dis- cussing, all of these are still on a sharp increase. When one projects ll 197 all of this over another 10 years or 20 years, it isthen that you come up with levels of contamination that do have some rather sobering implications. Mr. FOGARTY. Give us some examples of what you see as the prob- lems that will build up in 10 years. You could put them in the record. Mr. Home I do have some. I am not quite sure of the figures. If I may, I would like to submit a notation for the record. Mr. FOGARTY. All right. (The requested information followsz) CONTRIBUTING INFUENCES AFFECTING WATER POLLUTION The buildup in water pollution results from concentrations of people, the growth of industry, and the increasing use of industrial products. J Prior to 1940 city sewage for the most part was natural organ‘c material, household waste with its concentration of germs. Today metropol"tan and in- dustrial wastes contain increasing amounts of new contaminants, s ch as syn- thetic organic chemicals, radioactive material, and other waste of our stepped- up economy. Many of these new contaminants are persistent over long periods, and for the fost part, they are not removed either by sewage treatment or by water purification practices. We have much to learn about the behavior of these new contaminants in streams, their relationship to natural stream purifi- cation phenomena, and their effects, singular and in combination; on public health, on aquatic life, and on municipal and industrial water supplies. In time, the question of toxicity of water pollution will be added to the age old ques- tions of typhoid fever and other enteric diseases. 1 The increasing volumes and the changing character 'Of water pollution are the crux of our problem today. In the decades before 1940, the Water pollu- tion problem largely was one of controlling germ diseases. Over hese years we attained brilliant success in our efforts. Our world leadershi in water works and sewage treatment practices stands out in bold relief. T e question of germ diseases will continue to plague us—will even be multiplied with further population densities. But for the most part, on these problems we now know what to do and how to do it. The solution for this is largely one ofi economics. The health-related problems Of water pollution now broaden to 'nclude this whole array of new-type water pollutants—pollutants that have th ,ir origin in exotic substances. TO develop the basic intelligence on these polluta ts will not be easy. Involved is the matter of combinations of substances, of composites, and of synergisms. l By the way of specific illustrations, the chemical industry is a se ent of our economy which is showing phenomenal growth. Especially is this rue of syn- thetic chemicals—plastics. detergents, pesticides, weedicides, solven s, and the like. These skyrocket not only in quantities but also in diversity with hun- dreds Of new chemicals annually coming into production and use. ‘0 illustrate this growth: in the field of plastics in 1940, production was 150 million pounds. Last year it was close to 5 billion pounds. Synthetic detergents in ‘0 years in- creased from 15 million pounds to 1.3 billion pounds. For the s me period productions of insecticides and other agricultural chemicals increased from 8 million to 540 million pounds. I cite these particular examples because of their impact as pollutants on our water resources. 3 The Manufacturing Chemists’ Association, under date of February 29. 1960, released an article showing that domestic chemical production arid research facilities costing $1.65 billion will be completed in 1960—61. Additio :1] projects of $1.34 billion were completed in 1959. This MCA survey represen?s 820 proj- ects of 318 companies in 458 towns. More than 60 percent of this ne construc- tion will add to synthetic organic chemical production. While it would be diflicult to forecast for 1970, with any degree of preciseness, the resultant level of chemical contamination in specific streams, available data covering recent years, however, do show a pronounced buildup in streams of total chemical contaminants. l Mr. HOLLIS. The point is, as one views this fantastic growth curve and growth period that we are in, certainly somewhere ahead we are going to be in serious trouble in this field unless, first, we understand 198 what the composite problems are and work out soon a means of prac- tical and effective control measures. A simple example is, again, drinking water. If the composite levels of all of this contamination continue to increase as they have over the past 3 years, there is no question in the next 10 years that these levels are going to be high enough to cause serious troubles with present treatment practices—trouble of even conditioning the Water for normal use, to say nothing of the possible effects, the chronic effects, on public health. Economics will become a major factor if many of our water supplies become unfit for human use before we are able to adjust our water purification and wastes treatment. The cost of providing new sources of water supplies introduces, for most cities, cost factors that are extremely high. There is no question, from a purely economic point of View, that we would be ahead moneywise to learn how to handle pollution before it gets out of hand, rather than to wait and try to adjust or go to other sources of supply for our drinking water. . We are already past 100 million people depending upon surface streams for drinking water. This figure is increasing at a very rapid rate. It will reach 165 million within the next 15 years. Some of the specific ways of attacking the problem have already been outlined by Dr. Price and by Dr. Shannon. Rather than repeat these comments, I would like simply to endorse what has been said as an initial ap- proach. Mr. FOGARTY. Is there anything else you want to say? Mr. HOLLIS. No, sir. Mr. FOGARTY. Do you have any questions, Mr. Denton? Mr. DENTON. No, sir. P ML? FOGARTY. Do you have anything else you want