133
NATIONAL PROBLEMS OF ENVIRONMENTAL HEALTH*
Leslie A. Chambersf
For several millennia Man played an in-
significant role in relation to environmental
magnitudes coftiprising his ecological niche.
The ratio of his numbers to the huge reser-
voirs of air, water, phosphorus, nitrogen, car-
bon and other essentials to his existence has,
until quite recently, been inconsequential.
Similarly his available mean free path, basic
to existence without too frequent impact
with fellow members of his species, has not
been unduly restricted. Nevertheless, the re-
sources of our planet in living space, avail-
able food-production-potential, usable water
and tolerable air have absolute limits, and
must at some time become positive barriers
to further increase in the human population.
The only really debatable question involves
our capability for development of technologi-
cal means of utilizing more and more mar-
ginal fractions of fixed reserves, and our
capacity for adjusting psychologically and
sociologically to the progressive restrictions
on freedom of action necessitated by unfet-
tered reproductive freedom.
Considering the earth as a single entity,
the environment's ultimate limit may be im-
posed on the human biomass a few genera-
tions beyond the present. Some have calcu-
lated the exact date, assuming constancy of
current rate factors, and have found the re-
maining time to be astonishingly brief. On
this basis we can continue to exercise our
predilection for inaction with respect to the
good of following generations through a suf-
ficient number of decades to assure that we
who now live will have resumed our primeval
distribution in the physical environment be-
fore our descendants are forced to a climac-
tic readjustment to the consequences of our
reluctance.
Perhaps it is fortunate, in this contoxt,
that the human tendency toward homopara-
sitism, or other ecological imperative, has
already created for us more or less ponder-
able models of the predicted more general
crisis. Wherever a dozen primary consum-
ers have settled in the processes of resource
conversion to essential human requirements,
*Presented at the 58th annual meeting of the
American Sociological Association, Los Angeles,
August, 1963.
fDirector, Allan Hancock Foundation, and Pro-
fessor of Biology, University of Southem Califomia.
a hundred more have assembled to derive
subsistence from the cycles of exchange,
transport, and communication growing from
basic production. As mattors evolve, at some
stage even the nucleus of prime consumers
seems to be converted to derivative activi-
ties, until in our great cities we have mil-
lions of human units totally dependent on
each other and on the suctorial extensions
they are able to maintain into geographical
regions where food, water, forests, and min-
eral still exist. Within the cities consump-
tion proceeds in proportion to the number of
j>eople; indeed there is solid evidence that
per unit consumption increases considerably
faster than the actual number of consuming
units. Certainly water use per capita may
be two or three times as great in large popu-
lation centers as in smaller communities.
Concurrently, and as a direct consequence
of the increased intensity and extreme locali-
zation of consumption, there is a localized
and intensified development of all the waste
products of the metropolitan metabolism.
Garbage, domestic and industrial wastes,
combustion gases, smoke, dust, metallic
fumes, eroded rubber, and an endless list of
other unusable by-products of the city's life
accumulate at alarming rates, and require
disposal at unit costs which increase rapidly
with increase in size of the metropolis.
As another consequence of human homo-
parasitism (from which I suppose there is
no real escape) competition for space tends
to alter possible pattems of housing, not al-
ways to the advantage of the occupants.
Necessities of intornal movement, partially
govemed by resistance to housing pressures,
require freeway and transit pattems not al-
ways neatly compatible with other requisites
to existence. And the necessities of minimal
water supply for human consumption, in-
dustrial processing, minimal sanitation, lawn
irrigation and firefighting require heroic
extensions of the communal capability and
restraints on use not always compatible
with the needs of the city in other respects.
Most large cities in the United States have
felt the impact of these and other problems
of adaptation to environmental changes
brought about by the very manner in which
we strive to live; in most, one or more facets
of the interacting system have been attacked.
