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Op-Ed on Clean Air

By J. Routt Reigart, M.D.

Professor of Pediatrics, Medical University of South Carolina, former Chair of the Committee on Environmental Health of the American Academy of Pediatrics, and Chair of the Children's Environmental Health Network

As a pediatrician, I've never had a parent complain that the air was too clean for their child to breathe. Instead, they ask me how to prevent or relieve their child's asthma, bronchitis or cough.

I get such questions all the time, especially with millions of children suffering from asthma today. Rates of other respiratory problems are skyrocketing as well. According to the Centers for Disease Control and Prevention, asthma is now the most chronic childhood illness in the United States, affecting 4.8 million children under the age of 18. I prescribe all the best ways to protect their children that I can -- medications, treatments and behaviors -- except for one. There's one key component neither I nor any one parent can offer: less air pollution.

Yet cleaner air may be on the horizon -- if Congress allows it. The Environmental Protection Agency (EPA) recently proposed lowering the ozone (smog) standard and setting stronger standards on fine particulate matter (soot). Exposure to these components of air pollution has been linked to aggravation of respiratory diseases like asthma as well as to increased visits to emergency rooms and increased hospitalizations due to respiratory problems. Exposure to fine particulates has been linked to shortened lives. However, a major battle is brewing in Congress this year on the EPA's proposals. Opponents of the stronger standards, crying a familiar alarmist refrain, contend that we cannot afford to protect our children and that improving our air quality will bankrupt the economy. Their goal is to have Congress intervene to halt the EPA's proposals. If that direct assault fails, they will pressure Congress to adopt legislation that will require extensive court review and many years of litigation before these standards can be fully implemented. I believe that we cannot afford not to protect our children and that opponents of these protections will once again be shown wrong as the benefits will far outweigh the actual costs of such improvements in air quality.

Every parent should be watching this battle closely. Kids are especially susceptible to harm from air pollution. Their respiratory defenses are not fully developed and their airways are smaller than those of adults. Pound for pound of body weight, children need more oxygen and inhale more pollutants than adults. Children generally spend more time active and outdoors than adults, so they are even more at risk. If we are going to protect our children, the air quality standards we set must take these intrinsic factors into account.

Though children are only a quarter of the population, they are 40% of the asthma patients. In some communities, asthma is practically an epidemic. African American and Hispanic children here and elsewhere are bearing a disproportionate burden from asthma; they are more likely to live in communities with more serious respiratory hazards, such as higher levels of air pollution.

Dozens of studies have proven that our current air quality goals are not strong enough. Ozone levels that meet current standards (which have not changed since 1979) are still high enough to send people to the hospital. A recent study by the American Lung Association and the Harvard School of Public Health found that emergency department visits and hospitalizations for respiratory problems doubled on days where the ozone level was high -- even when the ozone level was below the current standard. At ozone levels 315 below the current standard, children at summer camp and healthy exercising adults suffer from shortness of breath, coughing, painful breathing and loss of lung function.

The current particulate standards fail to control the smallest, most harmful particles which lodge deep in the lungs. Studies have shown that as particulate levels increase, bronchitis and chronic cough increase in school children, acute respiratory symptoms and illness increase among adults, while emergency room visits and hospital admissions increase. Perhaps most alarming is the recent evidence associating breathing of particulates with shortened life spans. One seven-year study of more than half a million people from all 50 states found that people living in the most polluted city had a 17% greater risk of premature mortality than the people living in the least polluted city, due to exposure to particulates.

The EPA's stronger standards not only make public health sense but will also save dollars. Our experience with the Clean Air Act proves cleaner air is a wise investment. From 1970-1990, every dollar spent to comply with clean air regulations resulted in $45 in public health and environmental benefits.

The EPA estimates that its proposals will save 15,000 lives a year, improve protection to 40 million children and cut children's serious respiratory cases by 250,000 annually.

What Congress and the EPA decide this year will govern how much pollution will be permitted in the air our children will be breathing for decades to come. Congress should do what is necessary to protect our children and set lower air pollution levels. Congress should not force the EPA to take a pass on cleaner air while pediatricians and parents around the nation are forced to deal with soaring numbers of respiratory problems and escalating rates of childhood asthma-related hospitalizations. I hope we don't have to hold our breath after they decide.
02/10/2005
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