Environmental health [full issue]

ENVIRONMENTAL MV WORLD HEALTH The magazine of the World Health Organization August-September 1971 UK: 15 p. USA: 0.50 Scarce, precious water, but it may be dangerous to health. ( Kenya) Contents Man must save himself, by Ritchie Calder . . 3 India uses the sun as an ally, by A. S. Kochar .. 12 A profession we need, by Dr N. F. Izmerov . . 18 Preserving the springs of life, photo story by Peter Larsen 22 Air pollution—the search for guidelines, by Aaron Sternfield 26 Laws to breach the gap, by Dr J. de Moerloose 32 Taming the automobile, by Eric 0. Stork 38 Around the world . . . 46 World Health appears in English, French, German, Hindi, Japanese, Portuguese, Russian and Spanish. All correspondence should be addressed to World Health, WHO Avenue Appia, 1211 Geneva 27, Switzerland 2 MAN must save himself by Ritchie Calder Former Professor of International Relations, University of Edinburgh In the excavations of the Indus civili- zation of 5,000 years ago, the ruins of Mohenjo-Daro revealed the existence of booths where drinking-water was sold. Alongside were huge spoil-heaps of broken cups, far in excess of the ravages of the most careless dishwashers and evidence of a sanitary code: when some- one bought a drink of water, the crock was broken. That is what we call "hy- giene". Today, and every day, hundreds of millions of plastic containers, cans and non-returnable bottles are discarded. In the cities we call this "refuse"; in the countryside we call it "litter"; and, in general, we call it "solid pollution". The largest kitchen-middens of neo- lithic man, accumulated over centuries, measure no more than a few thousand cubic metres. Any town big enough to have a mayor will produce that much refuse in a week. Four thousand years ago, the Minoan civilization was advanced in sanitation. Clean water was brought to the capital, Knossos, in pressure pipes; stone drains sealed with cement provided the sewer- age system; and dry refuse was deposi- ted in large pits outside the city, earth silos in which the wastes fermented into compost for manuring the fields. The Romans adopted the Minoan system. In A.D.100, nine great aqueducts, with a total length of 424 kilometres, brought water to Rome, and lead pipes carried it to one thousand public baths and to houses. The Aedile (the nearest approach to the borough engineer) could ride his state-barge along the main drain, the Cloaca Maxima, under the city to the Tiber. His scavengers, slaves and con- victs, shovelled the city's refuse, domes- tic and animal, through manholes to be flushed into the river and thence to the sea. Today, grave concern is expressed, with justification, about the pollution of the Mediterranean by untreated domes- tic and industrial sewage. In 1239, Henry III granted the first charter to the town of Newcastle-upon- Tyne to dig coal for the comfort and warmth of its citizens. By the time of Elizabeth I, " sea-coal" (from Newcastle) was already blackening London with soot. By the nineteenth century, fog, the notorious "pea-souper", was a charac- teristic of Dickens's London. In 1952, as many as 4,000 people died in one London smog and the best beef cattle in the country, paraded for the Smithfield Show, were killed off as if they had been attacked with poison gas. Something had to be done, and a Clean Air Act imposing smokeless zones (where only smokeless fuels could be used) enabled the public buildings of London to be scoured back to their pristine state. Meanwhile, Drake's Well had been drilled at Titusville, Pennsylvania, and the age of the internal combustion engine was on its way to unleash ill-com- < A London boy wears a gas mask as protection against the stench of burning rubbish. The 3 photograph was taken during the four-week refuse collectors' strike of 1971. busted hydrocarbons from automobile exhausts. Today, 6,000 million tons of carbon dioxide, ransacked from the geological vaults of coal and oil locked up tens of millions of years ago, are being vented into the atmosphere each year by chimney-stacks and automobile exhausts and jet-engines, to add an annual increment to the 360,000 million tons of carbon already released in the industrialization processes of the past century. This, in excess of natural amounts of carbon, is of something more than public health concern; it can materially affect the climate and the con- ditions in the biosphere on which all living things, inc:uding humans, depend for survival. When, however, we deplore man's interference with his environment, it has to be remembered that the survival of the species has depended on just that. The ancient cities that cradled the social evolution of Homo sapiens which we call "civilization" depended on irri- gation. In Egypt, in Mesopotamia, in the Indus valley, in Aral and in China, the management of water enabled the tillers to extend and intensify their pro- duction of surpluses to feed the artisans, the priests, the merchants, the scholars and the soldiers. When water manage- ment was neglected or abandoned, irri- gation systems collapsed into malarial swamps, as at Babylon, where Alexander the Great died of the fever in 320 B.C. in his thirty-third year. It was not until 2,260 years later that Homo sapiens found the means to con- trol malaria. He discovered DDT insec- ticide to destroy the vector mosquitos and saved hundreds of millions of his species from premature death. Today, in a world still beset by vector-borne disea- ses—malaria, Chagas' disease, plague, typhus, yellow fever, dengue, encepha- litis, filariasis, trypanosomiasis, oncho- cerciasis, etc.—DDT has been denoun- ced as a pollutant. Hundreds and thou- sands of miles away from sprayed houses and sprayed fields, it has been found in the flesh of antarctic penguins and in the food-chain of marine life. It has been blamed for ravaging wildlife. Severe restrictions have been put upon its use in advanced countries, which also supply insecticides to developing countries where the human population is still ravaged by the diseases that insecticides can check. These "cautionary tales" are histori- cal reminders that "environmental pol- lution" of which we are very properly, <The Ergrikemer Aqueduct near Ankara was built in the 12th century. The supply line below runs between Istanbul's main water reservoir and the Kagithane treatment plant. Holidaymakers on the North Sea at Scarborough, England. As the pressures of urban life multiply, the need for recreational facilities multiplies apace. Pollution can rob people of these facilities. The automobile is a requisite of the industrialized society. However, the life of the automobile is short, and the need for automobile graveyards grows. These dumps befoul the landscape and contribute to the pollution of our planet. V but perhaps belatedly, aware is a ques- tion of definition, dimension and deci- sion. Pollution is that which contributes to the deterioration of the environment. A propos of what? It can be planetary, continental, national, local or a choked watercloset in a city tenement. It can be geophysical, for instance the " glasshouse effect" of carbon dioxide excess which could, it is asserted, melt the ice-caps, raise the levels of the seas and so change the fretwork of countries and continents, and radically alter our climate. It can interfere with the ecosystem of the biosphere and the oceans by introducing man-made factors which interrupt pho- tosynthesis, the biological process by which land and marine plants use the sun's rays to convert elements, in the soil or in suspension, into the carbohydrates and proteins indispensable to the food- chain of higher organisms including man. It can provide alien substitutes, analogues, which enter into the molecu- lar system of organisms and change their character, either directly so that they become deleterious to dependent orga- nisms including man, or genetically to produce mutations in the organisms themselves. These effects are part of our present (and emotive) awareness but are still imperfectly understood and call for much more research and evaluation. When we speak of "continental" pol- lution we are really talking about " transnational" pollution or saying that "pollution knows no boundaries", whe- ther it is airborne or waterborne. Pollu- tion from sulfur dioxide has been redu- ced at ground level in Britain but is airborne from high chimney-stacks to despoil the forests of Norway. Rivers common to several nations carry unwan- ted residues downstream, like rubbish thrown into the neighbour's backyard. When we speak of "national" pollution, we mean "What's the government going to do about it?" The present political response is to institutionalize the pro- blem in a Ministry, or Department, of the Environment. " Local" pollution is still considered the business of the public health department, whether or not it has powers to deal with air pollution and with that modern more-than-a-nuisance, noise pollution. And finally it is the business of the individual who contri- butes to pollution and suffers from it. Mount Etna (right) went on the rampage in 1971, pouring its deadly lava on the villages below and fouling the Sicilian air. A Texas oil well (left) sprays 200 feet into the air and soaks the surrounding farmland. Man is not altogether helpless against nature, but can he control his own excesses?

4. Man can fight pollution, but some of pollution's other victims are helpless. • " , Jr.* < • 44: • •- I. Rivers foam and lakes die. This stream was once noted for game fish; now all its life is menaced. Pollution stems not only from the industrialist seeking a quick profit but from the customer who wants things cheap regardless of the social cost. The deceptively attractive effect in the fore- ground of this seascape is in fact created by detergent. Mammoth oil tankers are sometimes involved in accidents. Here is the after- math of one collision. The rubber-booted worker is raking up heavy fuel oil to clear a bathing beach in Brittany. 0:- •-ck. • • ---• . ww- 4,'"' * -"'",-,-..ot.-..semp• • -- —women._ —m.—. 111•■ ' • I recall a conservation conference called (and quite rightly) to save the wild life of Africa. We had enthusiastically discussed the measures to protect the lions, the elephants, the hippopotami, the wildebeeste, the rhinos, etc. and their habitat until Sir Julian Huxley, that dedicated conservationist, was constrai- ned to remind us, " Gentlemen, gentle- men! Remember that human beings are also part of the ecology." The human species, with all its faults, needed con- serving too! Which brings us to the question of dimensions. Throughout the millenia, volcanoes and seismic vents have erupted contaminants into our atmosphere. Earthquakes have rifted oil-domes and released oil and natural gas into the environment. The rivers, with their effec- tive method of hydraulic mining, have scoured out mercury, lead, tin, copper and sulfur into the living waters on which biological systems depend. Nature has produced a tolerance in excess of which such metallic elements are toxic or lethal. What we are worrying about today are the man-made excesses which are a function of our ingenuity and survival rate. The copper miners of ancient Cyprus, whose wastes are found in the sediments of the eastern Mediterranean, did no great harm to the ecosystem. Nor (apart from the effects on themselves) did the Roman and Iberian producers of quick- silver. Italy and Spain today produce about half of the 9,000 tons of mercury which the world (outside China and the Soviet Union) uses each year. But it is not their workings, nor broken ther- mometers, that have produced the pre- sent concern about high concentrations of mercury in fish for human consump- tion. Particular blame for this is attribu- ted to papermaking. Mercury was intro- duced as a fungicide to destroy the slimes which interfere with the paper manufacturing process. It also enters into the making of caustic soda, which is used in pulping and bleaching newsprint. Furthermore, woodpulp is an avid absor- ber and concentrator of mercury from the vast quantities of water which are used in papermaking. Mercury gets into the effluent of papermills and is also released in the smoke from burning paper. In addition, it is used in pestici- des for agriculture. According to FAO, the world use of mercury-containing pesticide in the period 1948-1967 was 52,946 tons. Because technology con- trived to meet the needs of thousands of millions of people for newsprint and for food, there is more mercury in certain species of fish that people eat. If multiplying people want multiplying cars, then you have 250,000-ton oil- tankers and the risks of collisions and oil-pollution. If hundreds of millions of people want more lather in their laundry, then drains and rivers and sewage works will froth with mineral detergents that natural biological processes cannot de- grade. If they want plastics, then they are likely to have fumes and effluents and end-products that will persist becau- se they bamboozle nature, and so on, and so on. If firms want quick profits and people are greedy for products they 3 never knew they needed, then industry will take short-cuts and jettison as waste what they do not want. They vent that waste to the leeward or push it down- stream or disfigure the countryside with slag heaps and cesspits. Prevention of pollution is a matter of money. If the price does not go on the product, the tab has to be picked up as a social cost. This has been the bone of contention in all attempts to regulate pollution. Industrial concerns say "If you impose those precautionary charges on us, you will price us out of the market because our competitors abroad are not under such restrictions." Indeed there should be internationally enfor- ceable standards. We have built