134 JOURNAL OF HEALTH AND HUMAN BEHAVIOR
Air pollution control and water supply have
been prime concems in Los Angeles; sur-
face-water pollution has received the organ-
ized attention of cities dependent on major
basin drainage channels such as the Ohio,
Mississippi, and Delaware rivers. Transpor-
tation problems have been faced with vari-
ous degree of success in New York, Boston,
Philadelphia, and most other major centers.
Urban redevelopment has been stimulated
by availability of Federal funds, as one ap-
proach to the housing problem. All of these
are illustrative facets of the environmental
health problem and the measures being ap-
plied from city to city indicate a growing
public awareness that the health of a city's
peopletheir general well-beingis directly
related to the manner in which the metro-
politan structure permits them to function.
Here we have approached, in the term
"structure," the essence of my thesis. It is
the interlocked resultant of all the situa-
tions and actions comprising a city that de-
termines interaction of the metropolitan en-
vironment and its occupants. Until recent
years the analysis of so complex a system
of variables was unthinkable; hence the sub-
stitution of a piecemeal series of attacks ca-
pable of being reasonably encompassed in-
tellectually and mounted economically. Me-
chanical and electronic extensions of our
mathematical speed and manipulative skill
now make it possible to select optimal pro-
cedures based on literally thousands of in-
teracting parameters. Who, without logical
analysis of the entire system, can say what
effect the restriction on soft coal buming in
Pittsburgh has had on the quality of the
water supply, the pattem of community
housing, the general state of mental health,
or the transportation pattern? Who is to
say with confidence that multiple adminis-
trative jurisdictions within a metropolitan
complex are or are not optimal assurance of
a generally acceptable environment? Indeed,
who, without benefit of analysis of the sys-
tem itself, can do more than guess as to
optimal actions in respect to any one of the
operative parameters?
I suspect that it was partly because of the
emergence of new capabilities, and recogni-
tion of the fact that one cannot tamper with
one sector of an environment without risk-
ing undesirable change in another, which
prompted the Surgeon General of the U. S.
Public Health Service, by direction of the
Secretary of Health, Education and Welfare,
to set up in the fall of 1961 an ad hoc com-
mittee to consider the state of environmental
health programs in this country, and to rec-
ommend a pattem of federal, state, and local
actions consistent with the findings. The
Committee on Environmental Health Prob-
lems was headed by Professor Paul Gross of
Duke University and its eighteen-man mem-
bership represented a genuine cross section
of scientific, administrative, engineering,
economic, social, and other pertinent disci-
plines drawn from institutions and public
agencies throughout the United States. It
was empowered to utilize the informational
resources of the Public Health Service, and
to summon expert guidance as needed. About
25 consultants were enlists at various times
during the course of the committee's work.
While much of our work was a study of
current and projected programs of the
Public Health Service in the general field
of environmental health, it was recognized
very early that something more comprehen-
sive in concept than authorized categorical
programs would be needed if the nation is
to deal successfully with its developing prob-
lems. A group of subcommittees was "espe-
cially charged with a study of certain brog,d-
er aspects of environmental health, not spe-
cifically identified with existing programs,
as these related to the broad mission of the
Public Health Servicewith respect to en-
vironmental health."
Following its very intensive, but much too
brief, examination of achievements, trends,
projections, and national capabilities the full
committee concluded:
"That a national need exists for establish-
ment and maintenance of a vigorous and inte-
grated effort to maintain controls over the hu-
man environment compatible with projections
of change in both population and the environ-
ment itself.
"That the current 'categorical' approaches . . .
are incapable of providing (a) the necessary
cognizance of combined multiple effects of en-
vironmental impacts, or (b) the depth of effort
required by individual divisional programs.
"That accommodations to the National needs
in environmental health will require the estab-
lishment of a strong focal center adequately
staffed and equipped to prosecute an effective
and integrated program within the Public
Health Service and to manage and coordinate
a strong extramural lresearch, training, and
technical support program utilizing the avail-
able institutional resources of the nation.