to say, Dr. rlce. Dr. PRICE. No, sir. Mr. FOGARTY. Dr. Burney? CONGRESSIONAL ENCOURAGEBIENT FOR PHS TO TAKE THE LEAD IN FIELD OF ENVIRONMENTAL HEALTH Dr. BURNEY. Mr. Chairman, last year in commenting on our justi- fication, you mentioned your impression of the need for greater em- phasis in this field of environmental health. Also, you even suggested the thought that we might need, or should consider an environmental center somewhat as a counterpart to the National Institutes of Health, which is in the primarily medical and biological field. You also, on numerous occasions, have emphasized the role of lead- ership which you believe the Public Health Service as the primary health agent of the Federal Government should assume. And you have, the members of your committee in Congress have, recognized these emerging problems and have expected us, as Public Health Service, to recognize and anticipate not only these trends but others in the field of health, and then to present to the Congress for either legislative or financial support to carry these activities out and not to wait until something happens and then try to do something about it. Mr. FOGARTY. I think that is a very fair statement. Many Mem— bers of Congress are concerned about the increasing problems that are increasingly being written up in magazines, as I quoted from one this 199 morning, and in newspapers. We are concerned because we do not think: the proper leadership has come forth nor adequate programs established to cope with these problems. As long as we have respon- sibility for appropriating the funds for the env1ronmental health pro- gram, we Want to make sure that we have explored every poss1b111ty of doing something to correct the deficienCIes. . Dr. BURNEY. You certainly have stimulated us, and I thlnk have exerted some leadership on your own part as well as expecting us to exercise some leadership throughout the country in these areas. I do not want to repeat all of the hazards and the importance of these, which have been well covered by the outside witnesses whom you invited to testify yesterday and who did, I thought, a very able job in all of these areas of presenting from their experience and competent viewpoints the needs in this area. I would like to say that throughout the history of this country, . man has always been able to adapt his environment to his own capa- bilities and for his own enhancement. As we heard today, we drain swamps in order to eradicate malaria so men can live in certain areas. I think many of us now, Mr. Chairman, have serious doubts that we are the total master of our environment. Perhaps we are rapidly becoming slaves rather than in control of the situation. And this is what concerns us as concerned the outside witnesses which you had here yesterday. Mr. FOGARTY. Many people thought that Walter Reed was a little crazy, didn’t they ? Dr. BURNEY. That is true. Mr. FOGARTY. Not many people took his ideas seriously. Dr. BURNEY. I think when one exercises leadership, one expects and should expect to have an understanding that you are going to hit a few bumps, and if you don’t, probably you are not doing enough. I do not believe we have shown too many inhibitions in attempting to assert proper leadership. ‘ EVALUATION OF TOTAL PROBLEM It is my serious and professional judgment, Mr. Chairman, that along with the chronic diseases that air, water pollution, radiological health and these other environmental health problems which have been so well covered in these 2 days of hearings, are the most serious health hazards that face the United States now and will in the next 10 or 20 years. I think, also, as was emphasized yesterday, that we have begun a little bit late to learn the extent of these hazards, to do enough to learn better methods to control them, and prevent them in order to prevent health hazards to you and me and the other people in our country. The funds have been increased in air and water and some in radio- logical health last year, and I think this year there was in the proposed budget before you, a little over a $6 million increase in the whole field of environmental health. But I would like to say this, Mr. Chairman, if I am in order, that the concern of you and members of your committee and the Congress in theSe and in previous hearings, and the fact that you requested us, as a result of your concern, to make a study of the environmental problems, what they are, what 52946—60—14 200 needs to be done, that was an extremely timely and helpful directive on your part. It made not only those of us in the Public Health Serv- ice, but the many, many groups outside of the Public Health Serv1ce focus a little more attention and thought and study to these roblems and to the whole problem, rather than thinking of it in its and pieces, about which I think we are always a little guilty. One cannot think of air pollution by itself. One has to consider that in relatlon to water pollution, radiological health, industrial health. I think we, as professional people, have been a little guilty of taking an isolated approach to these. I seriously believe that your committee’s directive to us has made us take a look at the whole problem, and not only us, but the people outside of the Public Health Service who are concerned in this, in that we are now more aware of the need for ourselves as well as for the Congress and our own legislative bodies, and for the public to deter- mine and define more effectively for you and for the public what are the problems in environmental health, what is being done now, and what needs to be done, and what do we need in additlon to do what is. necessary to prevent or minimize these hazards to the people of our country. So our request was a very desirable stimulus to us, and I am not sure t at any of us appreciate fully the impact that this report and these hearings will have, not only within the Public Health Service but throughout the country in these important areas. I would hope that we would be able to