inter- national safeguards into industrial ato- mic energy so that they are the first cost that every operator has to meet and one that is common to his competitors everywhere in the world. People have grasped the idea of " Spaceship Earth", an encapsulated planet within whose confines man and his fellow lodgers—the beasts and even the bugs—have to live together. If we foul up that living space, vitiate the atmos- phere, poison the waters, restrict our food-rations, tamper with the heating system and wallow in the excrement, domestic and industrial, our tenancy will be limited. We can irreversibly damage the biosphere on which all life depends. This awareness has still to be quanti- fied. We do not know enough about the geophysical effects, nor the geobiological effects, nor the global ecological effects. The problems have been sensitized by 4 popular reaction, now highly emotive, but we need monitoring and evaluation to give us the facts and guidelines for decision making. Many scientific disciplines and many international organizations are involved in finding answers and defining safe- guards. The role of the World Health Organization is obvious. It is concerned with the human environment. Millenia before WHO existed, what we now call "pollution" was recognized in the sani- tary ordinances of the earliest cities. Thousands of years ago there were the consequences of overpopulation (con- gestion within the city walls), slum conditions, infections and contagions, water and sewage problems and, how- ever inadequate by our better-informed standards, measures to moderate them. The Old Testament is full of sanitary by- laws. The whole history of public health is an account, at local, national and eventually international levels, of efforts to prevent or correct the effects of degradation of the environment and the resulting health hazards. With the creation of the World Health Organization, these efforts acquired a global dimension. From its inception, environmental health was put on an equal footing with the eye-catching cam- paigns to control infections, contagions and vector-borne diseases for which medical science and the pharmaceutical industry had provided the means. But sanitation and public health engineering directed at environmental factors res- ponsible for massive mortality (e.g. gas- tro-intestinal diseases) did not ring bells until pollution became a tocsin-word. Sanitation in urban and rural areas is still in the front line of WHO's action because that is where pollution is a life or death issue for today's people. But WHO is also concerned with posterity, with the quality of life and with the conditions of living of which morbidity and mortality rates are a reproachful reminder. This concern with the well- being of the human race extends beyond environmental sanitation to the whole human environment which is threatened by degradation. That degradation involves the air we breathe; the water we drink or bathe in; the soil when its contamination consti- tutes a health hazard; the impairment of recreational facilities, which are the es- cape hatches from the stresses of modern ,life; the defiling of shores and estuaries; the possible insidious effects of radiation and chemical mutants which, on the scale of modern industry, are likely to be present in the environment however conscientious the safeguards. 10 Tens of thousands of new chemical compounds, artefacts, are produced ev- ery year for one purpose or another. If they are pharmaceuticals or food addi- tives or substances such as pesticides, herbicides or fertilizers about which the public is sensitive, they may be subject to careful scrutiny before being released on the market. But they may not come within that range. They may be indus- trial products which in their commercial use present no apparent hazards to health but in their preparation for dispo- sal or final break-up as refuse, or through their fumes or effluents, may release unnatural molecules into the environment. This has been true of many types of plastics and there is an unholy alliance between oil and DDT which can produce a tough toxic film on water. The trouble is that until some- thing serious happens to produce an outcry such hazards go unidentified and their pathways untraced. There is a need for identification and control an early warning system. Increasingly, noise is becoming a ma- jor pollutant. It may be just a distraction and a nuisance but under modern con- ditions of road and air transport it is becoming an assault upon the senses. The stresses which it imposes upon the hearing and the nervous system are as much a health concern as smoke from chimneys or bad drains or contaminated water. Noise abatement is always a matter of compromise between technical progress and human reactions— permis- sible levels are a matter of monitoring and evaluation, and must be established before noise can be curtailed by legisla- tion. The effects of environmental pollution and environmental degradation are al- ways heightened by urbanization and particularly by the confluence of one city with another in a vast urban sprawl. There the degradation of the environ- ment manifests itself in the degradation of the individual. Human dignity, let alone health, is hard to sustain in slum conditions, where streets are congested and noisy and where amenities are lacking. In the absence of escape- hatches, people are liable to take to drink, drugs and violence. Despair is also a "pollutant". When pollution affronts the senses as smog, stinking drains, rotting garbage, fouled-up water and screaming jet planes; when rivers foam and lakes die and no birds sing; when oil-slicks lap the beaches and when the country-side is disfigured by the litter of millions or the dumping of city garbage, then it is pretty obvious that something must be done. But there are more insidious, more pervading pollutants from more elusive sources. They have to be identified, measured and understood before action, local or international, can be taken. The what, the whence, and what-to-do-about- it can only be determined by monitoring, surveillance and codes of practice. That, like the epidemiology which made it possible to understand and control pesti- lences, can only be realized at interna- tional level. Pollution too, is epidemic and epidemiological methods are appli- cable. Pollution is a crime compounded of avarice and ignorance. It stems from the greed not only of the industrialist seek- ing the quick buck but of the customer who wants lots of things on the cheap, regardless of the social costs. He then becomes the "public" protesting about pollution. Ignorance is no excuse. We cannot pretend nowadays not to under- stand that our total environment and, within it, our human environment are in peril. But ignorance is relative. There is so much to learn about how the pollu- tants are transported by air, water, etc., about their nature and their harmful effects, and about ways of controlling them. That means monitoring on a world scale, evaluating the findings, identifying the pollutants and studying their physical, chemical and biological behaviour, establishing international standards about what is permissible and what is not, providing guidelines for those who have to act and enforceable codes of conduct for those who have to be constrained. This is a world problem, affecting all mankind. Only by inter-disciplinary and international means can the answers be found and the measures applied. Homo sapiens, Thinking Man, must come to the rescue of Homo insipiens, Unthinking Man. ■ Increasingly, becoming a major pollutant. The stresses which it imposes upon the hearing and nervous system are as much a health concern as foul air or contaminated water. Noise abatement must be a compromise between technical progress and human reactions. The com- promise is not always easily reached. The convenience of the transatlantic traveller and the well-being of the suburban house- holder are often in conflict. INDIA. uses the by A. S. Kochar The air in India's cities is fast deterio- rating as a result of industrial growth and urban congestion. Even the Hindi poets have remarked on it. Balswarup Rahi, of Delhi, begins his poem "Eve- ning Sorrow": My room is like a Closed-up well. Outside there is smog, Where can my mind roam? The ever-stretching net of factories and works is invading and polluting the Indian countryside, while the villages have their centuries-old problems of lack of sanitation and smoky air from the use of dried cow-dung for the kitchen fire. " A steady deterioration of the environ- ment is following in the wake of indus- trial progress, rapid urbanization and population growth in the country. The problems are staggering in magnitude and represent a challenge perhaps never before faced by a developed or develop- ing country anywhere." In these words Professor S. J. Arceivala, Director of the Central Public Health Engineering Re- search Institute (cPHERI) at Nagpur, described the situation. Population growth alone raises major problems. The present population of 550 million will increase by 12 million in the next year and may have grown by 200 million before 1985, an increase almost equal to the combined present popula- tions of the Federal Republic of Ger- many, France, Italy and the United Kingdom. The population of some of India's largest cities will have doubled within the same period, thus placing a severe strain on their already overloaded services. Considering the limited resources, the competing demands and the drive for rapid overall progress, how are health and sanitation services to be provided for the increased population when they are already insufficient for about 400 million of the existing population? Only 1,200 out of some 2,540 cities and towns have a modern water supply system. Not more than 16 per cent of the total population is served by a piped supply of safe drinking water; 84 per cent have to use water from usually unprotected wells or polluted lakes and streams. In most of the 550,000 villages scattered over an area of 3,268,000 square kilometres, the well is the only source of drinking water. Schemes of rural water supply undertaken so far have hardly made a dent on the problem. Fewer than 200 cities and towns have underground drainage, and only two of the 20 largest cities are completely equipped with modern sewage treatment plants. Some years ago it was estimated that adequate urban water supply and sewe- rage schemes would cost 10,000 million rupees* and rural water supply schemes would require a minimum of 7,000 mil- lion rupees. Today, despite the consider- * One rupee is approximately worth 50.13. 12 sun as an ally Rapid industrialization is adding to India's pollution problems. Once they were mainly caused by traditional domestic cooking methods, burning cow dung and straw as in this "chullah". On opposite page, thermal station producing electricity for New Delhi. able amount of work done, the needs and the cost of meeting them have both increased. It is against this formidable back- ground that CPHERI, since its establish- ment in 1959, has set out to design sanitation equipment that would be easy to operate, would require minimum capital outlay, could be made out of materials available in the country, and would replace imported articles without loss of efficiency. To achieve this objec- tive, CPHERI obtained help from the UN Development Programme which has pro- vided more than half a million dollars. WHO has provided additional assistance in the form of experts and fellowships. Making village wells safe One aspect of the project is the treatment of water in dug wells to make it safe to drink. Surveys carried out by CPHERI and other agencies showed that most open dug wells were highly pollu- ted. Faecal contamination was invariably present, due partly to unhygienic me- thods of drawing water and partly to insanitary practices in the surroundings. The death rate from enteric diseases in India is about 360 per 100,000, caused mostly by polluted water and lack of basic sanitation. One of CPHERI'S designs is an earthen double cylindrical pot which is filled with a moistened mixture of bleaching powder and coarse sand and then immersed in a well. This device will provide adequate chlorination dur- ing two to three weeks for a small household well containing about 4,500 litres of water and having a draw-off rate of 360 to 450 litres per day. Rivers are an important source of water supplies for urban communities and need to be protected against pollu- tion from the indiscriminate discharge of un-treated domestic and industrial waste. This danger is all the more difficult to combat since there is no regulating legislation. "Agra, the city of Taj Mahal fame, may well be drinking Delhi's sewage, " is an example that Professor Arceivala likes to cite. There is danger in providing a piped water supply without a proper sewer system. When people who have been using water from wells or other natural sources get a piped supply, consumption increases six-fold, and almost 80 per cent runs out as waste. Thus more problems may be created than are solved, for without proper drainage or sewage treat- ment this waste water tends to become a breeding ground for disease and may pollute nearby wells and underground water or streams. CPHERI has taken up the challenge, but in a very practical spirit. As conven- tional methods of sewage treatment are expensive and outside the reach of most municipalities, and since their technical complexity often causes maintenance problems, CPHERI scientists have concen- trated their efforts on devising processes that are inexpensive and unconventional 13 7' titt 2,7 VetlfrAri" , • • This scientist is making chemical analyses of water which has been brought in from eight field sampling stations run by the