The magazine of the World Health Organization May 1972 UK: 20 p. USA: 0.50 The ma.. Tld Naellh Omenienhon Mav 1972 On the cover, World Health artist Peter Davies interprets pollution. Contents Pollution and health 3 Environmental hazards, by Dr M. Kaplan 4 The decibel inferno, by M. Allain - Regnault 12 The sea, danger signals for man, by Dr B, and L. Halstead 16 Something in the air, by R. Pavanello 22 A nation copes with pollution, by P. Almasy 24 Bearing the brunt, by Dr B,H, Dietrich 28 Readers write 34 World Health Day posters 35 World Health appears in Arabic, English, French, German, Hindi, Japanese, Portuguese, Russian and Spanish. 2 POLLUTION AND HEALTH Is pollution the partner of economic progress? Must man pay for his economic well-being with foul water, noxious fumes and nerve jarring noise? Can we achieve the material benefits of industrialization for all the people of the world without jeopardizing our health and despoiling our environmental heritage? Today, the most widely discussed aspects of the pollution problem are those caused by industrialization, urbanization and motorization. Of graver consequence for the health of mankind is the polluted environment of underdeveloped areas where millions suffer the combined effects of poverty, ignorance, poor food and disease. Too many people still use water from contaminated sources for drinking and washing. Solid waste disposal is a serious world problem. Refuse of all kinds including human excreta help flies, mos- quitos, rodents and other disease agents to thrive, passing on illnesses to man. The environment is in perpetual change. It presents a challenge to the doctor, the engineer, the health administrator and many other professions. For this reason, the United Nations has called a conference on the human environment in Stockholm, 5-16 June. All Member States of the United Nations have been asked to send represen- tatives. Some 1,200 senior officials from all over the world will be present. The purpose of the conference is to identify the most urgent environmental problems and obtain agreement on action to deal with them. As may be expected, the conference will be a free forum in which many divergent views will be expressed. However, no matter what disagreements may remain with regard to methods and priorities, there can be no disagreement on the urgency of the problem as a whole, nor on the need to monitor changes in the human environment and to prevent further deteri- oration. The current issue of World Health deals with some of the health hazards of the human environment as did the August- September 1971 issue. The aim—then as now—is to show that the struggle for man's health is intimately linked with that of preserving and improving our environment. ■ <— A Kenyan woman draws clean drinking water. Between 75 and 90 per cent of the people in developing countries are exposed to unsafe drinking water. Low tide on the Thames River in London (below). The wastes of an affluent society are debasing the quality of modern life. The perpetual change in the environment presents a challenge to the doctor, the engineer and other professions. (Photos WHO/P. Larsen; L. Sirman ©) ENVIRONMENTAL HAZAR by Dr Martin Kaplan, Director, Office of Science and Technology, WHO Dead birds and floating fish have come to symbolize the environmental hazards that surround us, and dire analogies have been drawn of the catastrophes that threaten to engulf man unless dramatic steps are taken quickly. In the crescendo of present anxiety about the environment, the Cassandras with their predictions of doomsday around the corner—the year 2000 being a much used peg—have occu- pied centre stage by focusing on the pos- sibility of such macrodisasters as the world running out of oxygen or being menaced by a dramatic change of climate. However, scientific analysis has shown that a sig- nificant reduction of atmospheric oxygen is a non-existent problem and that gross changes in the global climate appear to be most unlikely, although prudence dictates a constant watch on indicators of any climatic changes on a global scale. On the other hand, one can understand the very legitimate concern with respect to global population growth and the required food supply which loom large on the horizon, and the problem of rapid and uncontrolled urbanization which face many countries right now. With respect to nature conservation there has been widespread recognition of the need to protect our flora and fauna for economic and aesthetic reasons. But, oddly enough, the issue of adverse effects of the environment on human health here and now—presumably the heart of the matter of environment—appears to have found hardly any echo amongst all the expres- sions of concern. One reason for this may be the very lack of spectacular visible evidence, since humans are not keeling over on beaches or dying in droves. One may cite, of course, smog incidents such as those that occurred in the Meuse Valley in December 1930, or in Donora, Penn- sylvania, in October 1948, or in London in December 1952, which caused many deaths and considerable morbidity. There are besides numerous outbreaks of water or food-borne disease, and sporadic cases of chemical poisoning from the environ- ment, but these are often of local and temporary interest. Acute episodes of large-scale harm to human beings are relatively infrequent and occur mainly when unusually high levels of the offend- ing substance are reached. But of far greater importance is the threat to man from subtler and less spectacular condi- tions in the environment that cause dam- age unobtrusively or that may not even be recognized as having environmental com- ponents. Let us examine more closely some well identified major health hazards of the environment. These are summarized in the tables on page 8. 4 Anti-pollution laws have brought about a change in Pittsburgh (USA), once a grimy city. The smoke-control programme launched in the 1940's has helped bring about a re-birth of the city. Shown here are photos in the mid-1940's and in 1970. (Photos Allegheny Dept. of Public Works) DS FOR HUMAN HEALTH Elsewhere in this issue the problems of food and water contaminants, and noise and vibrations are discussed. To these must be added thermal exposures (heat and cold, and altitude), radiation and microwaves, and problems of urbaniza- tion, including population growth and migration, housing and household agents which comprise many sources of environ- mental hazards to human health. The high toll of human life and health caused by environmental factors can best be seen in the economically depressed communities in developing countries. Here, populations are ravaged by infectious diseases set in motion by unprotected water supplies and inadequate waste dis- posal, food sanitation and vector control, and exacerbated by widespread malnutri- tion. For example, from 75 to 90 per cent of people in developing countries are exposed to unsafe drinking water, giving rise to gastro-intestinal disorders that are the most important causes of illness and death in infants and children. Every year, millions are stricken by mosquito and other insect-borne diseases such as ma- laria, yellow fever and "brain fevers" caused by many different viruses. In addition, trachoma (a cause of wide- spread loss of vision), worms and other parasites, fostered by unsanitary condi- tions, affect entire populations in many developing countries in terms of reduced work capacity and lowered resistance to other diseases. In considering environmental health hazards, it is important to bear in mind the following points: (1) there are many gaps in our knowledge of what constitutes hazardous levels of various environmental components; (2) surveillance and monitor- ing must be developed as a means of arriving at an early warning system for adverse effects of the environment on human health; and (3) psychosocial influ- ences must be considered an essential part of the environment. What is a toxic effect? When acute poisonings occur in people there is no doubt that the tolerance level of a toxic substance has been surpassed. Thus deaths occur when carbon monoxide emanating from automobile exhausts or from domestic gas leaks in an enclosed space reaches certain levels. What is not known is the effects of exposure to low levels of carbon monoxide over long periods of time. An answer to the problem is being sought in studies now underway to determine the effect on health of exposure to heavy automobile traffic over a period of months or years. 5 WHO REFERENCE CENTRES AND COLLABORATING LABORATORIES The same considerations apply to a long list of chemicals to which man is increas- ingly exposed because of industrialization. Some of these chemicals accumulate gradually in the body and show their effects only when certain levels are reached. A notable example is mercury. The phrase "mad as a hatter" (the Mad Hatter of Alice in Wonderland) owes its origin to the fact that workers in felt hat factories of the last century were exposed to mercury compounds in their work and were subject to neurotoxic effects. Many other chemi- cals that enter the body are rapidly eliminated or are detoxified by conversion to harmless substances through metabolic processes in the body unless too high a dose is absorbed. Others act only on certain organs and tissues at specific times, such as the action of thalidomide on the developing foetus during early pregnancy, which resulted, in the early 1960's, in the birth of hundreds of deformed babies to mothers who had taken the drug for its sedative action. People inherit different genetic constitu- tions and vary in their reactions to chemical substances. Thus, in dealing with the problem of environmental pollutants, we cannot consider the effects of particular substances alone. We must also beware of possible effects of these substances in com- bination with others, such as drugs and aliments, and on individual reactions to all of these. Delayed effects Another problem concerns delayed ef- fects of chemicals. Some authorities con- sider that over 80 per cent of all cancers have their origin in environmental insults, as from chemicals and viruses. Some of these insults may have occurred many years before the cancer develops. It is obviously difficult to ascertain the par- ticular insult and the time component, but this is sometimes possible by means of epidemiological studies. Through the years some information has been accumulated by observations on occupational groups, such as factory workers highly exposed to certain chemi- cals. A well-known example is the epi- demic of radium poisoning in the 1920s experienced by workers who were employ- ed to paint watch dials, and in the process licked the paint brushes to give them a fine point. But in the case of most environ- mental pollutants, information on toxic levels is not available and arbitrary levels are often established pending further research. As research in toxicology is usually carried out on laboratory animals, it poses 6 serious problems. The extrapolation to man of results obtained in laboratory animals is full of pitfalls of which toxicologists and others are well aware, for species of animals may differ widely in their reactions to various chemi- cals. Even costly procedures with pri- mates cannot satisfactorily solve the pro- blem of predicting effects in man, although these animals are more closely related to the human being than the mice, rats, guineapigs, and rabbits usually employed. Long -term effects