exercise even better leadership than we have in the past, that we would be able to promote, stimulate the better application of what we already know to prevent these hazards; that we would be able to promote, either intramurally or extramurally, through the universities, industries more research to secure answers to these areas. That we would be in a position to provide the kind of specialized technical assistance to our colleagues in the States and localities, and to industry and, in turn, would be receptive to the kind, of assistance that they can give to us in attacking this whole problem.. NEED FOR EDUCATIONAL AND INFORMATIONAL PROGRAM Finally, as you have reiterated here several times, to assume greater initiative in the educational process of not only professional people but of lay people. I think that it is true, as you have mentioned, environmental health is a comparatively unknown term to a great many people. This is probably one of the difficulties of professionals. They have their own little vocabulary and they are so imbued with the importance of an issue that they forget that other people are not as familiar with these problems as they are and are not nearly as un- derstanding of them. So I hope that we can provide a much stronger and better educa- tional effort in again cooperating with our colleagues in the States and localities, through industry, through professional groups such as the American Public Health Association, and many others. I would also like to emphasize, however, that we must be careful in this education program that we present substantiated facts and not just opinions, and let these facts, as you mentioned in your colloquy with Mr. Boisfeuillet Jones the other day that it be made freely available to the public, not as alarmists, not as unsubstantiated. 201 facts, but as information which can be fully substantiated on the basis of our knowledge and upon which we believe the public will react sensibly in support of our activities. I'do not think'we have done enough in education, Mr. Chairman, but this is not a very well known subject to a great many people and I suppose, like in many other areas such as in the venereal disease control program, without the initial dramatic efforts to impress upon the people the facts about venereal diseases, we might delay our attack on this program for many years. So I can assure you that we will improve our educational process along, as I say, with many other groups who have a contribution to make in this area and hopefully secure better public interest and understanding and support of these activities. IMPORTANCE or REPORT AND HEARING I would like to tell you again that I am not sure you appreciate the importance of this report. Maybe I should not say that, that you may not be understanding of the total impact that this report and these hearings are going to have, not just in the Public Health Service, but throughout the whole country, and particularly in those professional and industrial groups concerned in this area. I think, undoubtedly, it will have a very profound effect and I know many groups now are eagerly awaiting the printed copies Of this re port to you andrthe hearings which you have held, and I hope that this can be made available before too long a period. I would also like to emphasize many groups have a responsibility in this area and have a contribution to make to their solution, thinking again not only of industry, not only of the States and localities, but the many professional organizations and the public in general, that this job is too big for any one organization to assume the total role, and that our job in this, as I think you intimated, is one of leadership, of reserach, of stimulation, of application, of technical assistance, of education, and of giving some financial support to stimulate new efforts or expand the existing efl'orts. Again, the interest and concern of you and the members of this committee and the Congress as a whole have been of really inestimable help to us. We can say without reservation that we are very ap— preciative of this opportunity to present this total problem to you, together with the outside WltlleSSBS, and to assure on that as far as the Public Health Service is concerned, that we wi 1 do our utmost to merit in'thisarea, as I hope we have done in the others, your con- cern and confidence. W'e will try to make an even greater efl'ort within this particularly serious area—as Mr. Hollis and many others. have mentioned, of an increasing increment of the hazards over the next 10 years—within the available manpower, within the available physical resources, and within the funds available to us and others for the prevention or the minimizing of these hazards to the people of our country. Thank you, sir. 202 TOTAL FEDERAL GOVERNMENT ACTIVITY IN FIELD. OF EN‘TRONMEN’D‘AL HEALTH Mr. FOGARTY. Mr. Laird raised a question this morning about what the Army, the Air Force, the Navy, the Atomic Energy Commission, and other Federal agencies are doing in this field. You will get that information, Will you ? Dr. BURNEY. Yes, sir. We indicated to Mr. Laird that we would attempt , to secure the information relative to what is going into these areas from throughout the Federal Government, but alsoinoted the difficulty of defining these within a certain focus because, as was mentioned this morning, the military are doing some of these things in relation to their own defined objectives and not with relation to how they might affect the public in general. Mr. F OGARTY. I would like to make sure of this. I think it is im- portant that we have that information. (The requested information follows :) WORK BEING DONE IN ENVIRONMENTAL HEALTH BY GOVERNMENTAGENCIES Environmental health embraces a broad field of activities. These involve the impacts on health of contaminants in the environment and environmental stresses in our modern living. The categorical components of environmental health, such as air and water pollution, radiation, food