Hold your breath; Day to day health effects

The following tape recorded program is distributed through the facilities of the National Association of educational broadcasters. Just hold your breath. Hold your breath as long as you can. Soon discover how vital this natural resource is. Yes air is the most precious substance we have when it's plain it's healthy and useful when it's polluted. It's costly and it kills. Air pollution is a threat to our way of life and you should know more about it in these radio programs produced by Michigan State University under a grant from United States Public Health Service. Every aspect of this national problem from health effect to economic considerations will be discussed. Air pollution will be viewed by legislators scientists public health officials representatives of into three. We challenge you to draw some logical and responsible conclusions.

You know our last program we talked about tragedies caused by heavy concentrations of air contaminants under adverse atmospheric conditions. But a warning was also issued that the day to day insidious effects are far more important to most people than the isolated more sensational episodes. Today you'll learn more about the general health effects of air pollution. Dr. Terry a surgeon general of the Public Health Service and with responsibilities for the help of all the people in the country. Would you say that we have reached a critical period in the United States on this matter of air pollution. Yes I think definitely that we have reached a critical period in the United States. There is good scientific evidence that air pollution contributes significantly to a number of chronic diseases. I don't think there is any question but that we have a serious problem. Furthermore I think we should take into consideration that as our industry and technology advances there

we're going to have new and different problems and we haven't even begun to catch up on Brecht current day problems yet. How does it affect the average citizen in our large communities or even in the rural communities. Well I think one of our real problems in this direction is it is a question of saying exactly how it does affect a person. There are certain instances in which we know. For instance in late November and early December 962 when the great smog incident occurred in London we realised that there were acute effects of these acute effects. Generally speaking are more prone to involve persons who are elderly or who already have chronic diseases. As bad as this is I think more important are the ensuite incipient effects that take place over a period of time

where they take essentially the whole population. And one cannot say by any means that the effects that we see during one of the big smog episodes are clearly demonstrated at that. They are accumulating effects that take place over a period of years and this is one of the difficulties we have and this is one of the things that we're trying to approach today of course both through animal work and through observation zone human beings is a question of trying to define clearly what those pollutants are which are most dangerous from a long term standpoint. And in what concentration do they reach a dangerous level. And this is very important because it's not just a question of smoke a fog. It's a question of those chemical substances which are in the atmosphere. And this is one of the reasons that we need a tremendous amount of increased effort in terms of. Evaluation in this direction.

The difficulty in determining the extent of the health effects of pollutants is a very real one. Just as there is no disease of air pollution itis there is no single cause that can be traced and eliminated. As Dr. Terry points out. There is increasing evidence that many factors come in to play in producing chronic disease and that there is not. In most instances a single cause. Therefore we have a complicated study and we have complicated problems in terms of trying to evaluate the weight of each of these factors. One of the first things of course is to identify the factors and in many instances we're not even talking about quantitatively weighing them as to how important they are but whether they do not. And this of course has to be determined first studies to determine the nature of those pollutants in the air which are most harmful to us are being carried out among other places in California. Dr. John Goldsmith tells our interviewer

about some of the work being done. Dr. Goldsmith. We have responsibilities as head of the air pollution medical studies in the California Department of Health. Could you tell us a little bit about the things that concern your group within the health department. Appears to us we are concerned with all of the health effects of air pollution. We have conducted population surveys which provided evidence as to the proportion of the population. Who are bothered by air pollution in a manner in which they're affected. We have undertaken studies of many effects of air pollution on lung function. We have. Been particularly concerned about. The possible relationship of air pollution and chronic diseases. And finally we have watched with some concern the possibility that air

pollution might be causally related to sickness or our death. These are our main concerns we have a responsibility for carrying out research and also using this research to set air quality standards. Have there been any either significant or suggestive results concerning help that have come from your studies so far. I would be the wrong person to comment on the significance perhaps but I'd be glad to tell you what some of the results are less about some of those of what the first question that was asked of us was will this stuff kill us I think but when a population of people become. Frightened by things which are unprecedented for them and difficult for them to understand this is a very reasonable question and in the early stages and phases of the Department's program we spend a good deal of effort in fact we still do. But we were concentrating our attention on this general question. We

have since 1954 maintained a surveillance scheme in Los Angeles in which the. People who live in nursing homes with 25 or more beds reported to us each week. The number of individuals in these homes who have died or who've been transferred to hospitals. With such a system. We have two ways of making observations in the first case. If air pollution increases in severity how we can find out within a few hours whether there has been any increased mortality for example amongst this group of people there are elderly group and in frail health. And it's been our feeling that they would be a population group who would be most susceptible to any favorable change in their environment. We made a couple of observations on this population in