Perhaps the most difficult aspect of the question is that of determining the effects of low level, long-term exposure to chemi- cal substances. Screening tests are done in laboratories to determine the ability of various substances to cause cancer (car- cinogens), inheritable changes (mutagens), or defective embryos or babies (terato- gens). In laboratory tests, many chemicals are known to produce one and sometimes all of these effects, if sufficiently high doses are used. But often with lower doses no harm is observed. As a result, there are great differences of opinion among toxi- cologists on what constitutes an adequate safety test. How many animals should be used? For example, our present radiation exposure safety levels for man are largely based on information from exhaustive tests on millions of mice involving varying doses of irradiation for different periods of time. Obviously such a procedure is not feasible for the thousands of chemicals, new and old, to which man is constantly exposed. Industrialization and the continuous appearance of new chemicals is a fairly recent phenomenon. We may comfort our- selves on having thus far escaped any large-scale catastrophe that might have occurred (but did not), for example, from a widely ingested chemical such as caffeine, which is present in tea and coffee, and is known from laboratory experiments to alter chromosomes in cells. But can we afford to take similar chances with new, widely employed chemicals, such as those used in vinyl plastics, which have been found in the bloodstream of 86 out of 100 persons recently tested in the USA, and which have killed embyronic chicken heart cells in laboratory tests? These are hard questions and cannot be ignored. Our most immediate answer must be to increase the breadth and depth of scientific re- search in order to provide the knowledge necessary for proper action. Research for toxic effects that is limited to animals or other experimental systems NATIONAL AND LOCAL HEALTH AGENCIES SUPPORTING RESEARCH ACTIVITIES UN FAMILY SPECIALIZED AGENCIES AND OTHER ORGANIZATIONS ENVIRONMENTAL HEALTH SURVEILLANCE AND MONITORING NETWORK COLLECTION OF DATA DATA INTEGRATION AND STORAGE WORLD HEALTH ORGANIZATION ENVIRONMENTAL SURVEILLANCE AND MONITORING INFORMATION NETWORK ANALYSIS AND INTERPRETATION RESEARCH This chart shows the WHO international environmental surveillance and monitoring network which is being developed. The incoming information received from organizations, institutions, laboratories or national health services is treated by WHO (right). It is analyzed and interpreted so that any change of importance should be noticed and instantly signalled. The network is still in its initial stages. When the components play their full part it will be a sensitive alert system for detecting adverse changes in the environment. Agents or Pollutants in Air Possible effects on human health Oxides of sulphur in combina- Aggravation of existing respiratory diseases and tion with airborne particles contribution to their development; impairment (smoke) of lung function; sensory irritation. Airborne particles Increase in the effects of gaseous pollutants such as sulphur dioxide; possible toxic effects depend- ing on chemical composition (e.g. particles con- taining lead or asbestos). Oxidants including ozone Eye irritation; possible association with asthmatic attacks; impairment of lung function in diseased persons. Carbon monoxide By combining with haemoglobin deprives tissues of oxygen; individuals suffering from cardio-respi- ratory disease more sensitive; psycho-physiological effects possible even at low concentrations; smok- ing is an important source, perhaps more significant than exposure to motor vehicle exhausts. Lead Intake through food and water and air enhances the total body burden of this element; in excessive amount it may develop poisoning. Asbestos A possible factor in the incidence of lung disease along with other air pollutants and smoking; pleural calcification observed also in non-occupational ex- posure. Beryllium "Neighbourhood" cases of chronic beryllium poi- soning observed near beryllium production plants. Agents or Pollutants in Land Possible effects on human health Human excreta Schistosomiasis, taeniasis, hookworm and other infections. Sewage Urban filariasis; flies and other disease vectors. Garbage and vectors inhabit- Rodent-borne diseases; pollution of water and air ing it from disposal practices. Industrial and radioactive waste Effects from stored toxic metals and other sub- tances through food chains. Pesticides Contamination of vegetation and secondary food- stuffs and entry into food chain. (cultures cells, microbes) still leaves un- answered the crucial questions—whether and to what extent man himself is affected adversely by various environmental in- fluences. A valuable tool in this respect is epidemiology—the study of changes in the health of population groups and of factors that influence health status. Whereas epidemiological research in communicable and other diseases usually starts from a disease and looks for associated or causal factors, in many epidemiological studies on environmental hazard evaluation we set out with a given exposure and look for possible health reactions. Not all of these reactions will show as identifiable diseases; some impor- tant health responses are characterized by impairment of capacity, production of new symptoms, aggravation of a pre-existing illness, or non-specific effects on morbidity or mortality. The kinds of environmental hazards that lend themselves best to epidemiologi- cal study are those with long-term effects, or complex and non-specific effects. The effects of air pollution on communities in England were not fully appreciated until epidemiological data on unusually high mortality during episodes of pollution were reported. This fact, plus the simul- taneous finding that pollution was one of the causal factors in chronic bronchitis, provided a tremendous impetus for the Clean Air Act of the United Kingdom. Another striking and important accom- plishment of epidemiological research was the demonstration of the relationship between cigarette smoking and lung cancer. The health status of population groups can often be expressed in indices, e.g. the number of deaths and cases of illness per year in different age groups, and their specific causes. The baseline levels or indices relating to various causes of death—as for example in cancer, cardio- vascular disease, communicable disease, automobile accidents, suicides, and mor- tality in new-born infants—make it pos- sible for surveillance and monitoring activities to be started. Roughly speaking, surveillance means watching for unex- pected changes, for instance a rise in the usual number of polio cases. Monitoring consists of specific tests or procedures carried out periodically to determine levels of particular substances, such as radioactive strontium in the teeth of children or the number of bacteria in water samples from drinking sources. wHo has gathered a good deal of infor- mation through its machinery for collect- ing morbidity and mortality statistics as well as through research and operational programmes against many diseases includ- ing smallpox and malaria. Another valu- able source of data is the network of wHo reference centres and collaborating labor- atories for such diseases as influenza, rabies, cardiovascular diseases, cancer and many other diseases. The first steps have already been taken to organize inflowing data and to seek new information that will provide early warning of harmful environ- mental influences on human health (see chart). The development of a comprehensive surveillance and monitoring network is a long and difficult task. Short cuts and interim measures are therefore being developed for use until such time as a comprehensive network has been estab- lished. Short cuts can be made with cer- tain types of information that will serve as sensitive indicators of environmental sources of disease. For example, in addi- tion to strengthening on-going operations in many of the wHo activities mentioned above, attempts will be made to achieve better "signals" through standardizing methods of identifying and registering birth defects, determining body tissue levels of potentially harmful substances such as lead and mercury, detecting changes in health status of selected population groups e.g. school children or factory workers. This work will require collaboration with national authorities and with other international organizations such as the World Meteorological Organization, FAO, UNESCO, and the United Nations, which would supply information on the en- 8 vironrnental indices with which they are concerned. The cultural and social setting in which we live has a direct impact on our person- ality. Thus, what happens around us can exert considerable influence on our actions and state of being. And yet, because of the preponderant concern with the physical and chemical aspects of environmental hazards, psychosocial influences are fre- quently overlooked. The term "psychosocial" refers to the inter-relationship of the mental and behav- ioural functioning of an individual and the social and cultural milieu in which he lives. The importance of psychosocial factors becomes obvious when it is recognized that human health depends on genetic as well as environmental factors. How the genes manifest themselves will depend upon the impact of a very great number of environ- mental factors on man's genetic constitu- tion (his inborn "programme" of develop- ment and responses). Social and cultural conditioning From the moment of conception a human being is exposed not only to a physico-chemical environment, with its va- riations in climate, nutrition, diseases, and other factors, but also to a multiform social and cultural conditioning that influences the process of learning and determines individual health, character and responses. Many of these environmental factors can produce neurological injury and abnormal behaviour: stress, toxic substances, drugs, radiation, nutrition, infectious micro- organisms, and social and cultural factors. Let us examine some of these briefly. The body's mental and physical pro- cesses are self-regulating and normally in a state of equilibrium. If this equilibrium is modified by stress, and the organism cannot cope with an excessive load of stimuli, it goes into a state of breakdown. The stimuli may be physical or chemical, they may be introduced from the outside or generated within the body as a result of mental reactions, as for example in the release of adrenalin from a fear reaction. Stress proceeding from social or cultural factors affects people differently, even in the same group and in a similar environ- ment, for individuals vary greatly in their constitutional ability to handle stress of all kinds. It has often been claimed that the increased pressures of modern life may lead to a greater incidence of serious mental illness. This has not so far been demonstrated statistically but from infor- mation available it would appear that minor mental disturbances do tend to increase under conditions of stress. In Tokyo, one of the automatic monitoring stations that keeps track of water pollution. (Photo WHO/T. Takahara)
