Key Concepts

After completing this chapter, you will be able to:

1. Describe the history of environmental policy in the United States and the role of different groups in shaping environmental policy.
2. Trace the basic elements of the sustainability paradigm through the evolution of U.S. environmental policy, including the National Environmental Policy Act of 1970.
3. Understand the role of risk management as modern environmental policy has been implemented.
4. Explain the problem-driven nature of policy development, from relatively local agricultural problems to regional problems often driven by industrial development to global problems associated with population-driven human consumption.
5. Understand what public health is, recognize public health impacts of non-sustainable development, and identify key public health impacts of climate change.

Introduction

It is not uncommon to think of the sustainability paradigm as being a recent interpretation of environmental policy, one that was given credence by the United Nations report “Our Common Future” (the Brundtland Report) when it was first presented in 1987. Certainly, the period during the final decade of the twentieth century was witness to significant growth in our understanding of the complexity and global reach of many environmental problems and issues. The Brundtland report gave a clear voice to these concerns through its analysis of human dependency and quality of life on ecological systems, social networks, and economic viability—systems that are closely intertwined and that require more integrated approaches to solving the many problems that confront humanity at this time. It is also true that it was among the first widely disseminated writings to define and use the modern meaning of the term “sustainable” through the often-quoted concept of “sustainable development.” However, it would be a mistake to conclude that sustainability as a mental construct and policy framework for envisioning the relationship of humans and nature came into being suddenly and at a single moment in time. Most environmental historians who have studied U.S. policy have discerned at least three distinct periods during which new concepts and ideas, scientific understandings, technological advances, political institutions, and laws and regulations came or were brought into being in order to understand and manage human impacts on the environment. These were (1) the American conservation movement, (2) the rise of environmental risk management as a basis for policy, and (3) the integration of social and economic factors to create what we now refer to as the sustainability paradigm. In this chapter we will explore the roots of modern sustainability (The American Conservation Movement), see how our thinking about the environment has shifted (Environmental Risk Management), and examine the ways that our environmental public policies have changed through time (Sustainability and Public Policy). Along the way it is important to understand that this has been an evolutionary process and that these environmental “eras,” while reflecting the norms, attitudes, and needs of the day, are still very much embodied within the modern concept of sustainability.

The American Conservation Movement

To most early colonists who immigrated to North America, for whom the concept of “wastage” had no specific meaning, the continent was a land of unimaginably vast resources in which little effort was made to treat, minimize, or otherwise manage. This is not surprising, when one stand of trees was consumed for housing or fuel, another was nearby; when one field was eroded to the point of limited fertility, expansion further inland was relatively simple; when rivers became silted so that fisheries were impaired, one moved further upstream; and when confronted with endless herds of wild animals, it was inconceivable that one might over-consume to the point of extinction. European-settled America was a largely agrarian society and, apart from the need to keep spaces productive and clear of debris, there was little incentive to spend time and energy managing discharges to the “commons.” These attitudes persisted well into the 19^th century and aspects of them are still active in the present day. While such practices could hardly be said to constitute an “environmental policy,” they did serve the purpose of constellating a number of groups into rethinking the way we went about managing various aspects of our lives, in particular our relationship to the land and the resources it contained or provided. As early as the mid-18^th century, Jared Eliot (1685-1763) of Connecticut, a minister, doctor, and farmer, wrote a series of treatises on the need for better farming methods.

He summarized:

When our fore-Fathers settled here, they entered a Land which probably never had been Ploughed since the Creation, the Land being new they depended upon the natural Fertility of the Ground, which served their purpose very well, and when they had worn out one piece they cleared another, without any concern to amend their Land…(Carman, Tugwell, & True, 1934, p. 29).

Although Eliot avidly instructed his fellow farmers on better methods of “field husbandry,” there is little evidence that his writings had a lasting effect (he is most known for advances in the design of the “drill plough,” an early planter that produced even rows of crops, increasing yields).

By 1850, the population of the United States was approaching 25 million and increasing at the rate of three to four percent per year (for comparison the population of England was about 26 million, of France 36 million, and Germany about 40 million). Although the westward migration across North America was well underway, most people still lived within a relatively narrow strip of land along the east coast. By modern measures the United States was not densely populated, and yet the perception of the country as “big” and on the international stage was in contrast to the mentality just a few decades before of a new world that had broken with the old, one of endless open spaces and inexhaustible resources. The country was also becoming more urbanized (about 15 percent of the population lived in cities, three times the proportion of just fifty years before), and increasingly literate.