"That an adequate legislative basis for a suf-
ficient national program in environmental
health does not exist at present."
Pursuant to these findings the Gross Com-
 NATIONAL PROBLEMS
mittee offered, in its report te the Surgeon
(Jeneral, specific recommendations, all of
which are related, but only a few central te,
my present theme. In addition te matters of
administration, funding, manpower needs,
central facilities, categorical action pro-
grams, and eipbling legislation, the recom-
mendations include sections which I shall
take the liberty of quoting out of context.
Reference can be made te the published 300-
page report if these excerpts prove in-
triguing.
A key recommendation relative te the es-
tablishment of a national Center for En-
vironmental Health provides for the inclu-
sion of
(a) A new "Office of Environmental Health
Sciences, independent of the divisional structure
and with separate budgetary provision, consist-
ing of scientific groups reporting to the scien-
tist who is Director of the Office of Environ-
mental Health Sciences. These groups, which
would include biological, physical, and social
scientists as well as mathematicians, would
study basic problems in environmental health,
undertake research on problems of common in-
terest to the several divisions, . . . beyond these,
groups would be specifically charged with the
continuing responsibility for an overall purview
of the entire field of environmental health."
(b) "The administrative headquarters of a
unified environmental health grants program
in support of fellowships, university training
programs, university-related research projects,
and demonstration grants to properly consti-
tuted agencies."
The fate of the Gross Committee's recom-
mendations is presently being determined by
Congressional actions or their lack. It ap-
pears te most observers that the general pro-
visions embodied must eventually be acti-
vated in the original or some modified form.
Nevertheless, complete and unequivocal ap-
proval will constitute only a first step te-
ward application of analytically derived en-
vironmental control actions in our major
cities and growing smaller ones. Generalized
leadership and funding support can be ex-
pected from the propose center, but the
eventual utilization of operations research in
relation to the complex that is Los Angeles
will have te be undertaken in and by Los
Angeles. This statement is made, not be^
cause of any personal reluctance to delegate
responsibility and authority te a central
agency, but because the nature of many
facets of our tetal environment is such that
values for analytical purposes can be as-
sessed only by those sensitive te local mores,
prejudices, superstitions, traditions, caste
135
systems, and other motivational bases which
are as important te the complete structure
of a community as are tepography, climate,
enlightened administration, or a water sup-
ply. The best documented environmental al-
teration cannot become part of the urban
system if its inclusion runs counter te value
patterns of the residents.
In most of the foregoing I have tried te
speak of aggregates of humans in their hab-
itats as though they were an ecological sys-
tem in the biological sense, susceptible te
tetal evaluation, experimental manipulation,
and external control. But at the end I must
acknowledge the role of facters, the criteria
for whose selection lie outside the scope of
scientific methodvalues and value judg-
ments, ethical systems, and religious experi-
ence. Unquestionably these will be incorpo-
rated into any comprehensive operations an-
alysis applied usefully te an urban complex.
But their evaluation and appropriate weight-
ing must be done by those whose qualifica^-
tions in such fields are better than those of
a biological scientist who, within his area of
competence, is usually quite oblivious te
their existence. Nevertheless, in the off-duty
roles of ordinary citizens, scientists encoun-
ter, and wonder about, such matters and de-
velop opinions as indefensible as those of the
next man.
During the last few years of my contacts
with environmental health matters I have
become conscious of a phenomenon which
illustrates the point rather well. The impo-
sition of controls to reduce air pollution, or
water pollution, or te provide protection
against radiation, or food poisoning, or to
promote vehicular safety, usually involves a
cost te one or more elements of a communi-
ty. The degree of control acceptable there-
fore involves a compromise between the
rigid restrictions indicated by protecters of
the health of persons and the freedom from
restraint which is optimal in terms of the
economy. Furthermore, the basis of compro-
mise is usually some agreed-upon standard
of quality for the air, water, or other re-
source in question. Now the good of the com-
munity, and the good of the individual are
both worthy ideals and almost equally re-
spectable ethical bases from which to devel-
op an operational philosophy. But very often
the compromises must be of such a nature
that the end result may be for the good of
some individuals but not all.