Under very severe conditions, such as natural disasters, riots and wars, unusual mental symptoms are observed. Some of these symptoms may be temporary and quite normal in the sense that they repre- sent the individual's readjustment to a state of equilibrium; others may be pathological states revealed but not neces- sarily caused by the impact of severe stress. Among the environmental hazards of the present age is the exposure of people, especially in cities, to harmful effects of chemicals on the central nervous system. Many industrial chemicals, such as carbon disulphide, mercury, manganese, tin, lead compounds, trichlorethylene and carbon monoxide, have been shown to be selective agents producing neurological and behav- ioural disturbances. Lead poisoning in children from eating paint flaking off interior walls is known to produce brain damage resulting in perma- nent mental retardation. An important cause of brain damage in infants is infectious disease. Viruses such as measles and rubella may affect develop- ment and integration of function of the brain. Sometimes babies are born with eye and brain lesions as a result of toxoplas- mosis infection. This disease is caused by a protozoal organism often harboured and transmitted by cats, and is passed from the human mother to the foetus during preg- nancy. Other parasitic diseases such as cysticercosis (transmitted by certain dog tapeworms), cerebral trypanosomiasis ("sleeping sickness"), and some fungous infections are responsible for many cases of neurological and mental disturbance in tropical areas of the world. Some epidemiological studies have pointed to the higher rate of schizo- phrenia, crime, suicide, alcoholism and drug abuse in over-crowded urban areas. But such correlations are by no means clear-cut, and a great deal more research is required in this field. In some highly industrialized countries large portions of the population change residence frequently (in the 10 years between 1950 and 1960, for example, 52 million persons in the USA, one in four of the population, moved from one state to another, and about the same number moved from one part of a state to another). This is likely to cause stress in families, particularly for young children and the aged, who may have considerable difficulty in making new friends and generally adapt- ing to new environments. Uprooting and resettlement are more likely to be traumatic where migration has been involuntary, and such phenomena have affected large populations during this century. Particularly high rates of mental disorder have been found among migrants who have survived mass ill-treatment. All cultures in the world are changing, some slowly, others very rapidly, as a result of accelerated transportation and communication. There is little doubt that this culture change fosters different expec- tations and demands in people. Whether such change modifies the patterns and incidence of mental illness is highly controversial and the question requires a great deal of further research. A number of psychiatric illnesses and behavioural disorders have a profound meaning for society as a whole. Whether they are caused by social factors is not certain. Social factors may promote the emergence of many disorders, but do not appear necessarily to cause them. These factors include alcoholism, drug depen- dence, suicidal behaviour, criminality, and delinquency. The point of controversy is whether they are primarily biologically or socially determined, and to what extent. It is evident then that there are many environmental influences on mental health. The components here are often inextricably bound with the varying biological make-up of individuals and the separation of differ- ent factors is often not possible. Many hazards In summary, hazards to human health arising from environmental factors are many and varied. We know much about some and little about many of them. We must therefore depend on future research both in the experimental laboratory and by epidemiology to clarify many of our areas of ignorance. The development of surveillance and monitoring mechanisms for changes in health status correlated with environmental components should provide the warnings necessary to avoid serious harm to present and future genera- tions of the human race. In reviewing all these environmental effects and their possible dangers, we should not however reach too gloomy a conclusion. A comforting finding, which may be extended to many other aspects, is the recent discovery that fish caught in the last century and preserved in museums have been found to have similar mercury levels as those found in fish today. And after all, the human race with its great adaptability has survived the innumerable disasters and environmental hazards it has encountered for several million years. Modern life and times represent for man merely a new set of problems replacing old ones, and there is no reason to doubt that man's ingenuity and intelligence will prevail as far as environmental problems are concerned. ■ Rush hour crowds in the Paris Metro. Psycho-social stresses of modern times 11 are perhaps related to some forms of mental illness. (Photo WHO/P. Almasy) THE DECIBEL INFERNO by Martine Allain-Regnault Of all forms of pollution, no doubt the most insistent is the constant background of aggressive noise in airports, in the street, in factories and even inside buildings. This curse of modern times was already known to the ancient Romans according to the satires of Juvenal. In the sixteenth century, under Queen Elizabeth of England, husbands were forbidden to beat their wives after ten p.m. and, a century later, Boileau complained of the noise in Paris during the reign of Louis XIV. In our days the danger point has been reached and noise is becoming a major environmental problem. The difference is that air and water pollution can readily be detected and measured by chemical and other means while noises are much harder to identify. A definition of noise is "undesired sounds producing an auditory sensation considered to be annoying". Thus, al- though omnipresent, noise is a rather subjective phenomenon. In many fields, excessive noise is pro- duced as a by-product of progress resulting from the unprecedented develop- ment of modern techniques. Indeed noise appears to have become an inevitable and even necessary parasite of our society and our civilization. The temptation is simply to resign oneself to it, uncondi- tionally, and such an attitude has certainly led to the irritating situation in which we constantly find ourselves today. It is a situation that now requires drastic and costly remedies and forces us to consider its possible effects on human beings. Only 30 years ago, who would have dreamt that, despite the ban on the sounding of horns, the increase in road traffic would itself result in serious annoy- ance? Who could have foreseen that aircraft noise would prevent people from sleeping in the dormitory towns near airports or that the ambient decibel level in the home from refrigerators, refuse grinders, coffee grinders, mixers, washing machines, electric can openers and other such appliances would become almost more than the average householder cares to put up with? Not to speak of the special problem of occupational exposure to noise in factories which are a major source of this nuisance. However, being localized, it is easier to remedy, although at a price. Everywhere and at all times the city dweller is thus subjected to "the decibel hell". Is it simply a source of annoyance or is constant exposure to noise a real cause of injury? First let us look at some facts. When launched into space, a rocket produces a noise of 170 decibels and a siren as much as 150 decibels, both levels above the extreme limit of human tolerance which can be placed at 140 decibels. Pneumatic drills are estimated to produce 120 decibels (the pain thresh- old), motorcycles 110, and in an under- ground railway station in Paris 90, all in the intensity range considered as dangerous for the human organism. At a lower level, an alarm clock pro- duced about 80 decibels, which is also the level of a domestic quarrel. The telephone rings at 70 decibels and the speaking voice easily rises to 60. For sound sleep, a sonometre in your bedroom should not register more than 30 decibels, but it is now uncommon for the noise level not to go higher at some time during the night. In short, we are chronically subjected to ambient noise that usually varies between 35 and 60 decibels with occasional peaks of 90 to 100. To the question whether such back- ground noise is harmful to health, no scientist has yet taken the responsibility of giving a clear answer. However, the results of large-scale statistical surveys all point in the same direction. Epidemiolo- gical research in the USA has shown conclusively that hearing loss develops sooner in city than in country people, and sooner in the latter than among tribal populations in countries at an early stage of development. An investigation made in Sweden among candidates for industrial employment in the age group 15-20 showed that the proportion of those presenting hearing troubles attributed to noise was 19.5% in 1970, twice as high as in 1956 (9%). A survey undertaken in Great Britain revealed that between 20% and 45% of the population were living in places where the traffic noise exceeded the limit recommended by a government committee. It is, of course, the hearing system that is primarily affected by excessive noise, and this is the only area which is liable to actual physical injury. Even when ambient noise is an undoubted nuisance it rarely causes actual physical damage. However, a series of investigations undertaken both in the USA and in Europe produced evi- dence that noise was a significant factor in certain affections even though it could not be held solely responsible for them. There does not appear to be any real syndrome 12 The extreme limit of human noise tolerance is 140 decibels, and the pain threshold 120 decibels. TELEPHONES 70 SPACE ROCKETS 170 SIRENS 150 DRILLS 120 TRAFFIC 110 ALARM-CLOCKS 80 due to noise although it may be possible to speak of a so-called "sonic" pathology. It is recognized that the organism as a whole is adversely affected by excessive noise. If the cardiovascular system is chronically subjected to a high decibel level, tachycardia develops, the heart beats faster, and the blood pressure rises follow- ing constriction of the blood vessels. The rhythm of breathing may be modified and even the digestive system is affected. Gastric troubles may appear and the intestines become sluggish. The secretion of hormones, particularly adrenaline, is disturbed. Indeed noise appears to have a more or less direct influence on the pituitary gland, the adrenal cortex, the thyroid and the gonads. But it is undoubtedly in the nervous system that the disturbance due to the aggression of noise is most evident. The sympathetic nervous system is affected with a consequent increase in tension in the organs it controls. In some instances, excessive noise can affect sight. There is evidence that exposure to painfully loud noise lowers visual capacity in poor light conditions, especially at night, impairs the ability to judge distances and irregula- rities of surface, causes some confusion in colour perception and may even result in reducing the field of vision. Noise can also have a serious effect on the central nervous system, and it appears that nowadays doctors hold it partly responsible for one in every three cases of neurosis and for four headaches in every five. It may also play a part in the increase in violence and in producing depressive states and feelings of general "tiredness" and fatigue of uncertain origin but unquestionable reality. "Noise is the most offensive of inter- ruptions and can even shatter one's thoughts," wrote Schopenhauer, and Audier once said, "In the midst of noise, meditation is impossible, prayer is difficult, and to be subject to prolonged noise is torture". There is hardly any doubt that noise has adverse effects on the emotional as well as the intellectual spheres. The nervous system bears the primary impact of sound waves and also acts as a relay since the organs of hearing are linked with many other nerve structures and with the cerebral cortex. The brain waves recorded by an electroencephalo- graph are modified under the effect of Directions have to be shouted, for at this Cleve- land steel plant (USA) the noise makes normal conversation impossible. (Photo Sirman (D) Technicians at the acoustic laboratory of the Institute of Scientific Research in Moscoir test noise levels. (Photo Novosti1WHO) noise. Sleep is the first to suffer—a loud noise wakes the sleeper brutally, while chronic noise prevents him from getting that deep sleep which alone is truly refreshing. It has also been shown that against a background of loud noise (a steady 85 decibels), immediate memory is adversely affected while long-term memory shows a slight improvement. The ability to concentrate is also influenced by noise. In a frequently mentioned experiment by Professor Jean Boyer, of the French National Academy of Medicine, the re- duction of noise in an office by some 20 decibels resulted in a 9% increase in output and a 29% decrease in spelling mistakes. Similar results, although not supported by exact figures, have been obtained among steel workers in Germany and aircraft personnel in the United States Navy. Generally speaking, it is people engaged in (intellectual or manual) occupations requiring considerable concentration who are specially sensitive to the ambient noise level and to sudden noises. Research in factories has demonstrated that, when the noise level is lowered, productivity is in- creased, mistakes are less frequent, acci- dents are fewer and absenteeism is reduced. It is, in any case, well established that sudden or very loud noises provoke a series of "startle" reflexes accompanied by a state of anxious waiting and a build-up of nervous tension in preparation for a riposte to the aggression. Noise thus indu- ces a state of emotion and stress. In view of the above facts, there may be a temptation to consider noise as responsible for many ills. There is no doubt that occupational deafness is one, but it occurs only in certain well-defined circumstances. Apart from that, it cannot be said, in the present state of knowledge, that noise is anything more than an all- pervading nuisance; it should certainly not be held solely responsible for chronic insomnias, neuroses, psychoses, arterial hypertension, etc. Doctors and health workers who have made a particular study of the effects of noise on the human organism agree that, although a curse, noise very often does no more than reveal or perhaps intensify weaknesses. It is as if aggressive noise had the effect of magnifying existing faults in the organism. Looking towards the future, it is never- theless clearly necessary to take immediate steps to control noise in the interests of human health and well-being. In many countries there are some restrictions on aircraft noise and some legislation on industrial noise, but it has now become urgent to set permissible limits on noise in streets and buildings generally. It is not only loudness, rated in decibels, that must be considered, but other characteristics of noise as well. Sudden or intermittent noise is more harmful than continuous, and pure tones more harmful than wide- spectrum noise. Noise peaks are of great importance in estimating the effects of noise on the human organism. The estab- lishment of indices of noise exposure is an essential aspect of noise control that is receiving attention from the World Health Organization and other interna- tional bodies active in this field. In 1966, WHO published a brochure by A. Bell, Noise, an occupational hazard and public nuisance summarizing what was then known about the effects of noise and its control. A study of the health problems created by noise has been pursued for several years in Europe by WHO, and a report on the health aspects of noise research and noise control was issued by the wHo Regional Office in Copenhagen- in 1970. This was followed, in October 1971, by a meeting in The Hague at which specialists from eight European countries and from the USA made recommenda- tions on the development of noise control programmes with particular reference to noise in houses. In December 1971, WHO organized a meeting on urban and occupational noise attended by ten consultants from eight countries in Europe and North America. They reviewed the effects of exposure to noise on human health and examined the possibility of establishing exposure criteria applicable to noise from all sources, traffic, aircraft and industry. Participants discussed the desirability of establishing a common noise exposure index that would incorporate all physical characteristics of noise having significant biological effects, and could be internationally accepted for measuring exposure to both community and industrial noise. This would be an essential step to enable governments to take effective measures to protect their populations against the growing threat of pollution by noise. ■ 15 THE SEA DANGER SIGNALS FOR MAN by Dr Bruce W. Halstead and Linda Halstead Baldwin World Life Research Institute, Colton, California To appreciate the relationship of the sea to man it is well to understand its envi- ronmental setting. The oceans cover 71% of the earth's surface with a water volume of about 325 million cubic miles. Marine plants comprise about 80 % of all plant food grown on this planet. This aqueous mass provides the support system for nearly four-fifths of all living organisms. It is also the final cesspool into which flows most of the discharge of man's polluting activities. The parts of the sea most susceptible to pollution are the continental coastal re- gions and the insular shallow water areas in tropical seas. Together they do not exceed 10% of the total ocean area but this is the part of the sea from which the world's marine fisheries products are de- rived. The remainder of the sea is essen- tially a biological desert. Most of the world's fisheries are al- ready being exploited at or above their levels of maximum sustainable yield. It is obvious that any appreciable increase in the world's fish landings must come from unexploited species and undeveloped fish- ing areas. In this regard, there is a notice- able trend already for the world's fishing activity to be directed to tropical seas rather than towards northern or southern latitudes. Some of the insular shallow water regions in the tropics pose serious potential problems because of the extreme sensitivity of tropical reef organisms to all types of pollutants. The most productive and potentially useful parts of the sea are located near the areas of greatest human activity and are thus most susceptible to destruction by man-made pollutants. The interrelation- ship of marine products—that is, foods, drugs, and biotoxins—is only beginning to be appreciated by marine biologists and fishery experts. The problem of pollution adds a fourth dimension to the picture. Against the background of a world popu- lation of 3.6 billion—of which more than two-thirds are undernourished—and an acute protein shortage in the develop- ing countries, the subject of marine pollu- tion begins to take on new meaning. Unusual and alarming symptoms are being increasingly observed throughout the marine environment. They include gross pathological symptoms that have serious economic and health implications. Field investigations during the period 1956-1970 revealed thousands of Califor- nia halibut Paralichthys californicus with dull-coloured, listless, soft bodies. Spotfin croaker Roncador stearnsi were found suf- fering from exopthalmia (protrusion of eye-balls), as were white seabass Cynoscion nobilis. The latter also showed large skin ulcerations. Dover sole Microstomus pacif- icus displayed cancerous lesions about the mouth or body. Benign tumours or papil- lomas were found in white croakers Genyonemus lineatus, tongue soles Sym- phurus atricauda, cusk eels Otophidium scrippsae, and Pacific sanddabs Citha- richthys sordidus. Surface tumours were 16 — .....4.111116.0016111111M"'""--'"will"aliC Paper mill refuse is spewed into the sea on the French Atlantic coast near Arcachon. The most polluted parts of the sea are the continental coastal regions and the insular shallow water areas in tropical seas. (Photo Jacana ©) discovered in four species of flatfish (flathead sole Hippoglossoides elassodon, rex sole Glyptocephalus zachirus, English sole Parophrys vetulus, sand sole Pset- tichthys melanosticus). Out of a total of 5,250 flathead sole that were captured, 336 (6.4%) had observable tumours. Skin tumours were found in sand sole Pset- tichthys melanosticus and rock sole Lepi- dopsetta bilineata. Of 15,739 English sole examined, 12% were found cancerous with some showing as many as 33 tumours. Similar occurrences have been reported from the Los Angeles coast of California, the Puget Sound, Washington, and the New York harbour area in the United States. More recently an upsurge of neo- plasms and skin ulcerations has been reported in fish taken in the Irish Sea. Under normal circumstances, gross path- ological conditions in marine organisms are seldom observed in nature. Once an organism becomes diseased and ineffective in its daily activities, it is usually consumed by one of its predators or dies off within a short period of time. But documented studies show that diseases are appearing in increasing numbers and spreading geo- graphically. The phenomenon has severe economic consequences for populations dependent upon fisheries. As early as 1946, for example, Danish fishermen were com- plaining that diseases were proving disas- trous to the fishery industry. Of even greater concern is the direct threat to human health. Public health records of human poisonings and illnesses associated with eating contaminated fish and shell- fish multiply, along with recurring appear- ances of obnoxious plants and animals. Marine pollution suggests itself as the single sign pointing to the underlying cause of these problems. In each of the above studies the highest incidence of tumour growths, disease, malformations, emaciation, and genetic changes among fish and shellfish was found to be directly proportionate to the proximity of disposal areas and sewer outfalls. The highest incidence of tumour growths was found in fish taken where industrial wastes were in highest concentration. More than 25% of the shellfish beds of Canada are now inoperable and more than one-fifth of those of the USA have been closed because of pollution. Swordfish are now prohib- ited from sale in us markets because of mercury contamination. The pollution problem has many aspects but in its essence it is a question of toxi- cology : the toxic effects of a chemical substance on a specific cellular system of an organism, be it plant, animal, or man. The diagnosis of acute intoxications is relatively simple because of their charac- teristics which would be obvious even to the layman, but the most serious problems facing