contamination,,.and occupational hazards each is of such magnitude and breadth as to impinge on practically all aspects of community life. Because of this, various aspects of the problems are receiving attention in different departments of government, at both Federal and State levels. However, the focused attention in any one branch of Government is in terms of the mission and responsibility of that branch. Problems associated with ionizing radiation are receiving special attention in various departments and agencies. Again, in each agency the work relates to the specific needs and responsibilities of that agency; for example, the De- partment of Defense with respect to the broad military application of atomic energy; the Department of Agriculture from the standpoint of the effect of radiation on‘agricultural production, and the Department of Health, Educa- tion, and Welfare from the standpoint of public health implications. The basic responsibility of controlling radioactive sources, of course, is with the Atomic Energy Commission. In the field of radiation research, there are areas of interest and need that overlap. This raises the question of duplication of effort. Radioactive waste from-the production and use of atomic materials is relatively a new contaminant in the environment. The effects of such waste are so significant and there are so many gap areas that the bestefforts of all agencies will be required. to under- stand and to handle the problem. The President recently set up the Federal Radiation Council as a meansof developing a coordinated Federal effort in radiation protection. A number of effective mechanisms have been used to insure a free exchange among such research groups to avoid unnecessary dupli- cation of effort. - - For example, the publication of technical papers, discussions at national meet- ings, and the periodic symposia, all provided means for the exchange of informa- tion; Actually, there are many instances of combined efforts among agencies; for example, the matter of decontamination of drinking water supplies. The Department of DefensefWas interested in terms of field-operations; .the Public Health Service, in terms of public water supplies; and the Atomic Energy Com- mission, in terms of levels and types of isotope pollution that might be allowed. This problem was approached on a 2-year joint research program in which the Department of Defense provided the equipment; the Atomic Energy Commis. sion, the laboratory space and administrative direction; and the Public Health Service, the technical staff and senior project direction. The results are set forth in a joint publication by the three agencies. In air pollution, the principal Federal activity is centered in the Public Health Service. However, there is a major interest in the Departments of Agriculture, 203 of Commerce, and of Interior. An interdepartmental committee was established several years ago to insure free exchange of information and joint participav tion in research and investigations. Actually, the other Departments assign personnel to HEW to assist on special studies and projects. Similar working relationships exist with respect to water pollution. ‘ There would appear to be no practical way or essential need to have all work in the broad environmental health area or in the specific categorical areas car- ried on in a single agency. Experience has shown in activities of this nature that greater progress can be made by authorizing research and investigation in line with the mission and responsibility. Within the limited time available we have been unable to obtain complete data as to the total governmental expenditures in the field of environmental. health. LEADERSHIP BY PIIS Mr. FOGARTY. Is there any opposition to the Public Health assum- ing leadership in this field? Dr. BURNEY. I think quite the contrary, Mr. Chairman. Most of the—all of the groups with whom I talked before this hearing and during the hearing, Whether it was industrial medicine or Whether it was in radiological health, or water pollution, believed that the Public Health Service is the logical agency of the Federal Government to carry out these activities, and that we really ought to be doing more than we are doin at the present time, but also recognizing that other ‘ renps outsideo the Federal Government have a contribution. .The tatesshould be doing, many of them’should be doing a better job on water pollution than they. aredoing now. They should be doing other things a little better, and the universities should contribute more than they are. Again, this is related, as wasmentioned this morning, to var— iances 0n areas of developmental research in these areas, not to deter- mining'the problems that have accrued as a result of the develop- mental research. All I am trying to say is, I do not believe anyone but agrees that we are the logical group to be concerned at the na- tionallevel with the major part of this activity, but I want to em- phasizethat there are many other groups, State and local and indus- trial and universities, that also can and must be interested in this area. Mr. HOLLIS. Mr. Chairman, may I just make one point. In the engineering field, the American Society of Civil Engineers is the founder engineering society nationally that would have the keenest interest in problems of this kind. On January 14, 1960, the society passed what many of us think to be a very forthright and excellent statement of the problem of environmental health, environmental con- trol and health, and I have a copy here if we might be permitted to have it go in the record. ' ' ' " , ” ,' Mr. FOGARTY. All right, we will put that in the record. (’Dhe resolution referred to follows :) . . , 'AMERICAN SOCIETY OF CIVIL ENGINEERS RESOLUTION ON ENVIRONMENTAL ' ' CONTROL AND HEALTH , . » The continuing upsurge in technological developments and the increase and concentration of our Nation’s population are resulting in environmental control and health problems of mounting magnitude and