While climate change poses existential risks to human health and welfare, the public health research community has been slow to embrace the topic. This isn’t so much about a lack of interest as it is about the lack of dedicated funding to support research. An interesting contrast can be drawn with the field of air pollution and health, which has been an active and well-supported research area for almost fifty years. My own career journey started squarely in the latter setting in the 1980s, but transitioned to a major focus on climate and health starting around 2000. The journey has been punctuated with opportunities and obstacles, most of which still exist. In the meantime, a large body of evidence has grown on the health impacts of climate change, adding more urgency to the imperative for action. Institutionalization of climate and health within the federal regulatory and funding apparatus is now needed if we are to make the transition to zero carbon in ways that maximize health and equity benefits.
As a public health scientist with an interest in environmental factors affecting human health, there seem to be so many interesting problems to work on that one rarely finds the time to step back and ask, how did I get here? More personally, how did I make the transition from being a mainstream air pollution health scientist to one of the few public health researchers looking at climate change? Also, what opportunities and barriers molded my journey toward that outcome? These are questions I hadn’t given much thought to before agreeing to participate in the May 2018 Witnessing Professionals and Climate Change Workshop at Princeton University. I approach the questions that the conference posed from the perspective of my development as a public health scientist over a period in which the evidence for, and societal awareness of, climate change as an existential challenge grew exponentially from a very quiet beginning. Engagement by the public health field in the climate change discussion has grown proportionately, but remains surprisingly limited.
In many ways, the story of my career started in a small city in Pennsylvania. Donora is a steel town sitting low in the valley of the Monongahela River near Pittsburgh. October 27, 1948, was a foggy, smoggy Wednesday in Donora. In fact, the air was unusually thick even for Donora. The local steel mills and zinc smelter were spewing out noxious fumes as they always did. But on that Wednesday, the weather had changed in a way that made the pollution worse. A temperature inversion had formed over the valley. An inversion acts like a lid, preventing upward movement of pollutants emitted near the ground. Meanwhile, the hills ensured that nothing could move sideways either. As a result, pollution levels started to build up. By the next day, residents began to report severe respiratory problems. They were coughing and wheezing, and calling their doctors or trying to get to the hospital. There was no relief on Thursday, nor Friday. Pollution continued to build up. The air was so thick that driving became hazardous. Finally, on Sunday night, the rain came and cleared the air. However, during those few days when the air was unusually polluted, twenty of the town’s fourteen thousand residents had died. In the weeks following, another fifty people died of respiratory causes. And about half the town, around seven thousand people, complained of respiratory problems as a result of the smog.
The Donora experience caught the public and many health professionals by surprise. Until then, most people thought of pollution as a sign of economic development and progress. Sure, it was annoying and could make your eyes burn, but nobody really thought pollution could kill you. A few years later in London, in 1952, there was an even more severe air pollution disaster, brought on under similar meteorological conditions as in Donora, a temperature inversion. However, the pollution was different. In London, the culprit was coal combustion: residents and businesses in London burned coal to warm their homes and buildings. But because of the inversion, all that coal pollution got trapped over the city. And London had a much larger population than Donora, Pennsylvania. Based on an analysis of death records in London before, during, and after the episode, epidemiologists have estimated that over ten thousand people may have died from exposure to air pollution.
Like Donora, the 1952 London smog event drew a great deal of new attention to the health risks of air pollution from both the general public and policy-makers. This led in the following decade to the first regulations to limit air pollution levels in both the United Kingdom and the United States. In the United States, the Clean Air Act of 1963 called for setting National Ambient Air Quality Standards to protect human health, including for groups most sensitive to ill effects. The Clean Air Act also created new demands for knowledge generation, information systems, air quality planning and guidance, and air monitoring data. This soon evolved into a symbiotic regulatory-science ecosystem combining regulatory agencies, affected businesses, funding agencies, and academic researchers working together to clean the air. This would have profound and long-lasting impacts on the scientific and technical communities. And it was remarkably successful. Just since 1990, hourly sulfur dioxide concentrations decreased by nearly 90 percent; since 2000, average annual PM2.5 (particulate matter) concentrations have dropped by nearly 40 percent.
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