Central Public Health Engineering Institute in Nagpur. Piped safe water, even if not within the home, already represents a great improvement in water supply. A typical village scene around a traditional well. The women are drawing water. Their bare feet can transmit diseases from the dirt they have walked in. Furthermore, the ropes and the vessels used to draw up water are unsanitary. Around the well is slush that seeps down and adds another source of pollution. tt. ttIt '448, ' ' but efficient. Where sufficient land is available for these methods of sewage treatment to be used instead of conven- tional ones, it is sometimes possible to slash capital costs by as much as 80 per cent and running costs by up to 90 per cent. The methods recommended by CPHERI take advantage of the plentiful sunshine and warm climate of the major part of India, conditions that favour the treat- ment of waste in so-called oxidation or stabilization ponds. All that is needed is a large, shallow pond in which domestic or industrial wastes are stored for a few days. In the presence of sunlight and organic nutrients in waste, a healthy bloom of algae flourishes together with colonies of bacteria. Through the na- tural process of self-purification, the bacteria speedily digest the organic waste and render it harmless, so that the effluent can be used for the irrigation of farm land without any danger of pollu- tion. There is no foul smell if the pond is properly operated. It can thus be constructed near the locality it is inten- ded to serve without causing any nuis- ance. In tropical countries such as India, the process is highly efficient because microbes multiply faster in warm clima- tes. Its maintenance costs very little. To ensure a minimum liquid depth of three feet at all times, sludge will have to be removed about once in six years for a pond four feet deep, and only once in twelve years for one five feet deep. The first experimental stabilization pond in India was built at the Madras University campus in 1957. There are now over 50 such plants working satis- factorily throughout the country; most are for treatment of domestic sewage and only a few for industrial wastes. One of the largest designed by CPHERI was the first full-scale installation for the steel city of Bhilai, to serve a population of 100,000. Other methods recommended by CPHERI are oxidation ditches for exten- ded aeration, and mechanically aerated lagoons. For middle-sized towns, aerated lagoons are the answer. These require much smaller surface areas than oxida- tion ponds. The per capita cost of construction and maintenance of an aerated lagoon to serve a population of between 5,000 and 20,000 is about $2 as compared with $10 for conventional treatment methods using trickling filters or activated sludges. The oxidation ditch, which makes use of a simplified process of extended aeration by mecha- nical rotors, is another promising unit in appropriate circumstances. For treat- ment of the wastes of a population of between 5,000 and 20,000 an oxidation ditch requires an area of 1 acre as compared to 22 acres for an oxidation pond and 2.5 acres for an aerated lagoon. Professor Arceivala insists that low- cost treatment does not mean poor quality of treatment. Experiments by CPHERI'S Division of Microbiology have shown that oxidation pond effluents were free from the pathogenic bacteria responsible for typhoid, cholera and other intestinal diseases, and thus com- pare well with the results of conventio- nal sewage treatment processes. Low cost—high efficiency During the past two decades, India has made tremendous strides on the road to industrialization. The setting up of huge industrial complexes, ranging from steel plants and petro-chemical industries to the manufacture of synthe- tic drugs, has been the cause of a critical degree of pollution. One of the important functions of CPHERI is to advise industries and muni- cipal bodies on methods of waste dispo- sal and the control of air and water pollution. Its consultancy and extension services work on the principle of "low cost but high efficiency". The following are two examples of these activities. After two years of research, CPHERI scientists worked out a design for a waste treatment plant in a synthetic drugs factory at Hyderabad. It cost 2.7 million rupees as compared with 5.7 million rupees quoted by a foreign firm. The problem was to stabilize the factory wastes which contained about 70 diffe- rent chemicals, including a rich mixture of acids. Because of the prevailing rela- tive humidity, the rate of solar evapora- tion was reduced. Therefore, biological treatment by means of an anaerobic lagoon was employed. By this method, which has been in successful operation since 1967, between 70 and 75 per cent of the organic substances are destroyed within a 20-day period. In India's important rayon industry, wastes from viscose rayon processing contain a high concentration of zinc which, in excessive amounts, is toxic to fish and other aquatic life. This waste therefore represents both a danger and a loss, since zinc is a costly metal that has to be imported. The Kanpur branch of CPHERI has devised both a treatment to purify the effluent and a precipitation method by which 80 to 85 per cent of the zinc can be recovered. Seven million rupees have thus been saved in foreign exchange, while the treated waste water can be safely used for irrigation. In 1970 alone, CPHERI provided con- These men are taking samples of water from the oxidation pond which is used to purify sewage. This system of treating harmful effluents needs no complicated machinery and lets nature do most of the work. r The Nagpur Institute has promoted the manufacture of cheap, efficient latrines, the use of which helps to solve one important pollution problem. The old-fashioned removal of excre- ta in open pails exposes workers to disease and is regarded as degrading. The use of wheels is an improvement: workers used to carry the buckets on their heads. This wind velocity recorder and wind direction recorder were designed and manufactured locally by the Nag- pur Institute and are useful aids for assessing air pollution. 1 I W I 111 1 1 i i iiim VT sultant services in the treatment of sewage and industrial wastes to over 35 industrial units and 40 municipalities and advised about 10 organizations on water supply and treatment plants. It also undertook some 20 consultation jobs ranging from environmental pollu- tion surveys to designs of simple sanita- tion devices for the improvement of environmental hygiene both for com- munities and individual dwellings in rural areas. Advice was given on an extensive three-year study to monitor the air over the city of Bombay and on a feasibility study with regard to solid waste disposal for Calcutta city. As a result of CPHERI'S recommenda- tions, nearly 15 million rupees have already been invested in waste disposal systems. In the fight against air pollution caused by large-scale industries and domestic cookers, CPHERI makes use of eight zonal laboratories spread over the country in Ahmedabad, Bombay, Cal- cutta, Delhi, Hyderabad, Jaipur, Kan- pur and Madras. In 1968 and 1969, the Air Pollution Division at Nagpur under- took a short but intensive study of air pollution at Bombay, Delhi and Calcutta which revealed a concentration of dust in the atmosphere from two to five times greater than that of cities in Europe or North America. In New Delhi, for instance, the average dust concentration was found to be 700 mg/m 3 . The con- sumption of low-grade coal in India produces smoke with a generally high sulfur dioxide content. The dust particles act as "carriers" for man-made pollu- tants such as sulfur dioxide and hydro- carbons. The presence of sulfur dioxide and dust particles is considered to be one of the significant indicators of the general level of air pollution. The high level of air pollution in New Delhi was found to be due not only to industry and domestic cookers but also to automo- biles, especially the old cars with poor engine performance that are still so numerous in the cities. Similar air pollution studies are now regularly carried out in all the eight cities where CPHERI has zonal laborato- ries. These are being supplied with additional equipment so that at least three sampling stations can be operated in each city. Samples are collected during two 24-hour periods each month and transmitted to Nagpur for analysis. For use in the air sampling studies, CPHERI has developed a direction-activa- ted sampler whose components are all locally made. It automatically adapts itself to the prevailing wind. Wind direc- tion and wind velocity recorders are also manufactured. Since last year, CPHERI has been desi- gnated as one of the three WHO Regional Reference Centres on Air Pollution, the other two being Moscow and Tokyo. CPHERI is also a WHO Collaborating Institution for Community Water Supply and for Wastes Disposal. Rural sanitation Public health engineering research in India cannot neglect the sanitation needs of the villages which shelter 80 per cent of the country's population. For instan- ce, there is a simple design for a pit latrine which can serve the needs of a family of six for almost ten years and costs only ten rupees including labour. It can be kept completely free from odour with a minimum of water. To promote interest in better sanitary practices, CPHERI conducts short courses for villagers. During the last two years more than 15 such courses of two to three weeks' duration have been held to teach artisans the manufacture of sani- tary articles made of simple clay and straw or of cement and stone. It is still true that some communities resist the introduction of new methods, for example water chlorination. What people object to is not so much the need to go to wells in neighbouring villages to fetch water known to be safe, but rather the changed taste of the chlorinated water. With improved literacy in the countryside, however, more people are coming to accept the new ideas. Health education has always an important role to play. Professor Arceivala is justifiably proud of CPHERI'S achievements during its short existence but is still far from satisfied. "A serious handicap felt by us," he says, "has been the absence of proper legislation for the control of water and air pollution. We have been left as mere spectators." But the wind is blowing in the right direction. The Maharashtra state, with the assistance of CPHERI, has already enacted a law on water pollution. A comprehensive bill for the control of water pollution is ready for submission to the Indian Parliament. And, at the request of the Government of India, WHO has provided expert assistance in the drafting of suit- able legislation for the control of air pollution. ■ 17 A profession by Dr N. F. Izmerov Former Assistant Director-General, World Health Organization It is no good building fine hospitals without doctors and nurses to staff them. Similarly, plans to improve the environment and fight pollution require sanitary or public health engineers for their execution, that is to say fully qualified civil engineers who have had at least one year of specialized post-graduate training. They are most need- ed in the developing countries that are facing not only the demand for safe water supplies and waste disposal services, in which the more advanced countries have already a century of experience, but also the newer menace of pollution from mushrooming in- dustries, automobiles and sprawling cities. The demand for sanitary engineers increases at the same rate as urbanization and in- dustrialization. French-speaking sanitary engineers are especially hard to find. Two reasons may be advanced for this. One is the scarcity of posts in countries with systems copied from those European nations where health is traditionally the concern of the health servi- ces and where public construction, water- works, sewers, etc. are the exclusive business of publid work departments. In such coun- tries, generally speaking, neither side has a place for sanitary engineers. The second reason, linked to the first, is the shortage of institutions providing specific training in sanitary engineering. For instance, the only complete sanitary engineering cour- se given in French anywhere in the world is designed to meet the requirements of highly industrialized and densely populated coun- tries, leaving an almost complete vacuum as regards the French-speaking countries of the third world. None of the latter can afford to provide sanitary engineering training just to meet its own needs. To help fill this gap, the World Health Organization sponsored the creation in 1969 of an International Sanitary Engineering Centre at the Mohammadia School of En- gineering, Rabat, Morocco. In planning the Centre, experts from Canada, Italy, the Netherlands, the United Kingdom, USA, USSR and Yugoslavia were consulted. The Centre accepts students from all African and Asian countries and territories where French is spoken, and offers university level and post-university courses leading to a Diploma of Specialization in Sanitary Engineering. WHO provides fellowships of different kinds. In the present academic year, 19 fellows are at different stages of the regular four-year civil engineering course given at the Moham- madia School of Engineering, to which in- struction in the basic concepts of environ- mental health has now been added. When they graduate, they will go on to take the one-year post-university course at the wHo- sponsored centre. Five fellows who already possess engineering degrees are taking the latter course. These 24 fellows come from 18 somi rel we need • '•17-77-4- At the new International Sanitary Engineering Centre, Rabat, Morocco, practical work is emphasized. This allows students to see how theory is applied in real life. Here a group of fifth-year students are visiting a water purifi- cation plant outside Rabat. The first four years prepare the students to be civil engineers, and in the fifth year they specialize as public health engineers. The school, which has 250 students, occupies a modern building. 