us in the marine ecosystem are associated with chronic toxicities that man- ifest themselves slowly over a long period of time. An enormous build-up of toxic constituents in the environment may occur 17 A tumour growth on a croaker fish in Southern California. The fish was caught near a sewer outlet. Unusual and alarming symptoms are being observed increasingly throughout the marine environment. Most of the world's dev- eloped fishery areas are already being utilized at or above their levels of maximum sustainable yield. (Photo Halstead and Baldwin) In England, oysters are inspected to see if they are ready for culling. (Photo Sirman Press ©) Oil fouls the shoreline. The most productive and potentially useful areas of the sea are in the vicinity of coastlines with the greatest human activity. They are thus the most sus- ceptible to destruction by man-made pollutants. (Photo Jacana ©) Agents or Pollutants in Food and Water Possible effects on human health Bacteria Epidemic and endemic gastro-intestinal infections (typhoid, cholera, shigellosis, salmonellosis, lepto- spirosis, etc.). Viruses Viral infections, e.g. epidemic hepatitis; possible eye and skin inflammation from swimming. Protozoa and metazoa Amoebiasis, schistosomiasis, hydatidosis and other parasitic infections. Metals Lead poisoning; methyl mercury poisoning (through food chains); cadmium poisoning (through food chains); arsenic poisoning ("Blackfoot" disease) Nitrates Infant methaemoglobinaemia (a condition caused by changes in the haemoglobin molecule). Fluorides Mottling of teeth when in excess. Oil petroleum; phenols; solved solids dis- Impaired potability. Source: WHO Report by the Director-General to 24th World Health Assembly, April 1971, annex 2, p. 4. long before it is detected. There is evidence that this may be happening in the marine environment in many parts of the world. Since the 18th century, numerous in- vestigators have interested themselves in the very complex phenomena of ciguatera fish poisoning. A large number of natu- rally occurring marine biotoxins, present throughout the living spectrum of marine organisms, are recognized today. One of the most important is ciguatoxin. As the investigators have been warning, the toxin is believed to be triggered by contamina- tion of the water by war materials, indus- trial pollutants and sunken ships. A classic example is the outbreak attri- buted to the sinking of the freighter MS Southbank on 26 December 1964. According to all available public health reports from the area, poisonous fish had never been known to exist in the waters of Washington Island and Line Islands, where the ship was sunk. Many of the common reef fishes of the area were eaten 18 daily by the native population without ill effects. No illness occurred among salvage crews working on the wreck who for sev- eral months ate fish caught in the imme- diate vicinity of the partly sunken freighter. Then, in August 1965, the fishes previously edible, suddenly and without warning, became ciguatoxic, and the crew members who ate them became violently ill. That was the month when the portion of the ship containing the main cargo—metals and other substances—was submerged. Over the past 100 years many similar occurrences have been reported from other parts of the world. The problem of pollution goes beyond the mechanical destruction of the marine ecosystem. A key factor in the situation is the food web which has as its basic life- support system a delicately balanced fluid medium—salt water. This medium pro- vides a mixture of chemical constituents in the proper proportion to sustain life. When chemical pollutants are dumped into the ocean they do not become part of a static system. They are not only diluted and dispersed but enter the complex bio- logical food web of the sea. The sequence is believed to start with benthic marine algae which are ingested by herbivorous fish, which in turn are eaten by carnivorous fish. Each trophic level (organisms with similar feeding habits) ingests the poisons found in the bodies of the organisms they feed on. Marine organisms act as biolog- ical concentrators of chemical substances obtained either directly from the seawater or from organisms they feed on. A man eating a large toxic carnivorous reef fish receives the accumulated poisons that have resulted from the ingestion of toxins in their food by all of the organisms at the lower trophic levels in the food chain, down to the initial algae. Under certain environmental conditions pollutants may provide the necessary che- mical constituents to trigger naturally oc- curring biotoxicity cycles such as ciguatera fish poisoning. There is ample evidence that when the proper mix of chemical consti- tuents is present in the environment of some types of marine organisms, biotoxins are produced. Under normal circumstances most of the marine organisms concerned are non-toxic and may be valuable food resources. Antimony, arsenic, cadmium, chro- mium, cobalt, copper, lead, mercury, nickel, zinc—the list of heavy metals and other inorganics found in the marine system grows. All of these metals are relatively toxic and readily concentrated by marine animals. They may find their way into the marine environment through industrial effluents, mining operations and, in some instances, through air polluted by the burning of fossil fuels. The possibility of large concentrations of some of these substances appearing in the marine envi- ronment is minimal, but the following considerations cannot be overlooked: 1. Some of these metals are lethal to 19 humans and/or marine life in surprisingly low concentrations (antimony, cadmium, zinc); 2. Some are cumulative poisons and the symptoms may not develop for several years (arsenic, lead); 3. Many are known to have carcinogenic effects (nickel), caus- ing cancer of the liver and thyroid (sele- nium), connective tissue and lungs (cobalt), urinary tract (lead), skin, lung, liver, and bladder (arsenic), and bone (beryllium). Certainly the presence of cancerous growths and skin ulcers in marine fishes exposed to outfall areas containing these elements does not encourage one to con- sider the possibilities lightly. The problem of mercury poisoning, for instance, is a matter of considerable public health importance. Mercurial compounds are extremely toxic to laboratory animals and man. Mercury enters the marine envi- ronment largely as a direct result of industrial or agricultural technology. It is believed that about 90 per cent of it is transformed to highly toxic methylmercury by marine microorganisms. The intoxicant becomes involved in a cumulative sequence which may not destroy carrier organisms but may be toxic or even lethal to man as a result of bio-accumulation. A prime example of mercury poisoning is the outbreak of Minamata disease that occurred in Japan in 1953 and subsequent years. One hundred persons were taken ill after eating marine organisms that had been contaminated by mercury from the effluents of a vinyl chloride factory in Minamata Bay, Kyushu, Japan. Appar- ently the mercury was being picked up by the algae and invertebrates, and passed on up through the higher trophic levels of the food web to fish. The intoxication, which later became known as Minamata disease, is a severe illness affecting the central nervous system. The victims develop a wide range of serious neurological dis- turbances, including blindness, deafness, stupor, coma, convulsions, loss of emo- tional control, and intellectual impairment. About one third of the victims of the Japa- nese outbreak died. [Twenty-five cases are on record of congenital Minamata disease caused by ingestion of contaminated fish by pregnant mothers.—Ed.] The serious- ness of mercurial contamination has now become apparent not only in Japan but Hidden dangers in food Contamination of food by chemicals has become a cause for concern, particularly in the industrialized countries. Some chemicals enter the biological chain and are stored in high concentration by food plants and ani- mals. Other chemicals may contaminate food during processing and preservation. vvxo in collaboration with FAO keeps the subject under constant review. The broad categories of chemical contami- nants are metals, pesticides and mycotoxins. The best known metallic contaminants include mercury, lead, cadmium, tin and cobalt. Mercury becomes a danger to man mainly through such organisms as fish and shellfish. It tends to accumulate in the human body and may cause irreversible damage to the central nervous system. An outbreak of mass poisoning occurred in Iraq early this year when wheat and barley seed treated with a mercurial fungicide and strictly forbidden for use as food, was eaten nevertheless. Lead is found in most foods as a natural element and also as a consequence of food processing. If it reaches a high level it may cause anaemia and other illnesses. Cadmium can be stored by marine organisms in amounts that may be 4500 times its proportion in water. It enters man's food also through crops, such as rice and wheat, which take it from the soil. Cadmium can cause serious illness, pri- marily in the kidneys. Tin is found in most foods as a natural element. In canned foods— if the canning has not been done with due care—it may cause acute poisoning. Cobalt was responsible for the death of 20 out of 48 people affected in an outbreak in Canada in 1965 after drinking beer to which cobalt in the amount of about one part per million had been added to improve "foam stability". Cobalt in beer is now forbidden. Organochlorine insecticides such as DDT and dieldrin are among pesticides most widely used in agriculture. In laboratory experi- ments, both compounds have been found to cause increase in the incidence of liver tumours in mice. However, the levels of DDT and dieldrin used in these experiments were very much higher than those normally found in food. Parathion, an organophosphorous com- pound, is an insecticide associated with a number of serious cases of acute poisoning. Other pesticides in food have also caused concern. In the course of the harvesting or storage of a plant crop, the plant may be infected with a fungus. Some of these fungi produce chemicals that are highly toxic. One of the best known is aflatoxin, produced by a fungus which infects mainly the peanut. Mention must be made also of nitrosamines which have been found to be potent carcin- ogens for many species of animals. Concern is also being expressed at the recent detection in the environment of polychlorinated biphenyls, which are extremely resistant to bio-degrada- tion. Laboratory animals to whom these com- pounds were administered showed marked damage of the liver and other adverse effects. An extensive poisoning, that occurred recently in west Japan, was traced to the consumption of rice bran oil contaminated with a chlori- nated biphenyl compound. also in the Baltic Sea, the Great Lakes on the United States-Canadian border and in some lakes in Canada. Undoubtedly there are other areas having high mercurial residues that remain undetected because of the lack of effective environmental moni- toring systems. The petrochemical industry is producing an ever-increasing number of chemical compounds, some of which may contain potential carcinogens. Many of these are finding their way into the environment. Pesticides, washed into the river and hence into the marine environment, are consistently appearing in fisheries products used as food. Predatory marine animals, many of which are of great economic value, are especially endangered because of the nature of their food chain, and their capacity to accumulate and retain most of the ingested pesticides in the adipose tissue of the body. The effects of pesticides upon shellfish, particularly oysters, is of con- siderable importance because of the pheno- menal ability of these organisms to con- centrate pesticides in a ratio which is sev- eral thousand times that found in the surrounding water. Large quantities of mackerel catches have been impounded because of excessive residues of DDT, and alarmingly high levels of toxic polychlor- inated biphenyls have been found in other food fishes along American shores. Inefficient technology It is apparent that industrial prosperity has given rise to environmental destruc- tion. This is primarily due to an inefficient world technology. Most of the industrial waste products that are discharged into the oceans are of economic value. In most instances these toxic "wastes" command high prices when properly packaged. Yet these same elements or compounds are discharged into sewer outfalls and dumped into the sea. This is technological and economic inefficiency. Before one can begin to intelligently predict what will take place in the envi- ronment it is essential to know what inorganic and organic pollutants are pre- sent. The available data that have a direct bearing on the toxicological aspects of the marine pollution problem are widely scat- tered in divergent disciplines of study. 