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Ensuring
Environmental Health
n Postindustrial Cities
Workshop Summary
Bernard D. Goldstein, Baruch Fischhoff, Steven J. Marcus, and
Christine M. Coussens, Editors
Roundtable on Environmental Health Sciences, Research, and Medicine
Board on Health Sciences Policy
INSTITUTE OF MEDICINE
NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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THE NATIONAL ACADEMIES PRESS · 500 Fifth Street, N.W. · Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the
committee responsible for the report were chosen for their special competences and with regard for
appropriate balance.
Support for this project was provided by National Institute of Environmental Health Sciences, National
Institute of Health (Contract No. 282-99-0045, TO#5); National Center for Environmental Health and
Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention
(Contract No.200-2000-00629, TO#7); National Institute for Occupational Safety and Health, Centers
for Disease Control and Prevention (Contract No. 0000166930); National Health and Environment
Effects Research Laboratory and National Center for Environmental Research, Environmental Pro-
tection Agency (Contract No.282-99-0045, TO#5); American Chemistry Council (unnumbered grant);
and Exxon-Mobil Corporation (unnumbered grant). The views presented in this report are those of the
individual presenters and are not necessarily those of the funding agencies or the Institute of Medicine.
This summary is based on the proceedings of a workshop that was sponsored by the Roundtable on
Environmental Health Sciences, Research, and Medicine. It is prepared in the form of a workshop
summary by and in the name of the editors, with the assistance of staff and consultants, as an
individually authored document.
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Additional copies of this report are available from the National Academies Press, 500 Fifth Street,
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For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2003 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of
Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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"~(nowin,g is not enough; we finest outplay.
Willin,g is not enough; we waist do."
Goethe
.................................. - - .
............ ....
. :::::::
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Shaping the Future for Health
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THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a mandate
that requires it to advise the federal government on scientific and technical matters. Dr.
Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the
National Academy of Sciences, as a parallel organization of outstanding engineers. It is
autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of
~ . .
engmeermg.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examination
of policy matters pertaining to the health of the public. The Institute acts under the
responsibility given to the National Academy of Sciences by its congressional charter to
be an adviser to the federal government and, upon its own initiative, to identify issues of
medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute
of Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy's
purposes of furthering knowledge and advising the federal government. Functioning in
accordance with general policies determined by the Academy, the Council has become the
principal operating agency of both the National Academy of Sciences and the National
Academy of Engineering in providing services to the government, the public, and the
scientific and engineering communities. The Council is administered jointly by both
Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are
chair and vice chair, respectively, of the National Research Council.
www. nationa l-academies.org
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ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES,
RESEARCH, AND MEDICINE
Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, DC
Lynn Goldman (Vice Chair), Professor, Bloomberg School of Public Health,
Johns Hopkins University, Baltimore, MD
Jacqueline Agnew, Professor, Bloomberg School of Public Health, Johns
Hopkins University, Baltimore, MD
jack Azar, Vice President, Environment, Health and Safety, Xerox Corporation,
Webster, NY
Sophie Balk, Chairperson, Committee on Environmental Health, American
Academy of Pediatrics, Bronx, NY (membership expires June 30, 2003)
Roger Bulger, President and CEO, Association of Academic Health Centers,
Washington, DC
Henry Falk, Assistant Administrator, Agency for Toxic Substance and Disease
Registry, Centers for Disease Control and Prevention, Atlanta, GA
Baruch Fischhoff, Professor, Department of Engineering and Public Policy
and the Department of Social and Decision Sciences, Carnegie Mellon
University, Pittsburgh, PA
John Froines, Professor and Director, Center for Occupational and
Environmental Health, Southern California Particle Center and Supersite.
