Emerging Issues

Throughout the six topical sections of this focus area, a number of issues are emerging.

Outdoor air quality. Two major impediments to data collection and interpretation have been identified. First, annual weather may vary considerably so an annual summary statistic may not accurately account for short-term extreme weather, such as hurricanes or heat waves.²² Second, not all counties have monitoring stations; therefore, data may not be available for some populations.²³

The amount of air pollutants emitted per mile from cars has been greatly reduced.²⁴ However, these benefits are offset by the continuing increase in vehicle miles traveled and the popularity of light-duty trucks, SUVs, and minivans, which emit more pollution.

Water quality. Beach monitoring programs are typically run by local health agencies, and programs vary by location. Monitoring results are inconsistent because agencies use different indicator organisms and varying monitoring frequencies. As part of its beach grant program, EPA has set performance criteria that States and other governments must meet to receive beach grants.²⁵ These criteria are expected to improve the reporting of beach advisory data.

Toxics and waste. The public health issues associated with toxic substances are not always resolved after initial intervention. Some affected individuals may continue to have health concerns that must be addressed through ongoing case management, rehabilitation, mitigation of long-term sequelae, and other forms of tertiary prevention. For example, the Agency for Toxic Substances and Disease Registry (ATSDR) continues to provide health education at former vermiculite processing sites that received asbestos-contaminate. A number of these sites have been remediated, yet former workers and their families continue to be at risk for health effects from exposure to the ore. Health education provided by ATSDR teaches those affected how to reduce or mitigate their risk for developing exposure-related health effects.²⁶

Healthy homes and communities. The rising number of deaths from asthma and allergy has increased awareness of the role of indoor allergens in producing and exacerbating asthma and allergy symptoms. In 2000, the Institute of Medicine released Clearing the Air: Asthma and Indoor Air Exposures.²⁷ This publication reviewed the evidence relating to the causation and exacerbation of asthma by indoor air exposures, including allergens from dust mites, cockroaches, dogs, and cats, as well as fungi and combustion products from gas appliances. The study concluded that high levels of dust mite allergen can cause asthma in susceptible populations. In addition, dust mite allergen and cockroach allergen can produce asthma attacks in persons who already have asthma. EPA and the National Institute of Environmental Health Sciences within NIH produce educational materials on strategies to control indoor allergens and to minimize exposure to them.²⁸

Infrastructure and surveillance. The measurement of an environmental chemical in a person's blood or urine does not by itself mean the chemical causes disease. Although advances in analytical methods allow measurement of low levels of chemicals in people, separate studies of varying exposure levels and health effects are needed to determine that blood or urine levels result in disease. Such studies must also consider other factors such as duration of exposure, susceptibility of the population, and nutritional and other risk factors.

Global environmental health. Increased international travel and improvements in telecommunications and computer technology are making the world a smaller place. Actions in each country affect the environment and influence events around the world. For example, over the next several decades, more people will face water quality and quantity problems because of worldwide water shortages, especially in developing countries.^29,30 Some of the main problems underlying this crisis are scarce resources, waste, and ineffective water management. Other contributing problems include decreases in the size of large bodies of fresh water, such as Asia's Aral Sea and Africa's Lake Chad, deterioration of coral reefs, and the rise of coastal waters resulting from climate changes.^31,32 These situations indicate that many developing nations may experience future water shortages and deterioration of their sewer and drinking water systems. Improving the environmental health of people and their communities has positive social and economic benefits.

Water quality in the U.S.-Mexico border region faces diverse challenges. An important step to ensure future progress is to better coordinate with State, Tribal, and local governments, as well as with residents, industry, and nongovernmental organizations that have a stake in the border region. Through improved cooperation, priorities can be established and more effective activities initiated.

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