1955 there was a heat wave. Which was both preceded and followed by rather severe air pollution. During this period the number of deaths per day increased about nine times. Now the temperature dropped the temperature was over 100 degrees for a week and the temperature dropped at a time when the and the deaths dropped at the same time. But the smog period the bad air pollution which followed this did not cause an increase in the number of deaths for them are we went back in our records and examined daily mortality four thousand nine hundred thirty nine. When I think all of us realize that was a great deal less air pollution. And similar heat wave or Kurd with a proportionate change very similar to this in mortality. So we have two conclusions one of them is that the group we are studying are sensitive to adverse environmental changes and secondly

the data suggests that the heat was mostly concerned with this particular excess. This does not mean that the air pollution levels might not have contributed. But we cannot draw a conclusion that they have contributed. Haven't you done some studies concerning. Emphysema and your department also. Yes we've been looking with some concern at the death rate from emphysema over the last decade and we found that the the number of certified dowse due to emphysema. In the death certificates has increased about 400 percent over this period of time. This is sufficient to suggest an epidemic of chronic disease course most of us are not in the habit of thinking of an epidemic of chronic disease. But if there is such a thing. This is what it might look like. Now as to how this is

related to air pollution I'm fraid that the answers aren't all available. Of course the increase in emphasis is partly related to greater familiarity with the diagnosis amongst physicians. It's partly related to the fact that some people with chronic lung diseases such as tuberculosis and manya now survive when previously fractious diseases were gleeful. Partly it may reflect the fact that people with chronic respiratory conditions come to California because of the. Milder climate. And of course no one ever wants to leave once they come. And if they die with the condition they die in California. But on the other hand I think it's proper to say that all of us feel that a large part of the increase is real. And some of it may be related to air pollution. Some of it is probably related to cigarette smoking. In addition to the nursing home study and the studies concerning emphysema

is the department in your particular group within the department concerned with any other studies on the health effects of air pollution. Well we're concerned with quite a number there are 70 or 80 projects that we've been involved in at one time or another. One of the groups of projects has been the observation of groups of people with chronic respiratory conditions over the periods of time which they were exposed to sprog and which also lung function tests were obtained. The patients in this case they were hospital patients reported daily how they were feeling in these studies. A very instructive in the sense that they give us a great deal of information but it is not very easy to analyze. Them out of these studies. We've been able to conclude only that a few people in the populations we studied might in fact be reacting to air pollution. But most of them do not seem to be.

This. That is I gather is pretty hard to put your finger on in a positive sort of a way with would this be true. It's hard to find new cases of disease or an increase in the number of deaths which you can positively associate with air pollution. But it is not hard to find positive effects. Tell us about these. Well for example we've been studying the. Level of carbon monoxide hemoglobin are called Boxee hemoglobin in the blood of people who have a variety of exposures both to cigarette smoking and to community air pollution. Much of our work has been in the development of very simple methods for determining this. We merely collected a specimen of the expired air after a person has held his breath for a while and this turns out to be a very accurate reflection of the amount of. Her box of

hemoglobin in the body and on the basis of these studies we can detect the positive effect. Of air pollution in which a certain amount of the body's hemoglobin is. Combined with carbon monoxide and hence becomes unavailable to the body for the transport of oxygen. We. Feel that even small amounts of carbon monoxide will produce a detectable. Decrease in the amount of hemoglobin available for this vital function. And in the sense of this is a positive effect. Now the consequences of this are not necessarily new cases of illness or or deaths but they are nevertheless very real and in our opinion of some importance in the presentation that you have made that goes with that. At the National Conference on air pollution in Washington in December of 1962 you talked a little about the increased

