The Environmental Protection Agency estimates that the Clean Air Act (CAA) prevented the premature loss of 160,000 American lives per year in 2010. By 2020 this number is expected to rise to 230,000. This makes the Act one of the most important public health measures ever enacted. Where do these numbers come from and how likely is it that these gains will be realized?
The Act dates back to 1970, the year of the first Earth Day, the founding of the EPA, and the administration of Richard Nixon. The EPA established health-based standards for the air we breath, known as National Ambient Air Quality Standards, or NAAQS, for six criteria pollutants: lead, carbon monoxide, oxides of sulfur, oxides of nitrogen, particulate matter, and ozone. After an intense battle, the removal of lead from gasoline began with regulations that took effect in 1977. It was at about that time that Herbert Needleman reported that children who had what were thought to be relatively small amounts of lead in their teeth had significant IQ deficits, impaired attention and auditory processing, and poor classroom behavior. At that time, the average blood lead level was about 15 micrograms per 100 milliliters. By 2002 this level had dropped by almost 90 percent. Research has shown that this confers about five IQ points on each child. This gain has had enormous societal benefits: large numbers of children have been lifted out of the mentally retarded range, where they need expensive services in order to function, and a similar number have been added to the intellectually gifted category, where they will become the intellectual and scientific leaders of their generation. There is a reason why our grandchildren seem to be smarter than we are!
The CAA was amended in 1990 in order to curtail acid rain caused by the emissions of oxides of nitrogen and sulfur that were destroying lakes in the northeastern part of the U.S. Coal-burning power plants are major sources of these pollutants. In addition to acidifying lakes, oxides of nitrogen combine with organic molecules in the air in the presence of sunlight to form ground-level ozone, the primary component of smog. Oxides of sulfur, like ozone, irritate the lungs, and also react with atmospheric components, in this case to form small particles adding to the concentration of this pollutant that arises from other sources. These very small particles are inhaled deeply into the lungs where they trigger pathological reactions throughout the body. The acid rain program has been very successful. Emissions of sulfur dioxide have been reduced by about 50 percent and emissions of nitrogen oxides have been reduced by almost two-thirds. The health implications of these reductions are substantial, however there is still much more to be done.
Almost one third of Americans live in counties where the EPA's air quality standards have not been met. Ozone and small particles are the primary offenders. The 230,000 premature deaths expected in the current decade will occur primarily as the result of anticipated reductions in these two pollutants. In addition to these lives saved, the EPA predicts that each year cleaner air will prevent 200,000 acute myocardial infarcts, 180,000 exacerbations of acute bronchitis, almost 2.5 million exacerbations of asthma, 5.4 million lost days at school, 17 million lost days at work, and other health effects. As a physician, I see these gains in terms of fewer patients in emergency rooms and offices, but economists see them in terms of dollars -- huge numbers of dollars. In analyses that Congress requires of the EPA, the Agency concluded that the central estimate of total monetized benefits of the CAA between 1970 and 1990 was $22.2 trillion (range $5.6 - 49.4 trillion). Left untouched, annual benefits by 2020 are estimated to be about $2 trillion, at a cost of about $65 billion. Ten billion dollars of that cost represents modifications to coal-fired power plants. This is an astounding return on the needed investments.
A return to leaded gasoline is unthinkable. In a stark contrast, severe curtailments, even abolition of CAA regulations is a promise made by some politicians who have framed these life and health saving regulations as "job-killers." The anti-EPA lobbies are funded by those would pay the $65 billion. Those who benefit from better health, to the tune of $2 trillion, have virtually no voice in this debate.
Protecting the EPA and preserving its authority to regulate emissions, including its authority to update air quality standards, as required by the CAA, and to limit the carbon dioxide emissions, as mandated by the courts, produces a win-win-win scenario. We will win by reducing health care costs, we will win because most of those costs are borne by Medicare and Medicaid that are contributing to our national debt. Most importantly, we will all win, including those who favored roll-back of EPA regulations at the ballot box, the executives and employees of industries who would emasculate the EPA, because our health and productivity would continue to improve.
It is not enough to support the EPA. We need to back efforts to move toward a sustainable energy future. We must stop our reliance on burning coal in order to reduce pollutants that damage health and cause global warming, as I have described in my book, The Silent Epidemic: Coal and the Hidden Threat to Health. These pollutants are key contributors to the four leading cause of death in Americans: heart disease, cancer, respiratory diseases, and stroke and responsible for much of the death and disease that is costing us trillions of dollars we can't afford to spend.
In my medical school microbiology class we grew bacteria on Petri dishes. Soon after the culture was established, the bacteria flourished. However, as they used all of their food and other resources and were forced to live amidst their polluting wastes, they died. We humans are like those bacteria -- we live on a world characterized by finite resources and with a limited ability to neutralize the wastes we produce. Will we be smarter than my bacteria?
This may seem like a silly question, yet the challenges we face are real and the consequences of our actions are dire. Without a sustainable energy future that does not poison the air we breathe and lead to planetary warming, we face an uncertain future. It is past time to act. We need to use our resources wisely, to support critical energy research efforts and to support the education needed to train the next generation of researchers. We owe this to our children and our children's children.