complexity. The sanitary and civil engineering effort needed to deal with the many hazards in man’s changing environment must be substantially broadened and intensified. In addition to the traditional biological contaminants in air, water, and food, major attention must now be given to environmental contamination associated with microchemical substances. Man’s environment including problems of water and air resources, 204 transportation, the structures in which man lives and works, and environmental planning presents complex problems which need intensive research and study if future satisfactory development is to be achieved. A broad scale eifort should be launched with emphasis on research, development of trained manpower, and application of new knowledge. Full utilization should be made of Federal and State organizations as well as universities and other research institutions. The sanitary engineering division of the American Society of Civil Engineers endorses the timely request of the House Appropriations Committee that the Public Health Service make a thorough study of environmental health problems and the organizations and resources needed to cope with them. Theisociety feels that this study is extremely important and if desired, will gladly furnish such assistance as it can. Mr. FOGARTY. Thank you very much, gentlemen. That concludes the hearing. ‘ ADDITIONAL STATEMENTS (NOTE—The following additional statements were subsequently re- ceived by the committee.) STATEMENT OF THE NATIONAL MEDICAL ASSOCIATION Mr. Chairman and members of the House Appropriations Subcommittee of Labor, Health, Education, and Welfare, I am Edward C. Mazique,president, National Medical Association, and Wish to go on record in-support of the appeal by Surgeon General Burney of the U.S. Public Health Service for the establish- ment of a National Institute of Environmental Health with Federal financing and authority under the U.S. Public Health Service. _ On behalf of the National Medical Association of which I am president I sub— mit for the record a copy of a resolution passed by our national board this past February 7, on chemicals employed in food production and processing and ex- pressing grave concern over rising radiation measured in some foods. I wish to call special attention to recommendation No. 3 urging a coordinated Federal service for protection of the food, water, and air in the public’s interest. Thank you. CHEMICALS EMPLOYED IN Foon PRODUCTION AND PROCESSING (Resolution submitted by Dr. Edward C. Mazique (of Washington, D.C.), presi- dent of the National Medical Association, Inc., and approved by the executive committee of the board of trustees of the National Medical Association in interim session, February 7, 1960, in Pittsburgh, Pa.) Whereas the growing use of chemicals in foods and in pesticides for the pro- tection of crops have greatly increased effectiveness and advanced marketing on one hand, there is growing questions of their impact on the health of the citi- zenry; and - Whereas there may exist a casual relationship between these phenomena and the unexplained increased incidence of degenerative diseases such as cancer, leukemia, arteriosclerosis, and certain heart disorders, and the health and per- haps even the survival of the American people is at stake; and Whereas certain tests on animals (laboratory rats) and other research meth- ods of cigarette use, coal tar colors as used in lipsticks, pesticides, and weed- killers, DDT around dairy barns, medicated feed for meat animals containing organic chemicals and hormone preparations have shown the production of car- cinogenic conditions, in liver and kidney damage or other disorders; and Whereas respective industries marketing these products at great profit to themselves, and the consumers of these products may have become primarily con— cerned with expanding production of chemical additives for more and more products: and Whereas by a 1958 law the burden of proof as to the eflicacy, or rather dele- terious effect (that is, safe levels) tolerance to be established through research eiforts of the respective industries (chemical manufacturers) instead of the Food and Drug Administration; and 205 Whereas producers and users of chemicals ordered in September 1958 to docu- ment safety of additives have only cleared 180 of the almost 600, with March 1, 1960, as a deadline; and Whereas small quantities of zinc 65 (a radionuclide) was found in a variety of foods obtained from the local markets serving Cincinnati, Ohio (a radionuclide dispersed by high altitude fallout), from foods produced from farms irrigated with waters from Columbia River and seen in animals and people eating this farm produce and with highest levels of radioactivity detected in oysters har- vested from Chesapeake Bay and in view of the mass of information substan- tiating the increasing fallout: Therefore, be it Resolved, That the National Medical Association, an organization serving almost exclusively the population of consumers, go on record in support of: 1. Championing the cause of the consumer and work for rigid control of additives, fight for the Delaney amendment and in support of Secretaries Flemming and Benson and other administrators in their attempt to fight for us against producers and industries Who consider profits above people; 2. That Flemming’s role as watchdog over the health of the total Nation from childhood of its citizens onward be encouraged and strengthened with necessary funds and citizens support; 3. That we recommend a reorganization of administration concerned with ad- vancing protection of consumer against food poisons, radioactivity, air pollu- tion, providing that Secretaries Flemming, Benson, and Defense department cooperate in research and unify protective measures or propose a nonpartisan Government-supported commission or coalition to investigate the entire subject and propose legislation in interest of the consumer; 4 That we supp01t the Delaney amendment to maintain a clause in food and drug law prohibiting cancer producing substances in products consumed (H R. 7624). 