101111■111.11116i.cel riti7FintiliriFilfr5C11111111 11111111 1111 Ti nine countries besides Morocco. Fellowships may also be given for one-month intensive refresher courses at the Centre and for practical training periods during the summer. It would be difficult to find a better place for the Centre. Morocco is a country where people of different cultures can live together in a climate of mutual tolerance. The Mohammadia School of Engineering, the National Institute of Hygiene and the Morocco health authorities have all given their collaboration and support. The co- operation between the Sanitary Engineering Centre and the National Institute of Hygiene tends to create in the students a spirit of collaboration and teamwork with the doc- tors, biologists, chemists and other experts participating in the general task of impro- ving the environment. The Mohammadia School is housed in a modern building inaugurated in 1960. It has 250 students of its own, and graduates about 60 engineers each year. It has facilities for accommodating a much larger number of students, and the workshops and chemistry and physics laboratories are handsomely equipped. A good library and other modern facilities are available to students in the school. Up to 40 fellows taking the four-year undergraduate course can be housed either at the School or in the student quarters of the Mohammed V University, to which the Mohammadia engineering school belongs. A language difficulty For its part, the World _Health Organiza- tion has provided equipment and supplies for the chemistry, biology and. fundamental hydraulics laboratories that are needed for sanitary engineering education. It has also provided a sanitary engineering and public health library. Here, however, some difficulty has arisen, since the great majority of textbooks and scientific journals in this field are in English. Although undergraduates are required to study English, most of the students read that language with difficulty. There may be a possibility of obtaining French translations of Russian sanitary engi- neering textbooks, but that still does not solve the problem of scientific journals. WHO is also to provide four staff members for the Centre, of whom three are already appointed. The chief adviser is Professor Roger Labonte (Canada) who is a professor at the University of Montreal. He has been seconded to the Rabat Centre for an initial period of two years. He is assisted by Professor Steven Jankovic (Yugoslavia), pre- viously of the University of Belgrade, who teaches sanitary chemistry and biology, and Professor Bahjat Faddoul-Ashkar (Lebanon), 19 40 I{ i 4 latitilki ► ,100:1r .41,1e 1 Z !Sir/AO 1 a irorAardle:11111111le: lb / "11114gb!"."1.111111"1"111" u Alus1100/ " . --2,1111111111101Mers I 4'41/1, mow.. rimt. 'Om ; Waste can be useful. Properly trea- ted, it can be used as compost, thus increasing agricultural production. This mechanical composting machine at Rabat grinds raw waste and reduces it to fine particles which are stored and allowed to break down organically. These students are learning how to make water sample analyses to discover whether water contains pollutants, toxic substances or disease-producing organ- isms. Fifth-year students and their pro- fessor visit the pumping-room of a water purification centre which serves Casa- blanca. who was previously teaching sanitary engi- neering at the University of Moncton, Cana- da. The fourth international post is not yet filled. The staff of the Mohammadia School of Engineering will also teach at the Centre, and professors from the National Institute of Hygiene and from the faculties of medicine and of sciences of the Mohammed V Univer- sity may be invited to give instruction in special subjects. WHO pays for their services and for those of international experts assi- gned to teach at the Centre for short periods. The Moroccan Government has agreed to defray the local costs of the Centre and to place the existing buildings of the Moham- madia School of Engineering at its disposal to the fullest extent possible. It has also agreed to recruit four national counterparts to the international staff members. They will receive fellowships from WHO enabling them to study abroad in preparation for their future careers as professors specializing in sanitary engineering. With their help, the Moroccan Government will continue the work of the International Centre after assis- tance from wHo has ended. The students who have obtained wHo fellowships for the full five-year course (four years of regular engineering studies and one of specialization) are naturally somewhat anxious as to their future professional role when they return to their own countries. This is of importance also because the continuing attractiveness of the field of sanitary engineering to French-speaking stu- dents and engineers will depend' in some measure on the kind of activity they see the first groups of students performing. It would be of value, in this connexion, if the governments of the French-language coun- tries concerned would give official recogni- tion to the title, qualifications and post- graduate degree of sanitary engineer. This has already been done in most developing countries where English or Spanish is the official language. At present, eight countries besides Moroc- co have sent fellows to take the undergra- duate engineering course and two the post- university course. But there are as many as 30 French-speaking countries or territories that are in need of qualified sanitary engi- neers and could profitably send students for training. WHO has therefore undertaken to do what it can to induce those countries that have not already done so to recognize the validity of the degree awarded by the Inter- national Sanitary Engineering Centre and to persuade governments to recruit candidates and to support and encourage the new specialists when they return home with their diplomas. When I had the pleasure of opening the Centre in January this year, I referred to the sympathy and enthusiasm for this project shown by the civil engineers of Morocco, by Mr Driss Amor, Director of the Moham- madia School of Engineering, and by its faculty members. With their co-operation and the support of the Moroccan authori- ties, I believe that this Centre will gain recognition as a most valuable enterprise and one of far-reaching international impor- tance. As the need for sanitary engineers becomes more widely recognized, many more institutions will be needed to train them. They may well take this first interna- tional centre at Rabat as a model. Ultimately, however, the Centre's success will depend on the positive attitude of its students. It is there to meet their needs and those of their respective countries. Equipped with new knowledge and skills, they will be able to play their part in controlling the environment so that it serves rather than defeats human purposes and endeavours. ■ Preserving the sp photo story by P. Larsen Kenya is a large country with a varied climate. Most of its people lack a safe convenient water supply. There are well-watered lands near Lake Victoria and dry northern plains bordering on Somalia where drought is almost permanent. Rising to an altitude of 17,000 feet, Mount Kenya straddles the Equator near the centre of the country and on its slopes originate Kenya's important river systems. Fortunately, most of the people live in the reasonably well-watered region, but everywhere only a small proportion of them have piped water. There is enough water to supply the country's needs if it can be harnassed. But it costs money to buy pumps and pipes, and it costs money to maintain water systems. Knowledge is also needed as well as properly trained staff. People everywhere must be convinced that safe water may be the single greatest factor in promoting their health and a rising standard of living. Cholera, typhoid and other intestinal diseases can be stopped when safe water is provided, particularly when linked to safe waste disposal. A striking demonstration of the contribution that clean drink- ing water can make to health was given recently in a counter- attack launched to stop the spread of cholera in Kenya. The weapon used was a portable swimming pool. Swimming pools with a 2,000-gallon capacity can serve as emergency water tanks. They are light, can be shipped by plane and are easy to assemble; a crew can put one together in about two hours. This is how they were used: When a number of rural com- munities send out cholera warnings, emergency tanks, pumps, and rolls of barbed wire are flown out in small planes. A small pump is installed to move the water from the river or lake, its collection point being protected from children and animals by barbed wire. About one hundred feet away a site is cleared for the tank by removing sharp stones and obstructions. Once the tank is assembled and the pump installed, the water in the tank is treated to make sure it is free of disease. The water is then simply siphoned off through a one-inch plastic pipe. To keep the tank free from contagion, it is isolated by another row of barbed wire. In the communities where these tanks were set up the results were striking. Water-borne infections dropped off sharply. Water can benefit health and economy in a number of ways. Healthier people can work harder and more productively. Piping water to convenient places also frees women for other work than carrying water. Adequate water means that a higher standard of cleanliness can be maintained where cooking is done. Food will be cleaner and people are able to keep themselves cleaner too. The Government of Kenya is out to provide piped water to as many of its villages as possible. A master plan has been drawn up with the assistance of who; a who pilot programme carried out with the Ministry of Health and aided by UNICEF has already benefited 250,000 people living in more than two hundred villages. Kenya means to see that its people have water safely and in ample supply. ■ <This women suffers from enteric disease, and has already lost one baby. She is nursing another baby, and hopes that he at least will survive. Her community in the Nyaheera District, Kenya, will soon benefit from the new water supply. The only source of water for some Kenyans is the river. rings of life 3 Preserving the springs of life Harambee means "let us all pull together". Here volunteer workers are building a reser- voir to store water which will be pumped to the surrounding area. A WHO sanitarian discusses maintenance and explains how the water supply system will function. Safe water supply depends upon reliable equipment. These new water pipes are being carefully inspected. A A 10-year-old boy enjoys a clean mug of water without having to walk miles to get it, thanks to a new and better system of distribution. At present these children rely upon rainfall, which is caught in roof tanks. But rain is scarce and irregular in this region, and when the tanks run out the children must fetch their drinking water from faraway streams. 25 AIR POLLUTION The searc for guideline by Aaron Sternfield Today, air pollution is about as popular as the man-eating shark. If something smells, soils his clothing, causes him to cough or impairs his visibility, the average man is against it. Unless, of course, the cause of the pollution is the source of his income. In that case, man will regard air pollution as the necessary price for progress. Man's degree of anti-pollution fervour can often be measured in terms of his economic independence from the sources of pollution. How much pollution is too much? Me- thods of determining the extent of pollution vary from country to country and within countries. When man builds his factories, heats his home and drives his automobile, he creates pollution in varying degrees. When severe, it can befoul the countryside and, under certain circumstances, cause illness and even death in particularly vulnerable individuals. But how do you measure the degree of pollution? How can the scientist from Buenos Aires discuss air pollution with the scientist from Tokyo and use statistics which are comparable? The environmental pollution unit of the World Health Organization is seeking some of the answers to these questions. After four years of preparation, WHO has set up a system of 34 air pollution monitoring sta- tions throughout the world. It includes international centres in London and Wa- shington, with regional centres in Moscow, Nagpur (India) and Tokyo. The first step in the move to monitor air pollution on an international basis was taken at the end of 1967 with the designation of the Medical Research Council's Air Pollution Research Unit, St. Bartholomew's Hospital Medical College, London, as an Internatio- nal Reference Centre for Air Pollution. Later, it was given special responsibility for clinical and epidemiological aspects of the problem, while an International Reference Centre for Air Pollution Control was esta- blished at what is now the USA Environ- mental Protection Agency near Washing- ton. These reference centres and other labora- tories collaborate with WHO, advise on research results, carry out specific research on request and collect, evaluate and exchan- ge scientific information. The International Reference Centres test and review methods for identification and measurement of var- ious air polluants—methods especially suit- ed for the routine monitoring of air pollu- tion. Air pollution is generally considered