The Acting Assistant Secretary for Health chaired a review of progress on objectives for environmental health. This is the third round of reviews on the 17 objectives within this Healthy People 2000 priority area. The National Institutes of Health and the Centers for Disease Prevention and Control, as co-leads on Environmental Health, led a discussion which focused on drinking water safety. The status of the objectives was as follows:

11.1 The rate of asthma hospitalizations was 194 per 100,000 people in 1995; this is higher than the 1987 baseline of 188 per 100,000. The year 2000 target is 160. Hospitalizations in 1995 also showed increases over the baselines for 2 special population groups--Blacks and other non-whites, and children aged 14 and younger.

Asthma accounts for 1 percent of all hospitalization costs in the United States, amounting to $56 billion annually. It has a disproportionate impact on people in the inner-city, especially children.

11.2 In 1991-92, the prevalence of serious mental retardation (IQ<50) among school-aged children was 4 per 1,000, an increase over the 1985-87 baseline of 3.1. The year 2000 target is 2 per 1,000.

11.3 The number of reported outbreaks of waterborne disease from infectious agents and chemical poisoning declined from the 1988 baseline of 16 to 11 in 1994, thus meeting the year 2000 target. For people served by community water systems, there were 5 reported outbreaks in 1994 (1988 baseline = 4). The target is 2.

11.4 The prevalence of blood lead levels exceeding 15 micrograms per deciliter among children aged 6 months through 5 years declined from the 1984 baseline of 3 million to 274,000 in 1992-94; this surpasses the year 2000 target of 300,000. The reduction of blood lead levels in children has been one of the most significant achievements in environmental health in recent years. A unified approach among all levels of government and the private sector contributed greatly to this major public health success.

11.5 In 1995, 67.1 percent of the population lived in counties that had not exceeded Environmental Protection Agency (EPA) air quality standards for the 6 criteria pollutants (ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, particulates, and lead) in the previous 12 months. The year 2000 target is 85 percent.

11.6 In 1994, an estimated 11 percent of the nation's homes had been tested for radon concentrations. The year 2000 target is 40 percent. An estimated 8.8 percent of homes with smokers and former smokers and 13.1 percent of homes with children were tested. The target is 50 percent for each of these special population groups. According to the National Cancer Institute, up to one-tenth of U.S. lung cancer deaths may be caused by radon in homes.

11.7 In 1994, 0.17 billion pounds of toxic agents on the HHS list of carcinogens were released from industrial facilities. This is higher than the year 2000 target (0.12 billion pounds), which calls for a 65 percent reduction from the 1988 baseline of 0.35 billion pounds, but progress towards the target continues to be made. Some 1.02 billion pounds of substances on the Agency for Toxic Substances and Disease Registry (ATSDR) list of the 275 most toxic chemicals were released in 1994. This reduction of more than 50 percent from the 1988 baseline of 2.15 billion pounds surpasses the target of 1.08 billion pounds.

11.8 To reduce human exposure to solid waste contamination, a year 2000 target of 4.3 pounds was set for the average number of pounds of municipal solid waste produced per person per day (3.2 pounds after recycling or composting). In 1995, the average was 4.4 pounds before and 3.4 pounds after recycling.

11.9 In 1995, 73 percent of community water systems met safe drinking water standards established by the EPA, the same proportion as in 1988. The year 2000 target is 85 percent. The proportion has remained relatively constant over the years largely because EPA has continued to issue additional Maximum Contaminant Level standards.

11.10 In 1994, there were increases over 1992 baselines in the proportions of surface waters supporting beneficial uses (i.e., fishing and recreation) in all categories except for estuaries supporting consumable fish, for which there was a 2 percent decline.

11.11 Nine percent of people with houses built before 1950 reported in 1993 that the house paint had been analyzed for lead content, an increase from the 1991 baseline of less than 5 percent. The year 2000 target is 50 percent.

11.12 In 1993, there were three States in which at least 75 percent of local jurisdictions had adopted construction standards and techniques that minimize elevated indoor radon levels. The 1989 baseline was 1 State and the year 2000 target is 35 States.