5. For an enlargement of Federal funds to provide under Government control for research, tests, and inspection by Government agents rather than as under the 1958 law by independent chemical industries and users. 6. For the abandonment now of the present laissez faire program of opera- tion where our food and other intake products (cigarettes, lipsticks) are con- cerned in favor of a program designed to protect health and promote well-being of consumers. That citizen interests in 1960 become paramount. _ 7. That we unanimously endorse the Secretary of the Department of Health, Education, and Welfare and that we inform him and the public what he has done in the Nation’s) interest is not to his discredit but a reason for citizen support and that the board of trustees, speaking for its membership, their patients and friendsuwho have entrusted their health to us for safeguarding. 8. That the National Medical Association lend its support to bill H.R. 9150, which proposes a law for establishing a commission to conduct an impartial and scientific study and investigation to determine the effects on the public health of the practice of adding various chemicals to water supplies and food products, and to endorse joint resolution (H.J. Res. 523), designed to prohibit officers and employees of the United States from treating communal water sup— plies with fluoride and other such compounds until a report from the Commis- sion on Food and Water Contamination shall have been submitted to Congress. 9. That copies of this resolution be sent to the President of the United States, members of the congressional committees, the National Association for the Ad- vancement of Colored People, the American Medical Association, the National ,Urban League, and others. STA'I'EBIENT OF THE SPORT FISHING INSTITUTE SPORT FISHING INSTITUTE, Washington, D.0., March 10, 1960. Hon. J OHN E. FOGARTY, Chairman, Subcommittee on Health, Education, and Welfare Appropriations, House Ofiioe Building, Washington, D.0. DEAR CONGRESSMAN FOGARTYZ At the time I testified before your committee last Week on the Public Health Service appropriations you invited us to submit comments on the general subject of the need for an adequate environmental health program. At that time you indicated that you had received a report from the Department of Health, Education, and Welfare and were going to hold hearings on the problem this week. 206 The Sport Fishing Institute is very pleased to submit its ideas on this very important subject. We have not yet had the opportunity of reviewing the Department’s report, so we confine ourselves to the general problem. It may seem strange to you that an organization primarily concerned with sport fish conservation is directly interested in this problem which is essentially one of human resources and not fish and wildlife. At the same time, however, we have found that our basic biological background can be a very valuable one in consideration of these problems. Although we don’t like to think about ourselves as just another species of animal, the fact remains that it is true. Biologists are probably the best trained people to observe changes in the en- vironment and what it will do to the species who are trying to live there. There is probably no better example than a stream that is polluted. It is shocking to see how quickly a game-fish population will disappear with even slight detri- mental changes in the environment. The game fish are generally first replaced with trash or useless fish and finally, as the stream becomes completely polluted, there is no fish population at all. Many of us can foresee a somewhat analogous situation as far as the human population is concerned. The regrettable part is that there has not been enough research for us even to accurately predict what is currently happening in our metropolitan areas, much less to predict what the future will hold. This, of course, is not news to you or your committee. The committee’s April 1959 report on 1960 appropriations stated the total problem very well. We are pleased to see that the Department has reviewed the problem and has come up with a report outlining the needs in this most important matter. We hope that your committee is able to review this report and eventually come up with a program that will supply some of the answers to problems of air and water pollution and the use of radioactive materials. ‘ I believe that anyone who has studied this problem for some time will recognize the Public Health Service’s program in environmental health is scattered among a number of different functions. If one general recommendation can be made it is that more emphasis should be given to the biological aspects of the problem as far as research needs are concerned. I doubt if anyone Will question the need for research. At the same time, it is apparent that this is not the total problem. We feel that any program should go beyond the research phase and come up with some definite control activities. Encouragement to do a better job is more effective when it is backed up with enforcement responsibility and I believe that the experience of the Food and Drug Administration, which you are familiar with, bears this out as well as any other example I can recall. Another large general problem of environmental health with which we are specifically concerned is the problem of leisure time. We believe this is an environmental health problem that is extremely important. Relaxation and recreation are essential to combat the stresses of an increasingly urbanized and hectic way of life. Providing the facilities and even estimating what the demands would be is an immense problem and I believe concern over this problem has been reflected in the creation of the national Outdoor Recreation Resources Review Commission and by the various bills that have been introduced to create some sort of a national recreation function in the Department