Monitoring air quality in Healthy People 2000.

Abstract

The quality of the environment has historically played a significant role in public health (1). One of the early successes of public health involved limiting access to a contaminated water supply (1). While focusing on the environment is an obvious and sometimes successful approach to improving public health, the scope of such efforts is complex (2). This complexity is reflected in measurement of the levels of pollutants in the environment, the levels of individual exposure to these pollutants, individual susceptibility to the pollutants’ toxic effects and the health effects attributable to the pollutants versus other influences. Measurement of pollution levels is complicated by the diverse sources of pollution and the varied media of pollution migration and exposure (e.g., air, water). Lengthy time periods may be required to accurately monitor pollution levels; similarly, some environment-related health problems (e.g., some forms of cancer) may also require considerable time to develop before they are detected (3). Measurement of pollution levels is also related to physical characteristics of the environment (e.g., temperature, wind). While location may be a proxy measure for individual exposure to specific pollutants, its utility is somewhat compromised by individual behavior which may mitigate exposure to specific media. For example, an individual who spends a great deal of time indoors may be less affected by ambient air quality, but more susceptible to the effects of tobacco smoke or fungi. Similarly, individual susceptibility to the effects of pollutants may be affected by both genetic characteristics and/or health promotion/health care utilization. Data to monitor both individual exposure and susceptibility are not readily available for large area monitoring. Finally, attributing health effects to specific pollutants is complicated by both the previously described factors affecting measurement and also the impact of non-environmental causes of the same health effects (e.g., smoking, dieting). In chapter 11 (Environmental Health) of Healthy People 2000 there are 16 objectives related to a wide range of environment-related public health problems. The objectives measure progress in health status, risk reduction, and services and protection related to these problems at the national level. Some of the measurement issues in the preceding paragraphs affect the monitoring of these objectives. This report focuses on one of these objectives (11.5 ambient air quality), which poses special problems in measurement and interpretation. The report presents background information on the environmental problems associated with the objective, including the health risks, the source (s) of the problem, and the media of transmission. It also discusses how Healthy People 2000 monitors the objective, the data source used, issues related to the data source, and the interpretation of the data. The authors wish to acknowledge the technical consultation of Tom Curran and Barbara Parzygnat of U.S. EPA’s Office of Air Quality Planning and Standards. Number 9 September 1995