University of California, Los Angeles, CA
Howard Frumkin, Professor and Chair of the Department of Environmental
and Occupational Health at School of Public Health, Emory University's
Rollins, Atlanta, GA
Michael Gallo, Professor of Environmental and Community Medicine,
University of Medicine and Dentistry, New Jersey-Robert Wood Johnson
Medical School, Piscataway, NJ
Bernard D. Goldstein, Dean, University of Pittsburgh Graduate School of
Public Health, Pittsburgh, PA
Robert Graham, Director, Center for Practice and Technology Assessment,
Agency for Healthcare Research and Quality, Rockville, MD (membership
expires June 30, 2003)
Charles Groat, Director, U.S. Geological Survey, Reston, VA
Myron Harrison, Senior Health Advisor, Exxon-Mobil, Inc., Irving, TX
Carol Henry, Vice President for Science and Research, American Chemistry
Council, Arlington, VA
John Howard, Acting Director, National Institute for Occupational Safety and
Health, Washington, DC
Richard Jackson, Director, National Center for Environmental Health, Centers
for Disease Control and Prevention, Atlanta, GA
v
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Lovell ,Iones, Director, Center for Research on Minority Health; Professor,
Gynecologic Oncology, University of Texas, M.D. Anderson Cancer
Center, Houston, TX
Alexis Karolides, Senior Research Associate, Rocky Mountain Institute,
Snowmass, CO
Donald Mattison, Senior Adviser to the Directors of NICHD and CRMC,
National Institutes of Health, Washington, DC
Michael McGinnis, Senior Vice President and Director of the Health Group,
Robert Wood Johnson Foundation, Princeton, NJ
James Melius, Director, Division of Occupational Health and Environmental
Epidemiology, New York State Department of Health, New York, NY
James Merchant, Professor and Dean, College of Public Health, Iowa
University, Iowa City, IA
Sanford Miller, Senior Fellow, Center for Food and Nutrition Policy, Virginia
Polytechnic Institute and State University, Alexandria, VA
Alan R. Nelson, Special Advisor to the CEO, American College of
Physicians-American Society of Internal Medicine, Fairfax, VA
Kenneth Olden, Director, National Institute of Environmental Health Sciences
(NIEHS), National Institutes of Health, Research Triangle Park, NC
Peter Preuss, Director National Center for Environmental Research, U.S.
Environmental Protection Agency, Washington, DC
Lawrence Reiter, Director, National Health and Environmental Effects
Research Laboratory, U.S. Environmental Protection Agency, Research
Triangle Park, NC
Samuel Wilson, Deputy Director, National Institute of Environmental Health
Sciences, National Institutes of Health, Research Triangle Park, NC
IOM Health Sciences Policy Board Liaisons
Lynn Goldman, Professor, Bloomberg School of Public Health, The Johns
Hopkins University, Baltimore, MD
Bernard D. Goldstein, Dean, University of Pittsburgh Graduate School of
Public Health, Pittsburgh, PA
Study Staff
Christine Coussens, Study Director
Dalia Gilbert, Research Associate
Bina Russell, Senior Project Assistant (until August 2003)
Steven I. Marcus, Consultant
al
Pi
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REVIEWERS
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures ap-
proved by the National Research Council's Report Review Committee. The pur-
pose of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible and
to ensure that the report meets institutional standards for objectivity, evidence,
and responsiveness to the study charge. The review comments and draft manu-
script remain confidential to protect the integrity of the deliberative process. We
wish to thank the following individuals for their review of this report:
Ann ,Iones Gerace, Executive Director, Conservation Consultants, Inc.,
Pittsburgh, PA
Gerald Markowitz, Professor, Department of Urban Studies and Community
Health, John Jay College, New York, NY
Suzanne Seppi, Director, Group Against Smog and Pollution (GASP),
Pittsburgh, PA
Balius Walker, Professor of Environmental and Occupational Medicine,
College of Medicine, Howard University, Washington, DC
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the final draft of the report
before its release. The review of this report was overseen by Melvin Worth,
Scholar-in-Residence, Institute of Medicine, who was responsible for making
certain that an independent examination of this report was carried out in accor-
dance with institutional procedures and that all review comments were carefully
considered. Responsibility for the final content of this report rests entirely with the
authoring committee and the institution.
vim
. .
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Preface
In 1753, George Washington recognized the importance of establishing a
post along the Ohio River. Both the French and English began plans to establish
a fort critical to trade and expansion at the point where the Allegheny, Monongahela,
and Ohio Rivers met. Pittsburgh lived up to these expectations by being dubbed
the Gateway to the West, as early nineteenth century immigrants went down the
Ohio to start a new life. This port gave rise to two of Pittsburgh's first industries:
boat building and outfitting. However, it was in 1 811 that a marine engineer from
New York, Nicholas Roosevelt, built the first steam-powered boat and estab-
lished Pittsburgh's role in industrialization.
With its cheap energy sources from water, coal, and oil, nineteenth century
Pittsburgh gloried in being the iron foundry of the nation. It welcomed the sight
and smell of smoke as signs of leadership and prosperity. Penniless immigrants,
such as Andrew Carnegie, made fortunes and were exemplars of the American
Dream, inspiring legions of others to believe that the future was boundless.
However, there was another side to this prosperity. Poor sanitation, water, air,
and working conditions led to many health problems. Even the marble on build-
ings was stained dark gray to black. Large tracts of land were contaminated with
dumped slag and chemical by-products of manufacturing. This environmental
contamination was unjustly distributed in minority and disadvantaged communi-
ties. Formerly beautiful rivers were dead to fish and inaccessible to city residents.
During his American tour, Dickens described midnineteenth century Pittsburgh
as "hell with the lid taken off."