as besetting the highly industrialized nations. However, some early reports from the WHO monitoring system indicate that other coun- tries have their problems too. 26 The Osaka Pollution Control Centre is connected by radio with the main pollution-producing factories in the area. The office contains apparatus which registers automatically the degree of air pollution produced in a given area. Lights in four colours indicate to what extent pollution presents a health problem. Factories in the affected area can then be warned to lower their fuel consumption until atmospheric conditions improve. To take some examples, the average con- centration of smoke in Stockholm in 1969 was 35 mg/m3 . Bombay had seven times and Mexico City two and a half times that figure. Osaka has recorded concentrations ten times, Prague five times and Tokyo four times as high. In recent years, Stockholm has had an annual average sulfur dioxide concentration of 61 mg/m3 . This is just over one-third of that of Hong-Kong, less than half that of Osaka and two-thirds that of Tokyo and of Mexico City. Air pollution is not recent. Some 700 years ago, a Queen of England moved from London to Nottingham because she could not tolerate the smoke. Three hundred years later, the brewers of Westminster offered to use wood instead of coal because of the first Quenn Elizabeth's aversion to coal smoke. During her reign, the use of coal was banned while Parliament was in session. During the European industrial revolution in the eighteenth century, townspeople went to admire the smoke from the new factory chimneys. At that time, smoke was associa- ted with economic well-being. The industrial revolution raised the standard of living and people were more interested in prosperity than in smoke abatement. The developing countries are going through their own industrial revolution. Many of their citizens look forward to industrializa- tion. They see in the factory smoke an opportunity of employment. They see better food, clothing, shelter, education and medi- cal care. However, the developing countries have one advantage over Europe and North America in the eighteenth century. They can profit by the experience of the highly indus- trialized countries. They can develop their economies, and at the same time minimize the adverse effects of industrialization. This demands careful planning. First of all, factories must be properly sited. Though the factory may pollute the air, the effects are minimized if it is built away from residential or potentially residen- tial areas. A large oil refinery in Rome had to be dismantled and moved after a few years because a residential suburb had grown up around it. This is not an isolated example. Some industrial processes produce more pollution than others. The process which produces the least pollution can be selected before the factory is built or proper pollu- tion control equipment can be incorporated at the design stage. Pollution control intro- duced after the factory is in operation is often expensive and economically unsound. In 1962, WHO initiated a global environ- mental pollution control programme. Air 27 <I 4.)O.) ,n C .) z bo 0.", • t.0, • 0 . 0 to ,n szl, cy 4.) L ■-zs "•-, t' t:1 % ƒ -0 cy, z o .) - c.1 0 -0 *EY a 4.: ,n 1,7. *7Z3 t=+ 0.) • • • Z ‘4" 4 0 Es. 4) 1.: •74.1 c.) tt C:14 Et 4 0 ;"' .5 ""'" 0 O .) ^ '> - • ES 0 2 E pollution control is often a matter of com- promise, of weighing the cost against the risk. At one extreme are pristine air and a pastoral life. At the other extreme are the belching chimneys and the foul air. The former is not compatible with the needs of twentieth century life. The latter is not compatible with the requirements of physi- cal, mental and social well-being. People and governments must weigh both needs and make their decisions. WHO has selected six of the most wide- spread air pollutants for international study, and is continuing a survey to find out which areas are the most polluted and at what levels health is endangered. The pollutants being studied are: Sulfur dioxide, produced by the com- bustion of coal and fuel oil in industry. Particles, such as dust and soot from industry, which dirty the cities and provide nuclei for smog formation, Carbon monoxide, a toxic gas produced in motor vehicle exhaust and other combus- tion processes. It reduces the blood's ability to carry oxygen and causes headaches and malaise; in sufficient concentrations it can kill. Oxidants, resulting from the action of sunlight on unburned hydrocarbons and nitrogen oxides, both components of auto- mobile exhaust. They cause smog which reduces visibility and irritates the eyes. Nitrogen oxides, emitted in motor vehi- cle exhaust or during industrial production. They can be harmful to humans, attack a broad range of materials and join with hydrocarbons to form smog. Lead, a toxic substance added to motor fuel to prevent "knocking", and emitted in the exhaust. It tends to accumulate in the body. The \\filo study places the major emphasis on sulfur dioxide and particles—the two air pollutants that present the most serious health threats. The prime objectives of the monitoring network are to measure current levels of air pollution, to observe trends and to evaluate the effectiveness of legislation and control measures. At the same time wHo is moving rapidly toward the establishment of internationally accepted air quality guides. They will deal with four pollution levels expressed in terms of concentrations and exposure times—the level below which no harmful effects have been observed; that above which there is likely to be irritation of the sensory organs, harmful effects on vegetation, visibility re- duction or other adverse effects on the environment; that above which vital physio- logical functions may be impaired or chronic diseases or shortening of life may ensue; and lastly the level which may result in acute illness or death in susceptible groups of the population. Constant monitoring of air pollution can result in effective action. One of the most widely heralded pollution alert systems is that of Los Angeles, California, USA. It warns of three different degrees of danger. The first alert indicates that the air is still safe but that pollution is approaching the maximum allowable concentration for the population at large. It calls for preventive action, bans burning of refuse in the area, and warns motorists and industrial plants to be prepared in case a second alert is sounded. That happens when the air contamination represents a health menace in the preliminary stage. It limits the use of motor vehicles and empowers the air pollution control officer to shut down factories. He is also required "to keep the public suitably informed of all significant changes in the concentration of toxic air contaminants". The third alert is sounded when a danger- ous health menace exists. This carries all the provisions of the second alert and may also call for the declaration of a state of emer- gency if the steps taken by the air pollution control officer prove insufficient. The Los Angeles County Sheriff sends the alert by teletype and radio to local police, the California Highway Patrol, public offi- cials with air pollution control responsibili- ties, and to air polluting industrial plants. The plants follow pre-arranged plans to reduce the output of air contaminants. < Mobile vans are used for air pollution control in Osaka. This one is taking a reading near a chemical factory. Inside the mobile control van in the C. factory grounds, pollution concentrations are measured and wind direction is recor- ded. The Osaka power station has a console equipped with a TV screen that shows the tops of chimney stacks and a light panel that indicates the sulfur dioxide concen- trations. When the concentration reaches danger point, the power station cuts off or reduces fuel utilization. V ) ) ))) )))))J siaassessi ■ The Los Angeles alert system requires highly sophisticated equipment, highly trai- ned personnel as well as a substantial budget, and may not therefore be the answer for most communities. But it does show how an effective monitoring and reporting system can prevent a catastrophe. During the twentieth century several ca- tastrophes have been caused by air pollution. Most publicized has been the five-day Lon- don fog of 1952. In the two-week period during and following the fog, some 4,000 more deaths occurred in the area than during comparable periods in previous years. Other notable examples of death by air pollution occurred in Donora, Pennsylvania, USA (20 deaths), the Meuse Valley in Belgium (63 deaths) and Poza Rica, Mexico (22 deaths). As the world becomes more urbanized and industrialized, the chances of similar disasters recurring become greater unless effective air pollution measures are taken. The results from the wHo monitoring system will be long range, and governments are advised to take steps now, using what- ever knowledge and resources are at their disposal. Action must be taken also in the legislative arena. Historically, air pollution has been regarded as simply a public nuisance to be dealt with by local authorities. Most of the early legislation throughout the world was vague and ambiguous, and governments were often not able to employ technical staffs capable of understanding air pollution levels even when standards were established. The 1958 report of the wHo Expert Committee on Environmental Sanitation re- commended centralized air pollution control legislation, to be administered in part by the central governments and in part by local government units. In many cases this has meant governmental control of pollution from large industries, leaving the control of smoke and other emissions from lesser sources to the local authorities. The World Health Organization plays an advisory role and can help governments to frame legislation. It can assist them in weighing their industrial needs against the hazards to physical, mental and social well- being arising from air pollution. It will present the facts about health risks at different pollution levels so that governments may take their own decisions on standards. The WHO premise is that the first step in the fight against air pollution is uniform measuring and reporting. It recognizes that, while air pollution is a major problem, it is not mankind's only problem. The resources required to combat air pollution are limited. They must be employed where they will do the greatest good. The raw information collected by the wHo air pollution monito- ring network provides a start. ■ 31 LI the gap by Dr J. de Moerloose Chief of the Health Legislation Unit, WHO. 4.e The need for legislative and other measures to control air pollution is recognized throughout the world nowa- days, but in fact the problem is not an entirely new one. There is an eyewitness account of Paris in 1763 by Le Begue de Presle, Jean-Jacques Rousseau's last physician, in which we read " ... Paris has a particular atmosphere at all times except when a high wind is blowing. This atmosphere is composed of an air made heavy and prevented from rising very high by the quantity of particles and exhalations it carries. That is why, when you look at Paris from a certain distance, the city seems, even in the finest weather, to be covered and enve- loped in a haze. The foggy weather that the city so frequently experiences is no less dangerous ... Thus come about the thick Paris fogs of autumn and winter which smell so foully, hurt the eyes and the throat, and bring on coughs and fluxions." London, as described in 1733 by George Cheyne, seems to have been quite as polluted as Paris. The sources of pollution of what, he says, is "for aught I know the most capacious, close and populous city of the globe ... are more than sufficient to putrefy, poison and infect the air for twenty miles round it and, in time, must alter, weaken and destroy the healthiest constitutions." As early as 1661, measures had been advocated, fruitlessly it would seem, by John Evelyn in his book " Fumifugium." . In those days, the problem was main- ly restricted to large cities and thus affected only a very small part of the earth's surface. The pollution that we are experiencing today is evidently much more extensive than that of the eight- eenth century, and the countryside is no longer spared. In recent years, the number of legisla- tive measures against air, water and soil pollution has grown enormously, and the following cannot pretend to be anything but the merest outline. Three periods In a first period, up to the end of the nineteenth century, measures applied only to cities and took the form of very general sanitary provisions covering, for example, the production of thick smoke, the raising of livestock in towns, the location of certain trades harmful to the environment, etc. The second period was that of the industrial revolution in England, France, Germany and some neighbouring coun- tries in the nineteenth century. Blast furnaces, chemical industries and the steam engine were all sources of pollu- tion and were often situated in the heart of a city or just outside it, without the least regard for the consequences to human health. It should be remembered that in those days no such thing as a ministry of health existed, and there was complete ignorance about the effects on health of certain industrial effluvia. The third period, that of the twentieth century, is marked by the great develop- ment of industry in many countries and the fact that even agricultural nations are seeking to become industrialized. In the matter of legislation, this third period may be divided into three stages. During the first stage, the legislative texts reflect the notion that, to be effective against air pollution, measures should be taken on three fronts: in- dustrial pollution, pollution by fuel- burning power stations and domestic heating, and, more recently, pollution by motor vehicles. In the second stage, additional attention was focussed on the need to combat the pollution of water, and in some countries measures were even taken against noise and vibrations. At the same time, the need for compre- hensive rather than piecemeal legislation became apparent. The division of respon- sibilities among a number of independent or autonomous authorities tends to pre- vent any general solution of the problem. It will not do to pass legislation dealing solely with air pollution, especially as the same sources may pollute both air and water. During this second stage, the legislatures in a number of countries have set up a central body responsible for anti-pollution measures or at least for their co-ordination. Such authorities almost always attached to the ministry of health, since their main purpose is, after all, to protect human health. The third stage, the one we are now living in, is marked by the conviction of health authorities that the legislation of different countries must be harmonized. Air and water pollution know no fron- tiers. In Sweden, for instance, atmos- pheric pollution coming from the big industrial countries to the south has acidified the rain, with the result that the aquatic fauna in the Swedish lakes has been in part modified or even destroyed. Regional efforts to harmonize legisla- tive measures are therefore of conside- rable importance. Among the organiza- tions involved in such action are the OECD, the Council of Europe, the United Nations Economic Commission for Eu- rope, and also the Nordic Council < In Flanders... 