of Health, Educa— tion, and Welfare. There is no question that the Federal Government has an obligation in this area. Local governments generally are not able to meet this need of supplying services for a transient population. This is particularly true, as I can testify from personal experience, in such areas as providing adequate campgrounds and satisfaction in outdoor recreation areas. In conclusion we would say that Congress is the logical body not only to respond to the public demands in this field but to take the lead in identifying the critical problems and establishing the machinery so that they can be solved. We feel strongly that your committee has done an outstanding job on this is the past and we are confident that you will maintain your excellent record in the future. The important point to us is that we can’t wait much longer. Many of us want to see a major program get underway. At the same time, it is more realistic to build on what we have now and realize the inertia to be overcome is tremendous and it will be hard to sell. Fortunately, air and water pollution are not concerned with epidemics and this is a real tribute to the dedicated personnel in this field. The philosophy we need is that of the Food and Drug Administration—pollutants have no place in water even though they can be removed if we are willing to pay the cost of in— 207 creasing the degree of treatment for water supplies. It is not so simple to pro- tect fish life and recreation, unfortunately. We believe your committee is in an ucellent position to focus attention on this problem and hope that you will be able to make a specific start this year by in— creasing the budget for the environmental health activities to the limit of the Public Health Service’s capability. We appreciate the opportunity of commenting on this program. . Please let us know if we can be of further assistance. Sincerely, ROBERT M. PAUL, Executive Secretary. STATEMENT OF SETH GORDON Mr. Chairman and members of the Subcommittee on Appropriations for the Departments of Labor, and Health, Education, and Welfare. First, I should like to congratulate Mr. Fogarty, the chairman, and the other distinguished members of this committee for their farsightedness and great in- terest in the health and welfare of the people of this Nation. I refer particu- larly to the committee’s Report No. 309 under date of April 28, 1959, in which the committee requested the Public Health Service to make a thorough study of the environmental health purposes and the most efficient organization of our facilities to meet the needs of the ever-growing and increasing number of environ- mental factors affecting the health of the people of this country. Indeed, you are to be commended by all. But more particularly, you de- serve the plaudits of persons like myself, who, as an administrator of long ex- perience (almost 40 years in the conservation field), knows the dangers involved unless 'we do something and do it fast. In its report of April 28, 1959, it is most significant that this committee on page 10 of that document said: “The committee also recommends that in the preparation of the budget for 1961 serious consideration be given to setting forth separately in the budget all water pollution control activities and all air pollu— tion control activities. This will give everyone concerned a much clearer pic- ture of what is being spent on these activities than is shown when they are par- tially amalgamated under the general title ‘Sanitary engineering activities,’ and partially set out separately.” I, together with many of my colleagues in the conservation field, have been fighting for a number of years to establish a budget for water pollution and air pollution control separate and apart from other budget items, and the reason for so doing I shall discuss later. It is my great honor and privilege to have been appointed by the President of the United States as a member of the Water Pollution Control Advisory Board. This Board on two occasions, and as recently as January 19 of this year, has urged that this be done. I quote in full the resolution of the Board at its January meeting: “In view of increased public and congressional aware- ness and interest in the Federal water pollution control program, and their consequent interest in appropriations for such program, the Board believes that the budget should contain activities so as to be readily identifiable at all stages of the budget and appropriation process.” As I stated above, I am an administrator of long experience; therefore, I can well understand the desire of budgetmakers, as well as administrators, to con- solidate funds by logical groupings so that when unforeseen situations arise funds can be shifted to expedite the handling of them. But in the case of water and air pollution control, those who support the program want the moneys sepa— rated so that they may know from year to year exactly how much is set aside for these functions, also to make certain that those moneys are not siphoned 01f for other purposes. While I agree with the Surgeon General that the environmental health hazards are tremendous and it is the obligation of the Government to better man’s living environment, the air he breathes, the food he cats, and the water he drinks, I most respectfully disagree with the Surgeon General that a budget for water and air pollution should be consolidated with all other aspects of environmental health. It is my belief that public health agencies, State and Federal, traditionally have not demonstrated a willingness to tackle water pollution problems. Ex- cept and until waterborne disease epidemics forced them to act, they did not 208 wish to begin this tremendous task. It is interesting to note that our own US. Public Health Service took little interest or leadership, until Congress literally forced the issue and imposed this responsibility on it by the passage of Public Law 845 and further supplemented it by Public Law .660 in 1956. It is like- wise