11.13 Federal regulations were promulgated in 1996 which require disclosure of lead-based paint in all pre-1978 housing during sales or leasing. This achieves the year 2000 target. The number of States requiring that prospective buyers be informed of radon concentrations in buildings offered for sale increased from 1 State in 1989 to 25 States in 1995. The target is 30.

11.14 Ninety percent (n = 253) of the ATSDR cease/reduce exposure recommendations were followed among the 1,232 hazardous waste sites on the National Priority List in 1995. The year 2000 target is 100 percent.

11.15 Forty-six percent of the population was served by curbside recycling projects in 1995, an increase from 26 percent in 1991. The year 2000 target is 50 percent.

11.16 In 1996, Federal funds for childhood lead poisoning surveillance were used in 27 States. Systems to track additional sentinel environmental diseases defined by this objective are in varying stages of development.

11.17 The proportion of children aged 6 and younger who are regularly exposed to tobacco smoke at home declined from 39 percent in 1986 to 27 percent in 1994. The year 2000 target is 20 percent.

H I G H L I G H T S

• One third of Americans live in an area where, in 1995, the air was too polluted to meet health standards.
• One in 4 Americans lives within 4 miles of a Superfund site.
• Eating one fish from contaminated water is tantamount to drinking 1000 gallons of that water.
• Aquifers from which much of the Nation draws its drinking water are shrinking faster than they can be replenished. As this happens, they become increasingly vulnerable to toxic contamination.
• The Safe Drinking Water Act amendments of 1996 require water supply systems to file annual reports informing users about the origin and purity of their drinking water. The law also increases State flexibility, strengthens the EPA's scientific work, and provides a $1.2 billion appropriation for State loan programs for facilities that treat drinking water.
• In its "Environmental Goals for America" initiative, the EPA has embarked on a long-range, cooperative effort addressing 12 national goals in areas such as air quality, drinking water, ecosystems, toxic-free communities, and solid waste management. Progress will be measured against the "milestones for 2005."

F O L LO W- U P

• Work through the Environmental Health Policy Committee (EHPC) to strengthen collaboration with the Environmental Protection Agency (EPA), Department of Agriculture, Department of Housing and Urban Development, and other Federal agencies. Model our efforts in such a way as to identify opportunities for collaborations at State and community levels. To further collaboration, pursue another meeting of the regional EPA officials and the HHS regional health administrators.
• Identify critical gaps in our knowledge about the health effects of environmental hazards and develop strategies to address these needs.
• Work with EPA and the EHPC to better coordinate HHS and EPA environmental health data systems and surveillance activities to produce more useful information. Invest in analysis and use of these data so as to improve understanding of the health effects of environmental hazards. Look towards the development of a data set on sentinel events that could be widely used at Federal, State and local levels.
• Work to more effectively communicate issues to the public about water supply safety. Identify those individuals in the Department to serve as resource people on drinking water safety for State and local public health and environmental agencies and include their names on the EHPC homepage. Look for opportunities to bring Federal, State, and local public health officials together with water suppliers and environmental agency regulators to create working relationships before crises develop.
• Work on Healthy People objectives for 2010 that address human exposure to contaminants and other risks to health. Work with EPA on their milestones for 2005 to ensure that, to the extent possible, objectives can be made synchronous with Healthy People and the 2005 targets are on a trajectory compatible with targets for 2010. Whenever EPA and HHS pursue different objectives, acknowledge and explain these differences, especially to State and local public health and environmental agencies.
  

P A R T I C I PA N T S
Administration for Children and Families
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Environmental Protection Agency
Indian Health Service
Milwaukee (WI) Department of Health*
National Institutes of Health
Nebraska Department of Health**
North Carolina Division of Environmental Health**
Office of Disease Prevention and Health Promotion
Office on Women's Health
Pan American Health Organization
Regional Health Administrator - Region VI
Tri-County Health Department ( Denver CO)*

* Also representing National Association of County and City Health Officials
**Also representing Association of State and Territorial Health Officials

Jo Ivey Boufford, M.D.
Acting Assistant Secretary for Health

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