33 and the Council for Mutual Economic Assistance (coMEcoN). The need to reach some uniformity of legislation is felt also within countries having a federal structure. In 1970, the United States of America set up the Environmental Protection Agency which took over the responsibilities of the Federal Water Quality Administration, the National Air Pollution Control Administration and other bodies. The initial annual budget of the Environ- mental Protection Agency is $1,400 mil- lion. Moreover, the United States of America and Canada have set up a special commission to settle common problems in this field. One of the difficulties that countries meet in formulating anti-pollution laws is to know what standard methods to apply in analyzing and measuring pollu- tion, what are acceptable norms of air purity, and the related question of where to fix the permissible limits of pollution. It is here the World Health Organization and other specialized international or- ganizations can play a leading role. Some uniformity in legislation is in- dispensable, if only to prevent "polluter" countries with lower production costs from obtaining an unfair advantage in international competition and the strug- gle for markets. The accusation is often made that legislative measures are ineffective. In reply it may be said that, since the passing of the Clean Air Act in 1956, the number of sunny days in London has increased and the concentration of smoke has decreased by 80 per cent. During Pure Air Week in Paris in 1969, it was found that the emission of smoke could be stopped by organizing a check- up on 10,000 heating units. It should also be pointed out that a business concern can reduce the emission of hydrocarbons and eliminate smoke, often at very low cost. Industrial pollution At the present time, most countries are taking steps to fight pollution. New laws have recently been put into effect even in places such as Malta and Hong Kong, in geographical situations where one might expect the problem not to exist. Anti-pollution measures are being developed so rapidly at the present time that a first survey of existing legislation, published by vixo in 1963 and entitled Air Pollution, is completely out of date today. I shall give only a few examples of legislation on industrial pollution, taken for the most part from France and England, two countries where the indus- trial revolution began very early. Men- tion must be made of a piece of legislation that has been copied in a large number of countries of western Europe and Latin America, and also in several African and Asian countries. It is a French Imperial Decree issued on 15 October 1810 in which industrial concerns were classified in three catego- ries—those that should be located far from any dwellings, those that should be so located only in certain circumstances, and those that do not create a serious nuisance in their neighbourhood. In France, the first important revision of this decree dates from 1917. The text has since been further modified by several decrees and laws, notably in 1958, 1961 and 1963. A detailed nomen- clature was adopted in 1969. The decree of 17 September 1963 contains some mea- sures applicable to the entire French territory and some only to " special protection zones" for the stated purpose of controlling atmospheric pollution and odours that inconvenience the popula- tion, endanger health or public safety, or are harmful to agricultural production, to the preservation of buildings and monuments, or to the character of the landscape. This decree is specially con- cerned with fuel-burning apparatus and equipment, and also applies to industry. In England, smoke-abatement mea- sures have a long history—one ordi- nance dates from 1306. Present legislation is the result of the pressure of public opinion. In 1863, the "Alkali, etc., Works Regulations Act" was passed in response to the public outcry against the damage caused by the sodium carbonate manufacturing industry. At that time, three quarters of a ton of hydrochloric acid was liberated into the atmosphere for every ton of sodium carbonate ma- nufactured. The 1863 Act, now better known as the "Alkali Act", underwent several revisions and at present covers a large number of industrial activities responsible for emitting a variety of harmful or toxic gases into the air. The law is enforced by a relatively small number of officials known as "alkali inspectors" who, in 1968, were respon- sible for supervising some 2,970 different industrial processes. The Clean Air Act was passed in 1956 as a direct result of the notorious London "smog" of 1952, which is consi- dered to be one of the worst disasters caused by air pollution. The powers of the health authorities were found not to be sufficient to control the pollution of the air by smoke. The 1956 Clean Air Act was amended in 1968 to make its application more effective. It deals with the control of smoke, dust and impuri- ties in the air, and establishes "smoke control areas." The local authorities are responsible for carrying out the provi- sions of the Act, which applies to some 30,000 industrial concerns. The effectiveness of these legislative measures is shown by the spectacular improvement of the atmosphere in Lon- don, Sheffield, Birmingham and other cities and by the fall in the number of deaths from chronic bronchitis in large urban centres. In Poland in 1959, a draft law defined atmospheric pollution as any modifica- tion in the natural composition or pro- perties of the air produced by dust, gases, smoke, odours, radiations or noise that causes harmful effects or discomfort in men or animals or that is detrimental to plants or to natural resources. Accor- ding to the proposal, plans for the construction of new industrial plants should include gas-cleaning equipment. Maximum permissible concentrations of gases were also formulated. Industrial plants were divided into five categories according to the nature of the product, the production methods, and the effects of air pollutants on the surroundings. For each category, different sizes of health protection zones were prescribed. This proposal did not become law until 1966. The law now requires that concerns whose activity results or may result in concentrations of pollutants in the air in excess of the permissible maxima should install the necessary devices to avoid pollution. Plans are subject to approval, as is the choice of location and the development of the surrounding area. Buffer zones must be established in order to protect the neigh- bourhood from pollution. Any enter- prises likely to cause air pollution must carry out measurements and checks of the concentrations of the contaminants emitted, both at the point of discharge and in the surrounding zone. Checks and measurements are also made by state health inspectors. In addition, the law lays down the steps to be taken if the prescribed levels are exceeded. Existing plants are required to report the quantities of pollutants discharged into the atmosphere and provide infor- mation about the nature of their activi- ties and the anti-pollution measures taken. It is of interest that the respon- sibility for measuring pollution and esti- mating the effect of its dispersion on both topography and meteorological condi- tions is assigned to the State Institute of Hydrology and Meteorology. Thus it becomes possible to forecast the proba- 34 Italy is divided into three zones for monitoring air pollution. This allows a closer check of specific conditions. Here is a reputedly clean =one. ble paths of dispersion of the polluted air. In 1967, an ordinance was passed requiring that the protection zones should be suitably cultivated or else planted with bushes and trees. No dwel- lings, boarding schools, hospitals, creches or infant schools may be built thereon. The size of these zones depends upon the topography and climatic con- ditions, the degree of concentration of the emissions, their dispersion character- istics, and also on the methods of effluent treatment employed. Fuel-burning power stations and domestic heating furnaces The consumption of coal and hydro- carbons is constantly increasing and constitutes one of the most important sources of air pollution. Most legislation requires the use of fuels of low sulfur content and prohibits the burning in urban centres of soft coal, which can also spread quantities of soot and dust. The pollutant that causes the most dam- age is unquestionably sulfur dioxide, produced by the combustion of fuels containing considerable amounts of sul- fur. An idea of the dimensions of the problem may be obtained froni the fact that in Japan the consumption of electric energy more than tripled between 1957 and 1967, and reached the impressive figure of 245 x 109 Kwh, while the quan- tity of heavy oil fuel used to produce electricity in 1967 was 19 x 10 6 Kl, or 16 times as much as ten years previously. The Middle East is the principal source of the hydrocarbon fuels used in Japan, and the fact that they are rich in sulfur creates serious difficulties for that coun- try. It becomes necessary to desulfurize the fuels as far as practicable. Japan has to concentrate its industries in the limited area constituted by the plains of the four industrial islands. What is more, the height of smokestacks must be limited because of the danger of earthquakes. Since 1967, Japan has passed various laws and decrees for the control of air pollution and has fixed permissible levels for concentrations of sulfur dioxide. It is now proposed to make provisions to in- demnify those who suffer inconvenience due to air pollution. In France, the generating stations of the "Electricite de France" emit some 200,000 tons of sulfur dioxide into the atmosphere each year, and in spite of all precautions the quantity is constantly increasing. In New York it is estimated that 1.5 million tons of sulfur dioxide are discharged into the air each year. In large cities, measures are also needed with regard to domestic fires. In France, a police ordinance was issued in 1934 prohibiting the use of fuels contain- ing more than two per cent of sulfur in urban centres and within ten kilometres of residential areas. Smoke may not contain more than 1.5 to 2 g of dust per cubic metre. An important decree was adopted in France in September 1963 with regard to heating plants as well as equipment in administrative, industrial, or commercial establishments, residen- 35 Gee, it's great to get back to nature! tial premises or those where professions or trades are exercised. Fuel-burning equipment must meet strict technical specifications. In the " special protection zones" certain pollution levels may not be exceeded. In defining these zones, consideration is given to a number of factors such as the size of the population, the concentrations of sulfur dioxide or other toxic gases, the local climate, etc. Later regulations dealing with these zones are to lay down specifications for fuel-burning apparatus and equipment, its use and maintenance, the qualifica- tions of the responsible staff, and where necessary the use of fuels in such zones. In Bulgaria, a decree of 1964 contains provisions for central heating systems in large cities. Furnaces must be instal- led according to technical requirements designed to reduce air pollution to a minimum. The same tendency to regu- late heating installations in cities is found in other countries also. In Italy, heating installations burning either solid or liquid fuel are subject to special measures contained in a law of 13 July 1966. The whole country is di- vided into two zones, A and B, accor- ding to the size of the communes, their degree of industrialization or urbaniza- tion and their geographical or meteoro- logical characteristics. The more severe regulations apply to zone B localities where, for example, the burning of lignite and peat is actually forbidden. There are different requirements for each type of fuel; coal, for instance, should contain not more than 1 per cent of sulfur. The staff of thermal power stations of a capacity of more than 200,000 kilo