Very ofti the view has been expressed
136 JOURNAL OF HEALTH AND HUMAN BEHAVIOR
that the costs of action must be weighed
against the cost of inaction and a "calculated
risk" taken in the interest of the greater
good. What this means, in fact, is that if
total control is so expensive as to threaten
the average citizen's welfare, then the elder-
Jy infirm, and the premature babe, who can-
not withstand the consequences of compro-
wise, must be sacrificed. In this I find an
ethical conflict to which there seems no ra-
tional solution. Couched in legislative phrase-
ology, there is no obvious sentence of death,
but it may nevertheless be there; a judg-
ment has been passed.
To conclude, I should like to quote from
an address given recently by the Secretary
of Health, Education and Welfare in key-
noting the National Conference on Air Pollu-
tion : "My experience has convinced me that
we must increasingly think of our urban en-
vironment, and deal with it, as a wholeas
a single unit with closdy interrelated and
THE ENVIRONMENTAL HEALTH CHALLENGE:
ENVIRONMENTAL HEALTH IN THE
METROPOLITAN SETTING^
p. W. Purdomf
The primary purpose of this paper is to
indicate, from the perspective of an environ-
mental engineer, some of the potential con-
tributions of social science for environmental
health. But first, the meaning of the term
"Environmental Health," as used herein,
should be explored.
Man's interaction with his environment is
the focus of investigation of many profes-
sional disciplines. Environmental Health is
concemed with those aspects of the environ-
ment which affect man's health and with the
establishment and maintenance of a health-
ful environment.
The World Health Organization defines
"health" as "a state of complete physical.
*Pres6nted at the 58th annual meeting of the
American Sociological Association, Los Angeles,
August, 1963.
tFormerly Director, Division of Environmental
Health, Community Health Services, Philadelphia
Department of Public Health. Now, Professor and
Director of Environmental Engineering and Sci-
ences, Drexel Institute of Technology, Philadelphia,
Pennsylvania.
interdependent parts. In our modem cities
we cannot separate housing from health, or
either from transportation, or any of these
from the resources of our natural environ-
ment, such as air and water."
Such proposals and pleas for a rational,
comprehensive attack on the problems of
large cities of the twentieth century imply
the possibility of extension of methods de^
veloped within such models as the mathe-
matical theory of games, to achieve stabili-
zation rather than disaster as world popu-
lations increase and the limited environ-
mental defects of today become the norm.
Hopefully, too, such system-planning may
include some provision for restraining our
species in its rush toward death by repro-
duction. Whether or not such hopes can be
fully realized, there are aspects of this game
that will challenge exponents of all the nat-
ural, physical, social and political sciences,
humanists, moralists, and just plain people
who choose to play.
mental, and social well being and not mere-
ly the absence of disease or infirmity."^ In
the search for health, this concept leads to
investigation of more than the biological,
chemical, and physical aspects of man's en-
vironment. Little is known, however, of the
sociological criteria related to health goals
for the arrangement of our cities and for the
management of man's interrelationship with
the environment.
One of the earliest landmarks of official
concem with environmental health in the
United States is the classical 1850 Report
of the Sanitary Commission of Massachu-
setts.^ Despite the publication of this com-
prehensive report, official activities for the
following 60 or 70 years were confined pri-
marily to handling emergency conditions
such as epidemics.
1. World Health Organization, Handbook of Basic
Documents, "Constitution of the World Health Or-
ganization," p. 5 (undated).
2. Report of the Sanitary Com,m,ission of Massa-
chusetts1850 by L. Shattuck and others, Cam-
bridge, Harvard Univ. Press, 1948.