20 The Norway lobster, favourite of many seafood lovers, is threatened by the rising tide of marine pollution. Human poisoning and illnesses asso- ciated with eating contaminated shellfish are on the increase. (Photo Jacana (D) Only a computerized data retrieval system can provide the mechanism necessary to make full use of the data. The global pollu- tion problem requires a new generation of automated chemical sample analyzers op- erating on a continuous basis over an extended period of time in widely scattered areas of the marine environment. This could also necessitate a system coupled to long-range sensing equipment and an appropriate communications programme. Future monitoring systems should take into consideration all of the various ecotoxicological aspects relating to marine pollution. Information is urgently required on the toxic effects of these pollutants on a broad spectrum of marine plants and animals including their larval and adult stages in arctic, antarctic, temperate, and tropical waters. Pollutants acting at extremely low levels may be devastating to organisms during their larval periods. This situation could result in the loss of large populations of valuable food resources and the cau- sative agent would go undetected merely because our bioassay methods were not sensitive enough. Controlled toxicity stud- ies in a carefully monitored laboratory on goldfish and mice are not an answer to today's environmental toxicological prob- lems. We need a shift in emphasis to low level, long-term, chronic toxicity studies, utilizing a wide variety of test organisms. There is no longer any question whether or not undesirable materials are entering man's marine food resources. They very definitely are. The questions that remain are how and to what extent these poisons are affecting marine and human biological systems and how we can meet the threat. It is in answering these questions that the key will be found to the survival of the ocean and, perhaps, all mankind. ■ 21 SOMETHING IN THE AIR by Renato Pavanello The man breathing garlic fumes or blowing acrid cigar smoke in a crowded waiting room may be causing a minor annoyance but he forms part of an increas- ingly important problem of urban living: odour nuisance. Air pollution caused by odours or odoriferous substances has been demanding increasing attention from the hygienist as a phenomenon with a strong bearing on the quality and comfort of life in cities and possibly on human health. The magnitude of the problem may vary according to the nature of the substance or the manner of emission of the smell and its intensity, but often the problem is a real one and does not offer easy solutions. Take for instance a middle-sized town- ship located downwind from a source of odour such as a paper pulp factory using the kraft process, a rayon factory, a factory making gelatin from bones or a fishmeal plant, and we may well imagine the plight of the inhabitants. The complexity of the problem becomes obvious when it is realized that the township is economically dependent on its industrial section. Money may have no smell once it's in your wallet, but the paper manufacturing process does smell indeed. In fact, even in non-industrial towns one is likely to be assailed by odours of varying degrees of unpleasantness from such sources as coffee-roasting works, chocolate factories, fish markets, slaughterhouses, rubbish dumps or workshops where spray- painting or varnishing is carried on. The nuisance caused is determined largely by the nature of the product since the traces of some elements tend to disappear more rapidly while those of others linger on in the air. The most commonly met smells are sporadic, emanate from a known source or point and can be easily distinguished by most people. There are others, however, which pervade the air all the time. Their origin is diffuse or supposed to be so, and the inhabitants are so used to them that Chief, WHO Unit of Environmental Pollution they have no sense of discomfort. They become sharply aware of what they have been breathing all along only sometimes, as on a return from foreign trip or from a holiday in the mountains or at the seaside. Many examples of these continuous all- pervading smells can be found in the cities of Europe. In Czechoslovakia one finds the characteristic ambient smell resulting from the use of a certain quality of lignite for domestic heating. Many heavily populated steel towns in western Europe have a subtle and unique odour produced by mixed vapours of coal tar, hydrogen sulphide and sulphur dioxide. Paris has its characteristic smell of the metro and Venice of the canals. In the Netherlands, many villages are impregnated by the smell of sewage aeration because of the topography of the lowlands and the system of sewage dis- posal practised in the country. This is a problem akin to that of towns in certain developing countries where purification of sewage is carried out by spreading it over the soil. The United States furnishes many examples of the all-pervasive smell asso- ciated with the motor vehicle, particularly in winter, when the air in many towns carries the unmistakable—to the out- sider—odour of aliphatic aldehydes and hydrocarbons present in motor vehicle gases. These and various other odours may go completely unnoticed, even when they are aggravated by special weather condi- tions. For years, sometimes for gener- ations, the population has been used to them. It may be that continuous exposure to an odour dulls the sensitivity of the olfactory system, thus helping adaptation to the prevailing situation. What are the public health implications of the problem of odours? Obviously it is difficult to give a clear-cut answer or prescribe specific guidelines until better methods of estimating the quantity of odoriferous products in the ambient atmosphere are devised. The most sensitive odour-measuring apparatus at present available is the human nose. A proper scientific use of the instrument will entail standardization of the noses of groups of persons trained for odour measurement work. However, there are situations, which by reason of the nature of the odour emitted, its concentration and the duration of the emission, may easily be recognized as an attack on human health and well- being in the sense generally understood by WHO. One could mention such examples as acralein, produced during the curing of linseed-oil-bonded sand cores—an essen- tial process in the foundry industry; or the odour of hydrogen sulphide, a strong irritant simulating the smell of rotten eggs, released in the course of many industrial processes. With the development of the food processing industry, many authorities are becoming familiar with the problem of armine, the highly unpleasant smell asso- ciated with decaying fish. The main industries causing odour problems are kraft mills, oil refineries, mineral wool plants and several types of food processing installations. Consider- able progress has been made over the past several years in the control of odourous substances from pulp mills. Much more serious is the problem in areas where odours are emitted from so-called diffuse sources, which really means from a large number of leaking vents and tanks. The problem is compounded when several plants of the type are concentrated in an area. A notable example is the area adjoining Rotterdam where many oil refineries are located. The odour problem is so serious there that people living in the most exposed parts have begun to leave, causing serious economic loss to the com- munity. The problem, of course, is not being neglected and has resulted in the setting up of the world's most expensive and advanced system for the study and control of odours. While these and similar problems are receiving due attention from industry and 22 the authorities concerned, it must be admitted that there is a lack of objective information on the effects of odour on health. There is need for careful epidemio- logical studies to determine the long-term effects of persistent odours on the physical and mental health of communities exposed to them. Research on the physiology of the sense of smell has brought to light many details of practical value. We know more today about the capacity of the nose to discri- minate between different odours and their intensity, and the rapid fatigue of the sen- sory cells, which may go as far as a kind of anaesthesia. A good deal of the data in this field, however, is related to theories that are not fully confirmed and call for further research. Another aspect of research on the sub- ject lies mainly in the sphere of the psychol- ogist. It is well known that there are numerous personal factors of a psycho- logical nature that have a decisive bearing on odour perception and the individual's reaction to it. It has been shown that the sense of smell obeys deep-seated motiva- tions, acting sometimes through incom- prehensible associations. This is a pheno- menon with important practical implica- tions. For instance, in a dispute between the owner of an odour producing factory (the defendant), a citizen living near the factory (the plaintiff) and an outside expert called in as an arbitrator, it is probable that, with the same basic honesty and good faith, the three will express widely divergent views. The reason, of course, is that their personal motivations are quite different. Another factor that plays a part in different people reacting differently to the same smell is what is known in psychology as the masking effect, which makes a person oblivious of things to which he attaches no importance. Even in the case of physical reactions such as vomiting, headache or asthma directly associated with an odour, it is not easy to determine whether to ascribe the symp- toms to allergic reactions induced by the odour or to the psychological component. There is the question also of personality variability for it has been demonstrated that age, sex and race do have an influence on odour perception. Some people are hypersensitive to odours or to a particular odour. If the reaction of the most sensitive individual were taken as the basis for defining the concentration of the odori- ferous substance to be avoided—as is done in the case of particulate air pollutants—it would rule out so many important human activities as to render the solution utterly impracticable. While many examples can be given from industry of successful efforts to control odours, real progress in the field must await results of research aimed at develop- ing objective methods of measurement and at resolving many unanswered problems in the physiology and psychology of odour perception. ■ 23