For better and worse, the days of intense industrialization have passed for
southwestern Pennsylvania. Beginning before World War II and picking up pace
afterward, Pittsburghers realized the threat the industrial pollution posed to their
physical and economic well-being. In a region known for difficult relations
between labor and capital, remarkable collaborations promoted smoke abatement
and urban development, converting downtown Pittsburgh's rail yard into park
and offices. Manufacturing is now a small part of the region's struggling
ix
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PREFACE
economy. The steel barons left a legacy of support for libraries, education, and
cultural institutions that contribute to Pittsburgh' s being one of the nation' s most
livable cities.
More recent developments have included stadiums and museums, including
architecturally significant buildings. Some, including a new convention center
and the headquarters of Alcoa and PNC, are at the forefront of environmentally
sound design. A city that once turned its back on the rivers, as grimy highways or
worse, is now developing the riverbanks. Almost dead biologically two genera-
tions ago, the rivers support good fishing at the Point and expanding populations
of river otter upstream. Bicyclists ride along side active railroad lines and atop
abandoned ones.
The combination of civic and self interest that brought about those changes
was not enough, though, to prevent the collapse of the local steel industry, begin-
ning in the late 1970s. The result has been vastly cleaner air, along with a stagnant
regional economy. As might be expected, these overall changes have not affected
area residents equally. The good jobs for hard-working laborers, with middle-
class pay and benefits, have largely vanished. At the same time, the economic
potential of the area's world-class hospitals and universities has increasingly
been realized, bringing new opportunities. However, those institutions are both
close to some economically challenged communities and far from others that
once housed thriving industries.
Allegheny County long had one of the nation's highest African-American
infant mortality rates. It took concerted efforts by the health care community,
aided by local governments, citizens, and foundations to bring it down some,
although by no means enough. Local research similarly showed the difficult way
toward identifying and remedying the risks of lead pollution. The complexity of
these problems shows the intertwining of health and environment and their social
context. Addressing them requires not only good will and coordinated program-
matic efforts, but also solid, interdisciplinary science. For example, a simple
correlation of pollution and health does not capture the expression of environ-
mental justice issues in this area (or perhaps any other) (Institute of Medicine,
1999~. Neighborhoods that excluded minorities when the local mills hummed
became low-income housing when the mills closed, taking jobs away and leaving
pollution behind. Access to health services, training, and work requires reducing
cultural barriers and providing public transportation.
Similarly, complex connections attend the relationship between the region's
environmental and economic future. Dickens's image of Pittsburgh is still most
nonresidents' association with the area, generations after it is no longer a reality.
Thus, the region is paying a pollution tax long after much of the pollution is gone.
Both positive and negative images are hard to erase. One can only speculate
about the environmental reputations now being created elsewhere and their long-
term effects. California's Garden of Eden drew people there long after the area
was clogged with traffic and dirty air. The green images that drew people to
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PREFACE
Xt
Atlanta have been replaced by sprawl, imperiling the greenery and even water
supplies (Institute of Medicine, 2002~. California has become a leader in the
study and control of air pollution, while the southeastern United States has begun
imaginative thinking about regional planning. One might wonder whether the
current, sadder images will haunt those regions 20 years after they have turned
their respective corners.
Of course, the future is not a given. Southwestern Pennsylvania stands at a
crossroads. It might become the leader in postindustrial revitalization. It might
provide the science needed for effective and efficient cleanup and growth, as well
as developing the engineering and institutions needed to realize this potential.
The contrast between its new and old images might serve as an inspiration to
others facing similar despoliation. One striking image is the ongoing conversion
of a giant slagheap from the old Carnegie (and later US Steel) Homestead Works
into an upscale housing development. Reflecting a "new urbanist" architecture,
its popularity reveals residents' preference for a denser lifestyle (but without the
hassles of older homes).
A more complex image lies several hundred feet below this development, in
Nine Mile Run. One of many such ribbons of green, created by the region's
topography, it is also polluted by runoff from aging sewers. Cleaner in other
respects, local waters are threatened by leaky sewers, storm water overflow, and
septic systems ill-suited to the heavy local soils. Compliance with an EPA order
may require billions of dollars and an unprecedented degree of collaboration
among the fractured local governments. It may require a combination of top-
down efforts and local initiatives, like those benefiting Nine Mile Run.
As residents reclaim the environment about them, they will confront other
threats to it, some coming from outside the region. Pockets of nature created by
steep topography provide natural breathing spaces, even in poor neighborhoods.
However, a closer look often shows them to be deeply compromised by invasive
species: Japanese knotweed along the now-accessible rivers, tree of heaven
replacing native forests, and others. Upstream, there are abandoned mines, surges
of whose acidic waters periodically destroy aquatic life below them. The success
of local efforts to protect and restore these habitats will critically depend on state
and federal policies (e.g., mining laws, plant import regulations).