calories per hour must possess a certificate of aptitude. In a White Paper issued in May 1970 on the fight against pollution, the United Kingdom government insisted on the fact that domestic fires are the main source of smoke in the country. Al- though the Clean Air Act prohibits the use of any but authorized fuels in "smoke control areas", the legal requi- rements do not appear to be rigorously complied with. Indeed it would seem that some local authorities do not exer- cise the powers given them under the Act to take anti-pollution measures. The White Paper therefore states that the Government will make use of its powers to oblige local authorities in heavily polluted areas to take the necessary action. Motor vehicles Again it is a matter of hydrocarbons. In fuel-burning power stations hydro- carbons are almost completely oxidized, but in the internal combustion engine of the motor car hydrocarbons tend to be transformed into a variety of chemical substances that cause increasingly ser- ious problems, especially in urban areas. They include gases, such as carbon monoxide and nitrous oxide, a cer- tain quantity of non-oxidized hydro- carbons, and carcinogenic substances such as benzpyrene. Cigarette smokers voluntarily absorb the same carcinoge- nic substances—they are believed to cause lung cancer. Automobile exhaust also contains lead compounds, the con- sequence of adding tetraethyl lead to motor fuel. Unfortunately, this is not the whole list of substances emitted. It has been established that under the effect of strong sunshine photochemical reac- tions take place, resulting in the produc- tion of nitrogen dioxide, ozone and certain gases that are strong eye irritants. These different substances are the cause of the notorious Los Angeles smog. At present, in Los Angeles and in a number of other cities, the law requires that certain activities should be stopped when- ever pollution reaches a danger level. In 1960, the critical situation resulting from the smog led to the formation in the State of California of the Motor Vehicle Pollution Control Board, and the establishment of standards for the exhaust gases emitted by motor vehicles. The Federal Government adopted iden- tical standards which were applied for the first time to vehicles of 1968 model year. The requirements have become increasingly rigorous, and it is proposed that 1975 model year vehicles should have equipment ensuring that the emis- sion of certain pollutants will be only 10 per cent of that of 1970 models. In France also, various steps have been taken by the Ministry of Equip- ment and Housing and the Ministry of Public Health and Social Security. An or- der of 1969 required that the engines of vehicles of a total weight not exceeding 3.5 tons should be so adjusted that the concentration of carbon monoxide emitted at idling speed does not exceed 4.5 per cent of the total exhaust gases. 36 Switzerland now has a similar regulation. The French order of 30 June 1970 is stricter still, as it provides for the appli- cation in France of Regulation 15 (relating to the emission of gaseous pollutants by engines) of the Geneva Agreement of 1958 on conditions for the approval of vehicles equipped with a positive-ignition engine. The order also refers to a directive of the Council of Ministers of the European Commu- nities of 20 March 1970 on the subject of a possible alignment of the legislative measures of member states concerning air pollution by motor vehicles. In addition, it provides that after 3,000 kilo- metres vehicles may be required to undergo tests to see that the percentage of carbon monoxide in the exhaust when idling does not exceed 4.5 per cent. Beginning 1 October 1971, new vehicles with a new type of engine are required to undergo tests, as are all vehicles to be put into service during or after September 1972. Various restrictions are also placed on emissions of gases from the crankcase. In Japan, legislation was passed in 1970 to limit the concentration of carbon monoxide emitted by new models of automobiles to 4.5 per cent of the exhaust gases, while up to 5.5 per cent is permitted for vehicles already in use. Restrictions are also placed on the amount of lead-based additives in gaso- line. In Sweden, since 1969, there have been a number of regulations regarding exhaust gases from motor vehicles. For those with diesel engines the maximum permitted densities of smoke are speci- fied and seals must be placed on the injection pumps to prevent any interfer- ence by non-qualified persons with the standard adjustment. The Swedish Gov- ernment is also considering whether to require that 1971 and later model year cars should have equipment to control the emission of carbon monoxide and hydrocarbons, and that the carburettors of earlier models should be regulated to ensure that the concentration of carbon monoxide in the exhaust does not exceed 4.5 per cent at idling speed. To sum up, there is a general tendency in many countries towards general regu- lations which aim at the protection of the environment as a whole. Further- more, the need for international legis- lation has become increasingly evident and it is certainly time that we got down to it. ■ Even polar bears benefit from the abatement> of air pollution. These bears in the London Zoo have turned a whiter shade of white since the Clean Air Act came into force. 111111111111111 1\1\\S\\\\\\\\O"' Taming the AUTOMOBILE by Eric 0. Stork Acting Director, Bureau of Mobile Source Pollution Control, Air Pollution Control Office, Environmental Protection Agency of the United States of America The seeming vastness of our atmos- phere makes it difficult for many people to believe that we are in danger of running out of clean air. But we are. The earth's envelope of air is compa- ratively thin. About 95 per cent of the total air mass is concentrated in the first 12 miles above the earth's surface. And the portion that is used for breathing and for the disposal of wastes is yet a smaller part of that air envelope. In spite of daily and seasonal variations, the air supply for any particular area is basically fixed, and the ability of the atmosphere as a whole to dilute and disperse pollu- tants is limited. Polluted air constricts our throats and makes us sick. It debilitates and even kills some of us ahead of our time. It dirties our great cities, it robs of us of material goods and it deprives us of pleasures. Until recently, we did not notice what our developing technology was doing to our environment and, especially, to our air. It was not so much that we were immoral, but rather that we were uncon- cerned. In the United States of America, about half of all air pollution is caused by the operation of the transportation , system, and of that half the largest portion is contributed by passenger au- tomobiles. The principal pollutants emitted by automobiles and by other mobile sour- ces of air pollution are described in the list of pollutants selected by wHo for international study (see page 29). They are: Unburned hydrocarbons (HC) Carbon monoxide (CO) Oxides of nitrogen (NOx) Particulates, including lead salts The automobile pollution problem was first recognized in the state of California where, in the 1950's, the city of Los Angeles began to experience severe smog. The millions of people who had settled in that area found that the mild and pleasant climate they had come to enjoy was disappearing. After much study to pinpoint the causes of smog, California in 1963 required that new automobiles should be equipped with crankcase emission controls, and in 1966 imposed the first exhaust emission controls. Two years later, in 1968, the Federal Government decided that ex- haust emission controls should be fitted to all new automobiles; for 1970 model year cars, the standards were tightened, and again tightened for 1972 model year cars. In the USA, the latter will emit no more than 20 per cent of the HC and 31 per cent of the CO that was emitted from individual cars before the imposi- tion of exhaust controls. Since the early 1960's, all cars in the USA have been equipped with crankcase emission con- trols. Controls of the emission of NOx in car exhaust have been somewhat slower in coming. The state of California again took the lead by requiring such controls on new 1971 model year automobiles, and the Federal Government will apply a substantially stricter standard to all new cars sold in the USA beginning with the 1973 model year. It takes time to develop the needed control technology, to test it and get it operating in the ten million cars that are built for sale in the USA every year. Controls of particulate emissions have been considered, but not yet imposed. There are two reasons for this: (1) control techniques are not yet available; and (2) the particulate matter of greatest concern, and that constituting the lar- gest volume, is lead, and this may be reduced and eventually eliminated by controlling or prohibiting the addition of lead to fuel. Lead has long been added to gasoline as the cheapest way of increasing octane quality, which is the measure of knock-resistance. Recent reductions in the octane requirement of new cars, the probability that future cars will be made to run on unleaded gasoline to protect their more sophisticated emis- sion control systems, and the simple fact that it is possible to increase the octane rating of gasoline without using lead, all suggest that the lead particulate problem can be controlled more readily than was once thought possible. Further study is needed to determine whether the remain- ing particulate emissions would be of such importance as to require controls to be installed on vehicles. A recently enacted law will go far toward eliminating the air pollution caused by the automobile in the United States. Cars of the 1975 model will not be allowed to be sold in the United States if their emissions of HC and CO are more than 10 per cent of the levels for these pollutants allowed in 1970; and 1976 model year cars will, in addition, have to limit their emissions of NOx to 10 per cent of the level of that pollutant < To meet the draconian restrictions on air pollution, automobile companies have begun a series of tests and improvements. In Detroit, an automobile undergoes a battery of tests. Pipes leading from the exhaust collect the gases so that anti-pollution devices can be assessed. 39 emitted from the average car of the 1971 model year. These new requirements are great challenges to the automobile ma- kers. In case the automobile makers should find that it is not possible for them to clean up the almost universally used four-cycle reciprocating-piston internal combustion engine, the Government is supporting the development of alterna- tives. Several potentially low-pollution engines are being explored, including gas turbines, closed-cycle steam engines (Rankine cycle), all-electric vehicles, and various combinations of electric and heat engines. There is much international interest in such research. Last February, for exam- ple, a conference on the subject, attended by over a hundred representatives from twelve countries, was held at Eindhoven, Netherlands. Its purpose was to seek solutions to a problem that will sooner or later face all developed areas of the world. The -imposition of emission control requirements on new automobiles in the USA has also affected the automo- bile industry in other countries, since hundreds of thousands of cars are im- ported each year from France, the Fed- eral Republic of Germany, Italy, Japan, Sweden and the United Kingdom. Thus, even though automobile emission con- trol requirements are less strict in other countries, all of the major automobile makers the world over have gained experience in how to control emissions and are in a position to apply it to all their production. It is one thing to establish emission standards and quite another to make sure they are met. At the present time, such standards in the USA apply only to new automobiles; the Federal Govern- ment has no jurisdiction over the emis- sions of automobiles that are in use. The fifty states of the Union, which do have such authority, have not yet begun to use it to any significant extent. An automobile ceases to be new when it is sold to the first person who registers it for use on the highways, so for practical purposes only the manufacturers of au- tomobiles must meet the standards to- day. To make sure that they do so, each automobile manufacturer must make extensive tests of prototypes of the models that he plans to sell in the next model year, and must report the results to the Air Pollution Control Office of The public wants teeth put into anti-pollution measures. These young people are demons- trating in an "ecological protest" which coincided with the opening of the 19 71 New York Automobile Show. the Environmental Protection Agency. That Office itself makes tests of the prototype cars to check the results reported by the manufacturers. All pro- totype cars must be tested at 4,000 miles, the point at which the engine deposits have become well established, and some cars must be run for 50,000 miles with testing at frequent intervals to ensure that the emission control systems are durable. Only after these tests are com- pleted is the manufacturer given a Certi- ficate of Conformity for each car he proposes to sell. The manufacturer then has the obli- gation to produce cars that are substan- tially the same as the prototypes for which he received certificates. No vehicle may be sold in the USA if not covered by a Certificate of Conformity or if not substantially the same as the certificated prototype. There are severe penalties for violating that law. Surveillance of in-use vehicles during the past few years has shown that, in spite of the above procedures, significant