A NATION COPES VIIITH POLLUTION Since the end of World War II, indus- trial development in Bulgaria has pro- gressed at a rapid pace. The building of new factories and the introduction of new industries has taken place with an eye toward preserving the environment. Pol- lution controls are less expensive and more effective when they are designed simul- taneously with industrial development. That is precisely what the Bulgarian Gov- ernment has attempted to do. In 1963, the Bulgarian Parliament intro- duced a potent weapon in its fight against pollution by enacting a law that called for photographs by P. Almasy changes in factory fuel systems. Coal and coke had to be replaced progressively by liquid fuels or by hydro-electricity. Since the law was passed, new factories are forbidden to use coal. Several factories are now equipped with electro-filters. These filters eliminate up to 99.5 per cent of the pollutants. Changes in old fuel systems are continuing apace. Bulgaria also attacked the problem of rivers polluted by industrial wastes. Even before the water leaves the factory, it is purified, with most of the pollutants removed. The rivers are then dammed, creating small lakes. In these artificial lakes, natural self purification processes take over. The more important dams are also used as sources of energy for hydro- electric plants. Soil pollution is not considered a major problem in Bulgaria. Land lost to agri- culture represents only a small fraction of the total area. This polluted soil is generally in the suburbs of industrial cities. Great care has also been taken in Bul- garia to keep the beaches unpolluted and to preserve their full recreation value. A water purification plant is an integral part of this factory in Sofia. At the control point, emulsions are added so that the sediments fall to the bottom of the reservoir. The sedimentation basin (below) holds the contaminated water. ~ Cai: ;:: Coping with pollution .4—The great dam at Karzali, 100 metres high, on the Arda river stores 380 million cubic metres of water, and is a valuable source of hydro-electric energy. The artificial lake created by the dam helps to purify the water. The sediments sink to the bottom and the clean water at the top flows into the river. Freed from impurities, the Arda downstream from the dam pro- vides safe drinking water to many towns and irrigation to the fields. This picture was taken from above the spillway. BEARING THE BRUNT by Dr B. H. Dieterich Director, Division of Environmental Health, WHO The word environment has become a powerful expression for the concern people have about conditions in their surround- ings. Many people associate it with the pollution created by industries, with smog and air pollution, dying fish in the rivers, noise, polluted beaches, radioactivity and pesticides. These indeed are environmental problems in countries where large metro- politan and industrial complexes have been built for the enjoyment of a better life, and where high consumption levels have been accompanied by high levels of waste. The concentration of people and industries has led to congestion, to a life of rush, and to the fear that undesirable effects of high industrial development may spoil the environment to a degree that health and life itself will be endangered. Industrial development certainly has much to answer for, but we should not forget that industrial pollution is only one part of a vast problem. Indeed, it is only 20 per cent of the world population—liv- ing in the industrially advanced countries —which is directly affected by the environ- mental degradation caused by technology. To most of the world's population, the threat of the environment shows an entirely different aspect. This was vividly demonstrated in the recent past by the resurgence of an old— and, in the developed countries, forgotten —disease, cholera, which is transmitted from man to man by a polluted environ- ment—polluted, not by industrial effluents but by human waste and unprotected water supplies. Hundreds of millions of people fall victim every year to a wide variety of communicable diseases in places where the biological pollution from com- munity wastes are allowed to reach drink- ing water sources. It is not difficult to see that these diseases originate in a particular environment which also helps their spread, and that they can be prevented by efficient environmental control and maintenance of community sanitation. The leading role of environmentally induced diseases in the mortality and morbidity pattern of the world is not a new discovery. Professor J. Logan in a paper published in the American Journal of Tropical Medicine in 1960 was able to show that envi- ronmentally transmitted diseases were responsible for sufferings inflicted on 500 million people every year, particularly among infants and children. In the developing countries, the problem assumes a two-fold aspect. In view of the existing disease pattern, environmental sanitation, especially water supply and waste disposal, is a prime environmental priority. At the same time, new industries are coming up, which are adding to the existing environmental problems and must continue to do so because economic expan- sion is an obvious priority. Contradiction between the two priorities is more apparent than real. On the basis of experience gained in health and economic planning over the past few decades, it has been realized that investment in health is investment in eco- nomic betterment. In many developing countries today, top priority is being given to environmental sanitation and the intro- duction of water supplies and waste dis- posal systems as part of the overall pro- gramme for social and economic deve- lopment. The question has often been asked: how can environmental objectives be geared to the objectives of the development process? The solution to the apparent dilemma lies 28 • A WHO field project engineer helps in the construction of a canal near Bangui, Central African Republic. The improvement of water supplies is given high priority in many developing countries. (Photo WHO/Jean Mohr) in recognizing that there is ultimately a single objective; to bring into being a situation that will promote the physical, mental and social well-being of man. This is the theme that guides WHO in promoting environmental health in the developing countries. The immediate tasks are pro- vision of adequate water supply, sanitary disposal of excreta and other wastes, proper housing and community sanita- tion. These will not only reduce the burden of suffering and sickness but ac- celerate the development process by releas- ing millions of able-bodied people from the bondage of disease. As the community advances towards greater industrializa- tion, the environmental health services will progressively expand to embrace within their field preventive action against the pollution of air, water, land and food, and control of nuisances and physical hazards at levels that encourage optimal economic development without creating hazards to life or significant disturbances in the environment. The close relationship that exists be- tween an unhealthy environment and the economic condition of a community was pinpointed by a panel of experts which met in 1971 to discuss the environmental problems of developing countries. Poverty and the very lack of development, these experts said, constitute an essential envi- ronmental problem in the developing countries. They recommended an attack on the problems of inadequate water supply, poor housing, sanitation, nutri- tion and widespread disease as prime targets in an effort to improve the envi- ronment of millions of people, and to lay the groundwork for their economic better- ment. Development planners confronted with meagre budgets are often forced to keep some projects in abeyance and give pri- ority to others that may bring immediate economic benefit. It is now being increas- ingly recognized that it is not a practicable or economically sound idea to defer envi- ronmental health projects. Planners are beginning to look at environmental health projects in the context of the ultimate socio-economic objectives of the develop- ment process. Health projects are regarded not only as a means of alleviating suffering and promoting individual and social well- being but as a basic need which is a pre- requisite to many other undertakings of the development process. It is recognized that communities in the grip of such envi- ronment-induced diseases as schistosomi- asis, malaria and waterborne intestinal disorders including cholera will not only lack the healthy workers needed for dev- elopment projects but also the physical and psychological capacity to respond meaningfully to new ideas and techniques, which are the major tools of development and social change. Environmental health projects may be regarded as a direct attack on poverty, for it is not difficult to see that the poorest section of the population benefits the most from them. Low income groups go without sanitary facilities mainly because of their inability to pay. When these are made available to them as part of the overhead social investment, they get ser- vices they cannot afford. It has in fact been suggested by social planners that development goals should be redefined 29 and quantifiable targets fixed not only in respect of income growth but also in terms of services provided. Without com- munity sanitation and an indication of tangible reduction in disease and squalor, the handmaidens of poverty, how can the quality of life in a poor society be shown to have improved? The direct impact of environmental san- itation projects on the local economy is also a factor to be taken into account. These projects, which include the construc- tion of water supply systems and the im- provement of sanitation in developing countries, are mostly labour intensive and play a beneficial economic role by provid- ing employment and boosting the local manufacture of such materials as water pipes—plastic, concrete or vitrified clay—, simple pumps and many kinds of pre- fabricated parts for waterworks and sani- tary installations. These activities must be seen as offering real potential for the crea- tion of local small-scale industries. This is borne out by the experience of UNICEF and WHO, who are at present supporting water supply and environmental sanitation proj- ects in nearly 100 developing countr- ies. These projects—many of them sup- ported by funds from the UN Develop- *— Water pipes are laid down in Peru. By the end of 1975, the Peruvian Government plans to provide safe water to 92 per cent of the people living in villages of between 200 and 2,000 inhabitants. (Photo WHOIMTI) In the Central African Republic, work begins—. on a canal. Water supply system's, which require a large labour force to construct, provide employment to