A bit further away, Nine Mile Run's outlet to the Monongahela River may
soon be bridged by a highway, running along the riverbank. The Mon-Fayette
Freeway's advocates claim that it will bring economic opportunity to the de-
pressed Mon Valley. That could improve regional health care and even provide
resources for environmental restoration. It could also bring thoughtless develop-
ment, increasing air pollution and sedentary lifestyles. It might deplete the central
region, leaving its poor and their problems behind. It might undermine the
coordination needed to preserve the regional commons and create an area that
will attract outsiders and retain its own residents.
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. .
xt!
PREFACE
Thus, in southwestern Pennsylvania as elsewhere, health, economics, and
environment are deeply connected. Central to the connections in this region is a
past that has scarred it but has also provided resources. These resources include
universities accustomed to integrating research and practice, governmental bod-
ies that have long focused on environmental and occupational health, healthcare
institutions with a tradition of community service, firms accustomed to working
with other groups, and foundations with activist leadership.
In this context, the Institute of Medicine Roundtable on Environmental Health
Science, Research, and Medicine held a regional workshop at the David Lawrence
Convention Center, on March 13, 2003. This workshop was a continued out-
growth from the Roundtable's first workshop when its members realized that the
challenges facing those in the field of environmental health could not be addressed
without a new definition of environmental health one that incorporates the
natural, built, and social environment.
The Roundtable realized that the industrial legacy is not unique to Pittsburgh.
Other cities around the world have seen their industries disappear, and it is only
a matter of time before some of the Pittsburghs of today, such as Wuhan, China,
(a sister city) will need to address similar problems. One goal for this IOM
Environmental Health Roundtable Workshop is to extract lessons from
Pittsburgh's experience in addressing the post-industrial challenge, distilling les-
sons that might be useful elsewhere.
Early in the planning process, Roundtable members realized that the process
of engaging speakers and developing an agenda for the workshop was an impor-
tant part of the enterprise. In their efforts to encourage a breadth of participation,
Roundtable members sought the input of individuals from diverse fields indus-
try, health, foundations, environmental groups, engineers, architects, developers,
and others. Their input helped to shape the agenda. We would like to thank this
group of individuals for their contributions to making this meeting a success.
This workshop summary captures the discussions that occurred during the
one-day meeting. Although, environmental health is broadly defined by the
Roundtable, not all aspects of environmental health (e.g., social environment) or
secondary factors (e.g. budgetary constraints) could be discussed in their entirety
during the limited time of the meeting. This workshop summary captures the
discussions and presentations by the speakers and participants, who identified
areas where additional research was needed, the processes by which changes
could occur, and the gaps in our knowledge. The views expressed here do not
necessarily reflect the views of the Institute of Medicine, the Roundtable, or its
sponsors.
Baruch Fischhoff and Bernard Goldstein
Summer 2003
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Contents
PREFACE
SUMMARY
1 INTRODUCTION 4
Charge to Speakers and Participants, 5
Overview of the Workshop, 6
Wh at I s Enviro nment al H e alth ?, 7
2 KEYNOTE: ENSURING ENVIRONMENTAL HEALTH
IN PENNSYLVANIA 10
3 THE CHANGING FACE OF PITTSBURGH:
A HISTORICAL PERSPECTIVE 13
Grime and the Rivers, 14
Clearing the Air, 15
Beyond Celebration, 19
4 SPECIAL ISSUE FOR PITTSBURGH: OUR RIVERS
Cradle of the American Industrial Revolution, 20
Polluted Rivers, Sewage Overflows, 21
Rivers As Our Future, 25
..20
5 IMPROVING HEALTH IN THE BUILT ENVIRONMENT:
A DAUNTING BUT DOABLE CHALLENGE 28
"Landscraping" Degrades Environmental Health, 29
Driven to Depression, or Worse, 30
The Hazards of Obesity, 32
Where People Want to Be, 33
. . .
x~
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xlv
6 COMMUNITY PAST, PRESENT, AND FUTURE
"Active Living" in Walkable Communities, 37
Redeveloping Brownfields: Developer, 38
Redeveloping Brownfields: Regulator, 40
Environmental Justice, 42
Toward Healthy Homes, 44
7 SYSTEMS, BUILT ENVIRONMENT-
PAST, PRESENT, FUTURE ..........
Health and the Built Environment, 48
Smart Growth, 51
Transportation's Impacts on Environmental Health, 54
Green Building, 56
Revolutionizing Energy Systems, 58
8 WHERE DO WE GO FROM HERE?
More and Better Feedback Loops, 61
Information Sharing Gets Results, 62
Making Clear the Connections, 63
Facilitating Progress, 65
The Elements of Success, 66
REFERENCES
APPENDIXES
CONTENTS
- .36
- .47
.61
- .68
A AGENDA 69
B SPEAKERS AND PANELISTS
C MEETING PARTICIPANTS
- .75
.77