resistance to the breathing process with a difficulty in breathing Could you elaborate on that just a little. Yes I'd be glad to. The. Lungs function. By moving air in and out of them of course and the air goes through a series of tubes called Bronx High and Brucie old. These two are. Nicely fitted out with ways of protecting the deeper structures of the lawn from irritants they will constrict when they're exposed to irritation. Now the physics of airflow is such that a constriction of say one fifth of the diameter of a small air to it increases the resistance to airflow by 100 percent. And so the response to inhale the evidence and indeed to even large amounts of inner dust is an increase in

the resistance to air flow into and out of the lung of the practical consequences of this are that in order to exchange the same number of units of air it is necessary for the body to expend more work. While for most people in good health this may be relatively unimportant at least at the response levels we've observed experimentally for people and carousel for people with chronic heart lung disease. It may be of fairly great importance there been a good deal of work of this sort and there are both fairly elegant and elaborate methods as well as some relatively simple methods for estimating the resistance to airflow in and out of the lung. Elaborate methods as you may gather haven't been as widely used because they're more difficult to use. The simple methods we used extensively. And they were used for example in the studies I

mentioned about persons with chronic lung conditions that were studied through smog period. These studies and populations exposed to natural air pollution. Have as I indicated been somewhat difficult to interpret. The few patients who did seem to react. To air pollution levels with changes in the lung function tests did show them in tests which reflect airway resistance. Do I gather correctly then that the studies concerning the ability of the blood to transport oxygen. And the resistance as far as breathing are concerned while graps are not too important to the individual and robust health that might have a significant impact on the health of the person that was was not in robust health. Yes that's quite true not Eustace.

I think that it's the responsibility of those of us who are concerned with public health not to confine our attention solely to the healthy sector of the population when there is a more sensitive sector which may come to some harm that goes with all of us know that folks carrying out to research it studies US such as yourself are well justifiably somewhat reluctant to say this causes that or this causes the other thing in medicine it to be accurate we must make some qualifications but to back Answer me this if you can in spite of the qualifications that are necessary. In your opinion do we really know enough right now about the adverse health effects of air pollution to warrant the expenditure of relatively large amounts of money to overcome this thinking that this is money that sooner or later is going to come out of our own pockets as consumers. Well I'm afraid I'm only familiar with one state and it's big and

complex state and now I have no reluctance to answer affirmatively with respect to the metropolitan areas of California. And I'd even go so far as to say that areas that are not usually thought of as being metropolitan when we begin to make measurements of the earth pollutant levels we find sometimes to our dismay that they're in they're in a worse situation than we had thought. For example Sacramento which is a pretty large town about yet not a major metropolis of the same size is to try to send Cisco had some very severe pollution. Experiences last year and the carbon monoxide levels in the valley town Sacramento in Fresno was every bit as high as those that are observed in Los Angeles. So in answer to your question with respect to California I'm well aware of the hundreds of millions of dollars that I'm a control program

may cost the people in our state and I think the investment is essential and cannot really be today. Regardless of the lack of complete knowledge concerning harmful pollutants in the air or general agreement as to their respective of facts on health there is unanimous consent that enough is known to merit preventive control action. The surgeon general emphasizes this point. Oh I don't think there's any question but the day evidence today supports the believe that air pollution does cause disease and it causes exaggeration of other diseases. This point to me is quite clear. Well could you tell us a little bit about some of the specific contaminants Dr. Terry did. Could have an effect on House. Yes let let me say that. For instance in speaking of some of the contaminants one one of our studies is very clearly shown that asthmatic attacks among susceptible individuals. Have

correlated very well with the Solvay or pollution in Nashville Tennessee. Also a study in New Orleans showed a definite correlation between attacks of asthma and air pollution resulting from the incomplete combustion of refuse. There's been a clear association between employee absenteeism due to risperidone illnesses which has been caught a curragh lated associated with self-hate pollution. And there are many others so that I don't think there's any question but that we have some strong scientific evidence to support these facts. If Until now you have received the impression that the effects of air pollution on health are confined to statistical tables you'll find Dr. John Goldsmiths next comment very interesting indeed. Are there other things that lead you to the conclusion that that help is an important consideration. Air pollution