numbers of cars on the road have higher emissions of pollutants than the stan- dards against which they were certified. On the average, however, the emissions are not much above the standards, and since the standards represent major re- ductions from the emission levels of uncontrolled vehicles, there is no doubt that much progress has been made. Still, these failures are a matter of concern about which something must be done. The first thing is to discover their causes. These can generally be traced by asking the following questions: Are production cars really sub- stantially the same as the proto- types? Are the cars in use maintained adequately? Are the durability test procedures really valid? On the first point, the Federal Gov- ernment will soon begin to require that cars be tested as they come off the assembly line, so that the public can be better assured that production vehicles meet the standards. On the second point, we can expect to see installed, at least in our major centres of population, man- datory systems for periodic testing of emission of pollutants; the owners of vehicles failing the test would not be allowed to continue to use them until the faults had been corrected. On the third A city street combines many forms of pollu- tion. Emissions from heating systems in New York contribute to the problem created by the internal combustion engine. moo 1\4., I • A t '1 The driver reads his instructions as he drives this new model automobile through a series of tests. The tests .fixed by US Federal law last twenty-three minutes and take the car for a run of seven and a half miles. While the driver runs through the tests, a recorder monitors the results. These include acceleration, deceleration, braking times, and amount and type of exhaust. A new way to use an old device. This is a car run on steam. The system has a long way to go before being adopted for mass production but holds some promise o reducing pollution. Under special conditions, nitrogen oxt and hydrocarbons produce smog. This ma- chine in Los Angeles measures the smog- producing elements. 1111111111111150 point, research will be conducted to find out why emission control systems fail over time and to discover how the conditions to which cars are subjected over their useful life can be simulated in the relatively short time available for durability testing. It is easier to decide that assembly line testing and in-use testing are needed than it is to put them into effect. One major difficulty is that there are as yet no simple, quick and cheap ways of measu- ring emissions. Emissions from a vehicle can be defined only in terms of what is measured by a standard test procedure. The standard test procedure comprises the use of certain specific instruments to measure the pollutants and of a driving cycle on a dynamometer that simulates the typical trip that a car makes. The full Federal test procedure for prototype cars is complicated, expensive and time consuming, and is impractical for use at the end of the assembly line or at an inspection lane for in-use vehicles. Much work is going forward at the present time to develop a less expensive, short-test procedure that can be used for such purposes and that comes up with results acceptably close to those obtained by the full test. We hope shortly to have such a short test so that testing of production cars can begin next year. When it comes to testing in-use cars, more work is needed. For such cars, it is not enough to discover that emissions are higher than the permitted level. Few if any mechanics today would know how to bring the emissions down to the standard allowed. Thus a cheap, quick and accurate diagnostic procedure is needed to provide the information the mechanic needs to repair the car. Work on such diagnostic procedures is also proceeding. Finally, it will be necessary to estimate the results that can be achieved by mandatory emission testing of all cars on the road. Preliminary studies have shown that the operation of such testing and maintenance systems, however they are carried out, will be very expensive. The key question then becomes one of cost-effectiveness: What on the average, is the dollar cost per ton of pollutant that is eliminated through inspec- tion/maintenance systems? Is that the The prototype of a new dual-bed catalytic converter system and exhaust gas recirculation system for exhaust emission control. It speeds up burning of exhaust and reduces air pollution. The photograph below shows the system installed in an automobile. As yet the system is still in the experimental stage. This machine is a NOOD (nitric oxide optical detector). It uses the luminescent principle to neasure nitric oxide in the atmosphere or in motor vehicle exhaust, and is far more reliable than instruments used previously to take such mea- surements. best way to spend scarce dollars, or are there other ways in which the same dollars can do more for clean air? These are the questions that our engineers and scientists are currently trying to answer. We are also working on more effective standards for heavy-duty vehicles, such as trucks and buses, both gasoline and diesel. We are trying to identify the chemical constituents of diesel odour as an essential first step towards the control of this particularly annoying pollutant. We are moving in the direction of establishing limits on the emissions that may come from aircraft, from off-high- way mobile equipment—in fact from all mobile sources that contribute signifi- cantly to air pollution and that can be controlled. In the last analysis, however, it seems clear that all of these efforts to clean up the engines that power our transporta- tion system may not be enough, unless there are unforseen technological break- throughs. The use of motor vehicles has grown and continues to grow with the increase in population. This is to be expected—everyone wants a car of his own. At some point in our population increase, however, our way of life may have to change, and it may no longer be possible for most Americans to commute from their homes to their jobs in their private cars. Even though the emissions from each car may have been reduced, the increase in numbers will bring the total emission levels up again. The ultimate answer, in our larger cities, will have to be some form of public trans- port which will cause less air pollution for each passenger-mile than the private automobile. That necessity of course, goes hand-in-hand with the need to reduce the traffic that chokes our streets and highways, even if it involves great public expenditure for mass-transit faci- lities. Cleaning the air will not be cheap. But it is not really the money that counts. Money is just the way we keep score. The real cost will be in terms of our not being able to continue to do some of the things we have become accustomed to doing. These are sacrifices that cannot be offset by getting a job that pays more money, at least for the vast majority of people. We hope, of course, that these non-financial costs can be held to a minimum, but whatever they are, we must accept them if we are to continue to have available to us the one resource that we all need every minute of our lives—healthful air. ■ Kwashiorkor is the African name for a disease of young children whose diet lacks protein. This African boy has the characteristic matchstick legs and swollen belly. around the world Tetanus—more vaccination needed Farmers, gardeners and others work- ing on the land are the group most susceptible to tetanus, an acute and often fatal disease caused by a bacillus commonly found in dust and dirt. The bacillus can enter the body through even a slight scratch, and indeed many people who contract the disease are not aware of having hurt themselves at all. Thirty cases of tetanus were reported in 1969 in Belgium, all of them in people who had not been vaccinated and most of them due to minor injuries to the hand or forearm. The disease is more frequent and more severe among the older age- groups: in Belgium, a quarter of the patients under 40 died, but among those over 40 the proportion of fatalities was three quarters. At present, though 85 per cent of all Belgian children have been protected by immunization against teta- nus, the only adults vaccinated as a routine measure are soldiers and certain categories of workers. Intensified vaccina- tion campaigns will be extended to those at greatest risk. Mental Health : a massive problem for India The number of people needing treat- ment for mental illness in India is so far in excess of the services available that there is no prospect of being able to cope with all of them for many years to come. Twenty-one people in every thousand of India's population are thought to be in need of hospitalization for mental illness, which means a potential total of 12 mil- lion patients. Yet there are hospital beds for only 10,000 and out-patient facilities for 40,000, with only 400 qualified psy- chiatrists for the entire country. The responsibility for dealing with many of those needing help for psychia- tric illness in India must for the time being inevitably fall on the general practitioner. Fortunately, there are now more effective methods of drug treat- ment available to the family doctor, so that he can deal with many of the serious WHO COMPETITION Numerous readers have requested that the closing date for entries to the wHo contest, which was pre- sented in the May issue of World Health, 1971, be extended. Conse- quently, the deadline is now 31 October 1971 instead of 30 August. Photo Credits L. SIRMAN PRESS, pp. 2, 5, 6, 10, 37 ©. WHO/J. MOHR, pp. 3, 8, 38, 40, 41, 42, 43, 44, 45. WHO/J. BREITENBACH, p. 4. WHO/PUBLIFOTO, pp. 7, 35. AGENCE JACANA, pp. 8, 9 ©. Y. DEBRAINE, pp. 10, 11 (). WHOA. KOCHAR, Back cover, pp. 12, 13, 14, 15, 16, 17. WHO/D. HENRIOUD, pp. 18, 19, 20, 21. WHO/P. LARSEN, Front cover, pp. 22, 23, 24, 25, 29. WHO/TAKAHARA, p. 27. WHO/K. HEmzo, p. 28. WHO/E. SCHWAB, pp. 30, 31. WHO/P. ALMASY, pp. 32, 33. WHOP. DAVIES, p. 36. wit°, p. 46. psychiatric illnesses which at one time were chronic and permanently disabling. In the long run, large-scale remedial mental health care will become a reality only after many years of steady increase in the teaching of psychiatry in medical schools. Though efforts are being made to increase the number of psychiatrists and mental hospital beds, they will not be adequate to deal with the need in the near future. Malaria protection for travellers The United States had 452 cases of imported malaria between 1963 and 1970 because people were ill-informed about the preventive measures they should take before travelling to tropical countries, according to the Malaria Sur- veillance Unit of the US Center for Disease Control. All of the 452 people who caught malaria had been to Africa. Most of them were tourists, but there were also missionaries, seamen and Pea- ce Corps volunteers among them. Eight- een people died, and there were many instances of very severe illness. All these cases were avoidable—a course of chlo- roquine tablets for one week before and until four weeks after a journey guaran- tees protection from malaria. An inves- tigation has revealed that only a small number of travel agencies give any warning to intending travellers of the risks they run in visiting malarious areas. Malnutrition—a continuing Over the past fifteen to twenty years, death rates for children have decreased dramatically in many developed coun- tries as standards of medical care, nutri- tion and sanitation have been improved. However, the situation in the developing countries is far from being so reassuring, and there are still places where 150-200 infants die out of every 1,000 born and where another 30 in every 1,000 will die before they reach the age of four. The factor most commonly implicated in these alarming statistics is malnutrition, a matter of grave concern to all those who are striving to improve the health and well-being of the underprivileged. More than a third of children under 14 in the developing countries do not have enough to eat. There are more than 267 million such children in the world, who as a consequence of the poor start they get in life will probably never catch up. They are the victims of a vicious circle, since malnutrition lowers their resistance to infectious diseases such as diarrhoea, and a large intestine damaged by infection can less easily assimilate protein, thus increasing the effects of the original malnutrition. Mental retarda- tion is also a hazard for such children. Brain development, which is rapid dur- ing the first months of life, depends largely upon a constant supply of pro- teins and is highly susceptible to dietary deficiency. A large proportion of chil- dren starting school at the age of seven in the developing countries are physically retarded by two to three years, and their psychological development and learning capacity are also likely to be lower than a normal child's elsewhere. WHO is collaborating with FAO and other agencies of the United Nations to try to improve the lot of these millions who begin life at a disadvantage. The immediate aim is to improve their basic nutritional status in the early years of life, principally by developing foods rich in protein and whose low cost will make them accessible to all. At the same time programmes of immunization and im- provement in sanitation are carried out to control infectious diseases, and pa- rents are educated in good nutritional habits which will maintain the child's resistance in future. Malnutrition is not a problem that can be solved in a few years, and the final and permanent answer to it must rest on raised stan- dards of living through social and eco- nomic development. ■ Technicians measure air pollution in India (see p. 12).