interesting to note that because of the inertia of State health departments many States have created separate agencies to set up and deal with water problems, especially pollution. In view of the apparent inability or the unwillingness of the U.S. Public ,Health Service to persuade the Bureau of the Budget to separate out the funds for water pollution control from the moneys for environmental health activities, as well as its-inability to convince the Bureau of the Budget to request ade- quate appropriations to cope with the terrible need to combat water—borne diseases such as infectious hepatitis and others, there is developing country- wide a strong demand to transfer water pollution control functions to some agency other than the Public Health Service—one that will make a serious ef- fort to convince the Bureau of the Budget that these functions are important enough to stand separate and apart, and important enough to have an appro- priation commensurate with the ever-increasing job to be done in the face of exploding and shifting population. I hasten to state, that I, together with most conservationists in this country, would prefer to see this work remain in the US Public Health Service, provided, of course, the Service will, in good faith, set it out and segregate it so that it can be identified. Nevertheless their patience has already been strained, and they are demanding action now. I need not tell you, Mr. Chairman and members of this committee, of the seriousness of this situation, the terrible need to combat diseases such as in- fectious hepatitis actually in the shadows of the Nation’s Capital. Recently, the headlines of the Washington papers told of an outbreak among the school- children of Prince Georges County. The sources of this infection could have been near or far, because the virus lives and travels in sewage water. Hepatitis is a disease hard to combat and highly contagious. Young people are most sus- ceptible. The terrible toll of this disease, when allowed to get out of hand, was demonstrated in New Delhi, India, a few years ago. The water supply became grossly contaminated by sewage, and thousands of people died like flies. Just last year, the American Medical Journal reported an epidemic of hepatitis close to home, at Clearfield County, Pa. This growing threat of disease stresses the urgency for more sewage plants in a nation with an exploding population. I strongly urge this committee to force the issue by demanding increased ap- propriations and the separation of funds in the next annual budget so that the entire sums for water and air pollution control, plus the grants-in—aid, will be easily identifiable and also to avoid the danger of having such moneys diverted to other purposes. LIST OF WITNESSES Ackerman, Stephen Page 147 Adams, M. P 1, 138 Bosch, Herbert Burney, Dr. L. E Doran, H. T. Eliassen, Dr. Rolf--- _ _ Hilleboe, Dr. Horman Hollis, M. D 1, 33, 147 147 1, 76 1, 53 147 Jones, Dr. Boisfeuillet Kelly, J amps 1, 82 147 MacKenzie, Vern on 147 McFarland, Dr. R. A Nelson, Dr. Norbon-- 1, 103 1, s7 Price, Dr. D. E Shannon, Dr. J amps Whittenberger, Dr. J. L ‘Wolman, Abel _________________ 147, 190 1, 128 1, 45 INDEX Page Accident prevention activities _____________________ 39, 41, 69, 103, 150, 155, 182 Additional funds needed 123 Driving simulator 125, 127 Legislation 120 Poisoning ' 70, 74 Separate appropriation for 126 Air pollution 61, 88, 130, 148, 155, 174, 189 Chemical contaminants 7'7 Appropriations in 1959—61 41 Appropriation structure, change in 188 Authority for expanding activities 41, 43, 152 Awareness of public to environmental health problems ________ 45, 79, 83, 85, 196 Cooperation of industry 81, 95, 169 Coordination and exchange of research, need for ________________________ 90 Director, NIH, statement of 190 Diseases caused by environmental factors 88 Educational program needed ______ 193, 200 Expansion of program: * Additional funds for: Amount of ______ 153, 166 Use of 40, 153 Authority for 41, 43, 152 Consequence of failure to expand 53, 95, 194 Need for 87 Expenditures, Federal 42, 44 Facilities, need for additional 43, 92, 94, 138, 187’ Federal activities in environmental health, total _______________________ 202 General engineering and sanitation services 66 Importance of program____ 199 Integration of diiferent phases of program 168 Legislation needed- 40, 41,152 Milk and food and general sanitation 149, 171, 183 National Advisory Health Council, recommendations of ________________ 83 National Medical Association, statement of 204 Occupational health 150, 180 Organizational structure for expansion of program_._______‘_ _________ 2, 31, 35, 40, 43, 59, 78, 93, 187 Personnel requirements ______________________________ 42, 72, 100, 133, 138, 176 Training of 101, 137, 154, 167 Radiological health activities ___________________________ 39, 45, 63, 131, 134, 148 Assistance to States, technical 174 Increase in diseases 136 Overlapping of activities of PHS and Food and Drug Administration. 170 Strontium 90 in milk 171 Studies presently being made 89 Waste disposal problems 159,169 X-rays, danger of 172 Relationship with other public health activities _________________________ 156 Research and training programs proposed __________________________ 93, 94, 137 Research performed by other Government agencies ____________________ 156, 169 Responsibilities for handling environmental problems ________ 12, 38, 92, 96,193 Public Health Service role ____________________________ 52, 55, 147, 198, 203 Sports Fishing Institute, statement of 205 State and local agencies, working relationships with ____________________ 158 Surgeon General's report _____________ 4 Summary of _____ -_ 34 Training program____ 93, 101, 137, 154, 167 Universities and other groups, use of 42,178 Centers for research 84, 132, 138, 177, 194 Water pollution _____________________________________ 60, 140, 149, 17 8, 184, 197 Chemical contaminants- 77 Enforcement program __ 179 Shortage of trained personnel 149, 175 m 0 {I