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Clean air is a delicate balance of nitrogen and oxygen, with small amounts of argon, carbon dioxide, neon, helium,

and other gases. Unfortunately, pollutants are altering this mixture by adding myriad ingredients which alone and in concert pose health risks to everyone who breathes the air, particularly children. In fact, children represent the largest subgroup of the population susceptible to the effects of air pollution. Over the last ten years, a considerable number of scientific studies have reported adverse health effects associated with air pollution. The effects have ranged from respiratory symptoms and illness, impaired lung function, hospitalization for respiratory and cardiac disease to increases in mortality. A recent study estimated that approximately 64,000 people in the United States die prematurely from heart and lung disease every year due to particulate air pollution -- more people than die each year in car accidents.[3] Among children, air pollutants are associated with increased acute respiratory illness, increased incidence of respiratory symptoms and infections, episodes of longer duration, and lowered lung function.[4] Asthma, the most common chronic disorder of childhood, is on the rise in the United States and in other industrialized nations. During the 1980s, the prevalence of childhood asthma increased nearly 40 percent.[5] Many different factors have been associated with asthma, including genetic makeup, environmental tobacco smoke, dust mites, cockroach allergens, and air pollution, both indoor and outdoor. Several studies have linked ozone and particulate air pollution with exacerbations of asthma in children afflicted with the disease. Due to their greater respiratory rates, children breathe a proportionately greater volume of air than adults. As a result, children inhale more pollutants per pound of body weight. They also spend more time engaged in vigorous activity than adults. In addition, because of young children's height and play habits (crawling, rolling) they are more likely to be exposed to pollutants or aerosols that are heavier than air and tend to concentrate in their breathing zone near ground level.[6] Children's physiological vulnerability to air pollution arises from their narrower airways and the fact that their lungs are still developing. Irritation caused by air pollutants that would produce only a slight response in an adult can result in potentially significant obstruction in the airways of a young child. The harm caused by air pollutants has been recognized by medical scientists, government officials, and the public for some time. Historic air pollution disasters -- Meuse Valley, Belgium in 1930, Donora, Pennsylvania in 1948, and London, England in 1952 -- in which large numbers of people fell ill and died, have been clearly associated with high concentrations of particulate and sulfur dioxide pollution.[7] Such acute air pollution episodes have killed children because of their heightened susceptibility to the damage that can be done by air pollutants. [8]

Existing stationary sources of air pollution include coal combustion for power production, oil refineries, and industrial manufacturing facilities. Additional sources of air pollution have emerged; today automobiles are a major polluter of the air: Americans drive some 150 million private cars and nearly 50 million buses and trucks.[9] The exhaust from these vehicles contains nitrogen oxides, and other ozone precursors, particulate matter, and carbon monoxide -- all deleterious to health, even in small quantities. Also of importance in vehicle exhaust are toxic organic compounds including formaldehyde, acetaldehyde, and benzene. And, even though new cars start out far cleaner than the cars of decades ago, we drive them far more and they fail to remain clean as they age. To protect citizens, the federal government began setting standards for ambient air quality as early as the 1950s. In 1970, Congress passed the Clean Air Act, the first major national law for air pollution control throughout the United States. This Act, amended in 1977 and 1990, requires the EPA to establish national health standards for ambient air pollutants and to assure that states adopt effective programs for attaining these standards. The most successful parts of the Act, such as the acid rain program, the ozone depletion program, and the introduction of emission standards for automobiles and the reformulation of fuels, established very specific federal standards. Yet these standards are not enough. In 1995, about 127 million Americans -- half of the nation's population -- lived in regions with air quality that did not meet federal standards for certain pollutants.[12] Based on U.S. Census Bureau estimates of the population by age group, 18 million children under the age of ten lived in these "nonattainment" areas. The health risks from air pollution are greatest in these regions, and those at greatest risk include children. Citizens must seek additional remedies to assure the health of their families in the face of increasing air pollution threats. Toward that end, this chapter describes scientific research on the health effects of air pollutants on children, suggested measures that concerned parents and others can take, and model programs of local solutions that have worked throughout the nation, as well as government reforms that should be supported.

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