local workers, and are there- fore beneficial to the country's economy as well as to its health. Improved water supplies are necessary for development in many sectors. (Photo WHO/Jean Mohr) ment Programme—are essentially four- way partnerships. UNICEF provides the imported materials required for construc- tion work; the national government pro- vides transport, locally available material such as cement together with professional services and skilled artisans; the commu- nity provides labour and local facilities; who's contribution is technical guidance and supervision at all stages from the plan- ning of the project, through its design and construction, to any advice that may be necessary during the maintenance and operation phase. These are not large pro- jects in terms of financial outlay but they have a great importance as pilot projects leading eventually to countrywide pro- grammes and providing scope for the education and training of key workers at many levels. An example of how this works in prac- tice is the "Plan Junin" of Peru, launched in 1962. At the end of five years that the plan lasted, 22 rural piped water supply schemes and 65 wells had been completed as demonstration projects in the depart- ment of Junin in the Andean region of the country. Even more important, various categories of staff had been trained and the Government planners had become convinced of the feasibility of providing safe water to the country dwellers. Accord- ingly the National Rural Water Supply Plan was drawn up in 1965 to be carried out in the ensuing decade. As things now stand, the Government is well on the way to achieving the plan target of providing safe water to 92 per cent of the people in villages of between 200 and 2000 inhabitants (a total of 2.4 million people) by the end of 1975, after which the plan may be extended to cover the remaining 8 per cent of this group. The work is being done entirely with national resources. Thus, many com- munities which, in view of their income levels, could hardly have afforded a piped water supply, are getting it under schemes, the cost of which they have partly borne by contributing labour. The Government —the major investor—can look forward to an economic return in terms of a reduced sickness load and possible rise in earn- ings. The area in which the most spectacular results in this field have been achieved is Latin America. Under the Charter of Punta del Este, 24 governments of the region recognized health as the most im- portant factor in economic development, and sanitation—water supply in particular —as the key to raising health standards. Accordingly a plan was adopted for the decade 1962-71 aimed at increasing life expectancy at birth by five years and improving the health as well as the learn- ing and production capacity of the people. Progress was made in the development of basic services, in nutrition, the eradication of malaria and the control of other diseases, but the most spectacular results were ob- tained in the field of water supply. In the 24 countries concerned, nearly 70 per cent of the urban dwellers are now provided with a safe and ample water supply. In the villages still only one person in five receives safe drinking water but even this figure is nearly double the world average for rural water supplies. The importance attached by wHo to envi- ronmental health programmes is reflected also in the targets for the United Nations Second Development Decade. WHO has recommended that a high priority be accorded to water supply and waste dis- posal projects in activities aimed at realiz- ing the goals of the Decade. The quanti- fiable targets include increases in the per- centage of urban dwellers receiving piped water supply in or near their homes (from the present 51% to 100%) and in that of people served by sewerage systems (from 8% to 25%). In rural areas, where only 10 per cent of the population now receive safe water, it is recommended that the pro- portion be raised to at least 20 per cent. Other WHO targets for the Decade include strengthening of education and training programmes for environmental health per- sonnel; expansion of training of engineers in environmental health; basic legislation relative to the control of environmental pollution, and the establishment of labo- ratory and other facilities to gather data that will enable corrective or preventive action to be taken in case of pollution reaching dangerous levels. The United Nations Development Pro- gramme (uNDP) has been collaborating with WHO by providing financial assistance for pre-investment planning for commu- nity water supply and waste disposal ser- vices. During the past decade, more than 50 such projects have been carried out. The work involves preparation of master plans, preliminary engineering and feasi- bility studies, as well as management and financial studies for community water sup- plies and waste disposal systems. Several of these projects have progressed from the study and planning phase, and entered the execution phase after attracting capital investment from outside, particularly from the International Bank for Reconstruction and Development (IBRD) and its sister agency, the International Development Agency (ODA). A good example is the Accra-Tema project in Ghana started in 1963 to study the water supply and sewage situation in these two cities and formulate a long-term solution. During the first phase of the project a master plan cover- ing the cities and adjoining areas was pre- pared and a number of studies were carried out. An institution capable of managing the system and the Ghana Water and Sewage Corporation were set up. The second phase began in January 1968 when blueprints for the water supply and sewer- age system were prepared. Meanwhile, the Government has negotiated an Inter- national Development Agency credit of $3.5 million to cover the cost of the work in the design stage. Much of this work is now in progress and negotiations are under way for a second amount of $12 million to cover the cost of additional constructions. Kenya offers an example of bilateral aid 32 being attracted to an environmental health project once the basic problems have been tackled and a cadre of trained national workers has come into being. The project, started with demonstration and training is now developing into a national pro- gramme with funds provided to the Gov- ernment by the Swedish International Dev- elopment Authority. A national survey of water supply and waste disposal needs is being carried out by the Government, using Swedish development funds. The increasing trend towards interna- tional and bilateral financing of environ- mental health projects in developing coun- tries is to be welcomed as a sign of the growing awareness in the international community of the true nature of the prob- lem of human environment. It is in accord with this trend that wHo and IBRD entered into an agreement recently to strengthen their collaboration for the improvement of water supplies and waste disposal in dev- eloping countries, helping them to under- take nationwide studies and assessments of their water supply and waste disposal sectors, and to identify and prepare invest- ment projects, which the Bank may later finance. A programme of work under the agreement has already started. Pre-invest- ment studies in ten countries are planned for 1972. Missions will be sent to thirteen others to facilitate pre-investment plan- ning and appraisal of some of their pro- jects for future financing. The UN Conference on the Human Envi- ronment meeting in Stockholm will have the opportunity of considering the ques- tion in its various aspects. One of the proposals before the Conference is that governments assess their urban and rural water supply and sanitation problems, adapt and implement national policies to solve these problems, make water supply and sanitation part of national develop- ment plans, set targets within the UN Second Development Decade and create the necessary institutions and skilled man- power. One may hope that the delibera- tions of the Conference will help bring in sharper focus the basic issue: how best to break the vicious circle of poverty, disease, ignorance and hunger without degrading the environment of man, which encom- passes the entire biosphere. ■ 1962-1972 These pictures, taken 10 years apart ( 1962-1972), tell the story of the progress of a rural community in Peru. Gone are the days when the villagers, along with their children, spent long hours every day trekking to and from water points. Now piped water, free from the danger of lurking disease, is within everybody's reach. ORDER FORM Please enter my subscription to World Health as follows: One Year Two Years Three Years One year: 1 I US$* 5.- 8.— 10.— Two years: Sw. fr.* 1.20 12.— 2.20 22.— 3.— 30.— 1 Three years: I enclose cheque/postal order in the amount of Name: Street: City: Country: • or equivalent in local currency. Readers write WORLD HEALTH for readers everywhere In World Health for October 1971, you published a map showing "Distribution of leprosy in the world". To our regret, we find that Romania has been shown as having a morbidity rate of 0.1 to 0.9 per thousand. This does not correspond to the reality. According to our statistics, the incidence of leprosy in Romania is 0.005 per thousand ( 101 cases). We do not know the source of information used by the WHO leprosy service regarding leprosy morbidity in Romania, and prior to the publication of the issue of the magazine in question we were not asked to supply current statistics in this field. We rely on WHO publications for the most recent and reliable data concerning the protection of public health in member states. We hope, therefore, that you will rectify this error in a subsequent number of World Health, so that your readers have the true picture of the leprosy situation in Romania. Dr Dan Enachescu Minister of Health Socialist Republic of Romania I would like to tell you how much I enjoy reading World Health. My copies go to the libraries of our junior and senior high schools after they have been circulated among our 14 school nurse-teachers. I would like to make a suggestion. According to reports published in our news- papers, health care in the penal institutions of the USA is not satisfactory. It may be worse in some countries, but in others it may be much better. May I suggest a number of World Health on prison health? Dr Albert N. Meyerstein New York For heaven's sake, don't print the cap- tions to your excellent photos black on dark-grey ground. It is hard punishment to the eyes and spoils the pleasure that I have received from this otherwise interesting August-September 1971 issue on pollution. By comparison, your June issue, where you printed black on orange ground, is an unmixed pleasure to the eye of the reader. Thanks for an outstanding publication. Professor Robert Heilig Jaipur, India 34 MVVIottISOAVititittirctt. 4 A 7 9 • 5r-fgft -f.- tgirMi777 bizt.,bq brz Lot, II 7. 0 nith fikloolt • 2 t- 9 .1 0 7, F. I/ 7 it 1...• Farm CD t. A • L. U.) 75, (zi*kgr-L-A, 0 t; 9 ts.M.Ift ,("IVINI. I , fel- 7.K1-(= t:tb, WHO (tInigq41111) (VAR 1_, T • APOOKIKOMM Situ, 411,46T. Nit A.7181111Nn114f 1 te+Rittei. L, to,"14118.112. MIT. WC. a. MIL 1.1.1,T. , 19121.9.111ttl , I.M*MPLTE./Tktnr, th1•..,•,..01.1nTAMATM.”L1£TatTT4.n MAtL1L.4111..,...W11.111.1,11T.,, TC.-•■••13 • 15••••■11,11eTT.L0.51,4•T1M11£ 121.1. TN • , •••erl.s. 470,1 AntI11•111C L TN • • T. 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