control either in California or our and other metropolitan areas. Well a number of physicians in California have reported that their patients. Are affected unfavorably by air pollution. Now while it isn't easy to measure this we don't care to subject these people to. Experiments. Nevertheless the number of physicians who report this and the number of people for example. Who have been advised by their doctors to leave Los Angeles because of their health is fairly impressive. One of the estimates seen by the. Los Angeles County Medical Society and study that they did jointly with the TB Association estimated that 10000 people had been advised by their physicians to leave the area because our pollution

was potentially harmful to their health. Most of the people had respiratory conditions according to this survey of course this was a sample survey and there and what I refer to is an extrapolation. This I think is fairly impressive. Even more impressive is the complaints of people themselves the complaints of IRA respiratory irritation from our surveys we know that those who are bothered by air pollution. Reporting a substantial fraction of responses that air pollution interferes with their breathing. Now I will agree that this has been difficult for us to measure and put an exact equation. To with respect to what it is that causes exactly how much interference. But I believe this when people tell us and I believe we should be attentive

to what their symptoms are. After all the practicing physician is attentive to his patient's symptoms and I think we in public health of similar responsibility the responsibility does not belong exclusively to those in public health of course. We have been accustomed to think of air as an inexhaustible commodity as pollution of the air continues to take its economic and health toll however. This attitude is changing. Dr. Goldsmith at the National Conference on air pollution held in December of 1962 we heard a great deal about air as a resource. Would you comment on that just a little. Yes I believe this is a new and extremely important idea. We have learned the use of water from lakes and streams is neither Freeney nor are is it something that one person can do without affecting the well-being of others. These two

conclusions in certain areas of the country are beginning to be true for air. When we use the air as a dumping ground for our refuse as a garbage disposal system we are interfering with its use for other purposes. Some of these purposes are industry and some of them are. I agree cultural But of course the most vital is the support of man's own well-being and life. And the accumulation of information about health effects pollution I think makes it very clear that we can no longer afford to treat air as a free resource which we can use for disposal of wastes and our liberty. We only do this at any cost which is increasing. For example the US Air Pollution Control alone cost people in Los Angeles about 50 cents a person. My recollection of the figures are correct. The

installation of motor vehicle exhaust controls will be extremely expensive. It will cost almost as much in the state of California as a rapid transit system that is now being planned for the San Francisco Bay area. So we are paying a very high price for the use of air and I believe we're going to have to pay more attention to utilizing the principles of resource management. That have been used for men hauling water resources and apply them to the field of atmospheric or air resources. Dr Luther Terry United States surgeon general summarizes the importance of our air. You can live approximately two minutes without air. You can live a long time in May and did that without some of the other resources so that I think it's important when we talk about air and the cleanliness and value are

important surveyor that we think in terms of the fact there they are no reserves in effect. And furthermore that there are no substitutes. Therefore we have to use the air which is is available to us. Which is it was for breathing purposes and to sustain life. Now to go just a little bit further as a surgeon general I have a broader. Responsibility in interest with our other health people and medical people throughout the country such as your doctor hears this in terms of the health of all of our people. And in this particular area I am concerned that air pollution has deleterious health effects. I am also concerned about the fact that the problem is constantly increasing and we are not conquering the problem as as fast as we should. I don't think we have to wait for a disaster like the

London disaster to really get focused on the fact that we must do more. And when I say we I'm talking about the American people. I'm talking about the federal government the state governments the local governments. I'm talking about the the medical profession the civic groups industry. Oh all of the American people because this is a problem that affects all of us. Unless air is treated as a resource to be preserved its contamination will continue. Health officials agree that breathing polluted air day after day can precipitate disease and in some cases death. Next week's program will consider the relationship of air pollution to specific disease namely cancer. Be with us then hold your breath was produced by Patrick Ford at Michigan State University under a grant from the division of air pollution Bureau of

state services U.S. Public Health Service. Our interviewer was Dr. Albert used as commissioner of health for the state of Michigan. These programs are distributed through the facilities of the National Association of educational broadcasters. This is the end E.B. Radio Network.