Thus, by the mid-19^th century the American public was prepared to listen to the messages of various groups who had become concerned about the impacts of growth on society. Three groups, of considerably different sympathies and character, came to have profound influences on the way we thought of ourselves in relation to the environment, on our land use policies, and on providing environmental goods and services to the growing population: the “resource efficiency” group, the transcendentalist movement, and organized industrial interests.

Resource Efficiency

As typified by the concerns of Jared Eliot nearly a century before, there were always some who were alarmed at widespread agricultural practices that were wasteful, inefficient and, using the modern terminology, unsustainable. By the early 1800s the cumulative impacts of soil erosion and infertility, decreasing crop yields, and natural barriers to expansion such as terrain and poor transportation to markets led to an organized effort to understand the causes of these problems, invent and experiment with new, more soil-conserving and less wasteful practices, communicate what was being learned to the public, and begin to build government institutions to promote better stewardship of the land and its resources. Although initial conservation concerns were associated with farming, the same approach soon found its way into the management of forests and timbering, wastes from mining and smelting, and by the end of the century the control of human disease outbreaks (most commonly associated with cholera and typhoid) and the impact of chemical exposure on workers. There were many individuals who contributed to understanding the scientific underpinnings of the environment and educating practitioners: Eugene Hilgard (agricultural science), John Wesley Powell (water rights), George Perkins Marsh (ecological science), Franklin Hough and Gifford Pinchot (sustainable forestry), J. Sterling Morton (forestry and environmental education; co-founder of Arbor Day), Frederick Law Olmsted (landscape architecture), and Alice Hamilton (industrial hygiene), to name a few. These resource conservationists were instrumental in applying scientific methods to solving the problems of the day, problems that were rooted in our behavior toward the environment, and that had serious consequences for the well-being of people. It was as a result of these efforts that the basis for the fields of environmental science and engineering, agronomy and agricultural engineering, and public health was established. Over time these fields have grown in depth and breadth, and have led to the establishment of new areas of inquiry.

Just as importantly, several federal institutions were created to oversee the implementation of reforms and manage the government’s large land holdings. Legislation forming the Departments of the Interior (1849), and Agriculture (1862), the U.S. Forest Service (1881), the Geological Survey (1879), and the National Park Service (1916) were all enacted during this period. It was also the time when several major conservation societies, still active today, came into being: the Audubon Society (1886), the Sierra Club (1892), and the National Wildlife Federation (1935). Arbor Day was first celebrated in 1872, and Bird Day in 1894.

The Transcendental Movement

It is beyond the scope of this text to analyze in great depth the basis of the transcendental movement in America. It arose in the 1830s in reaction to the general state of culture and society, increasing urbanism, and the rigidity of organized religions of the time. It professed a way of thinking in which the individual’s unique relationship to their surroundings was valued over conformity and unreflective habits of living. But however philosophical its aims and ethereal its goals, transcendentalism had a profound connection to the natural environment; indeed, it is difficult to understand without reference to human-environmental interactions and a re-envisioning of the social contract of humanity with nature. Such were conditions at the time that transcendentalism resonated with an increasingly literate society, and became a major force in the further development of conservation as an accepted part of the American experience.

The acknowledged leader of the transcendental movement was Ralph Waldo Emerson (1803-1882). In his seminal essay Nature (1836), Emerson sets the tone for a new way of envisioning our relation to the natural world:

To speak truly, few adult persons can see nature. Most persons do not see the sun. At least they have a very superficial seeing. The sun illuminates only the eye of the man, but shines into the eye and the heart of the child. The lover of nature is he whose inward and outward senses are still truly adjusted to each other; who has retained the spirit of infancy even into the era of manhood. His intercourse with heaven and earth, becomes part of his daily food. In the presence of nature, a wild delight runs through the man, in spite of real sorrows. Nature says, — he is my creature, and maugre all his impertinent griefs, he shall be glad with me. Not the sun or the summer alone, but every hour and season yields its tribute of delight; for every hour and change corresponds to and authorizes a different state of the mind, from breathless noon to grimmest midnight. Nature is a setting that fits equally well a comic or a mourning piece. In good health, the air is a cordial of incredible virtue. Crossing a bare common, in snow puddles, at twilight, under a clouded sky, without having in my thoughts any occurrence of special good fortune, I have enjoyed a perfect exhilaration. I am glad to the brink of fear. In the woods too, a man casts off his years, as the snake his slough, and at what period so ever of life, is always a child. In the woods, is perpetual youth. Within these plantations of God, a decorum and sanctity reign, a perennial festival is dressed, and the guest sees not how he should tire of them in a thousand years. In the woods, we return to reason and faith. There I feel that nothing can befall me in life, — no disgrace, no calamity, (leaving me my eyes,) which nature cannot repair. Standing on the bare ground, — my head bathed by the blithe air, and uplifted into infinite space, — all mean egotism vanishes. I become a transparent eye-ball; I am nothing; I see all; the currents of the Universal Being circulate through me; I am part or particle of God. The name of the nearest friend sounds then foreign and accidental: to be brothers, to be acquaintances, — master or servant, is then a trifle and a disturbance. I am the lover of uncontained and immortal beauty. In the wilderness, I find something more dear and connate than in streets or villages. In the tranquil landscape, and especially in the distant line of the horizon, man beholds somewhat as beautiful as his own nature (Emerson, 1836).

Here Emerson makes clear that his connection to the “Universal Being” is made possible through communion with Nature, a creation so much greater than he that he sees his physical reality as “nothing,” but his true nature (i.e., his soul) becomes visible in the “tranquil landscape,” and the “distant line of the horizon.” Such metaphorical language was and remains a powerful reminder that our existence is dependent on the natural world, and that we mismanage the environment at our peril.

Yet, it is difficult to fully appreciate Emerson’s vision of humans and nature through language alone. As might be expected, the counter-reaction to the state of society and its attitudes toward the environment found expression in other media as well, in particular the rise of a cadre of American landscape artists. The camera had not yet been perfected, and of course there was no electronic media to compete for people’s attention, thus artists’ renditions of various scenes, especially landscapes, were quite popular. Image 15.1, Kindred Spirits, a rendering by A.B. Durand (1796-1886) of an artist and a poet out for a hike amid a lush forest scene captures much of the essence of transcendental thought, which had strongly influenced Durand’s style. The offset of the human subjects, to left-of-center, is purposeful: the main subject is nature, with humans merely a component. This theme carried through many of the landscapes of the period, and helped to define what became known, among others, as the “Hudson River School,” whose artists depicted nature as an otherwise inexpressible manifestation of God. This is further expressed in the painting, In the Heart of the Andes, by Frederic Church (Image 15.2). Here, the seemingly sole theme is the landscape itself, but closer inspection (see detail in red square) reveals a small party of people, perhaps engaged in worship, again offset and virtually invisible amid the majesty of the mountains.

Image 15.1. Kindred Spirits. The painting, dated 1849, depicts the artist, Thomas Cole, and poet, William Cullen Bryant. Source: “Kindred Spirits” by Asher Brown Durand via Wikimedia Commons is licensed under CC0 1.0.

Image 15.2. In the Heart of the Andes. The painting, dated 1859, depicts a majestic landscape and closer inspection reveals a small party of people near the bottom left. Source: “The Heart of the Andes” by Frederic Edwin Church via Wikimedia Commons is licensed under CC0 1.0.

Other notable contributors to the transcendental movement were Henry David Thoreau (1817-1862), abolitionist and author of Walden and Civil Disobedience, Margaret Fuller (1810-1850), who edited the transcendental journal “The Dial” and wrote Woman in the Nineteenth Century, widely considered the first American feminist work, and Walt Whitman (1819-1892) whose volume of poetry Leaves of Grass celebrates both the human form and the human mind as worthy of praise.

It is important to recognize that the transcendental redefinition of our social contract with the environment was holistic. Within it can be found not only a new appreciation of nature, but also the liberation of the human mind from convention and formalism, attacks on slavery, the need for racial equality, concern for universal suffrage and women’s rights, and gender equity. In many ways it was a repositioning of the ideals of the enlightenment that had figured so prominently in the founding documents of the republic. These social concerns are represented today within the sustainability paradigm in the form of such issues as environmental justice, consumer behavior, and labor relations.

Transcendentalism as a formal movement diminished during the latter half of the 19^th century, but it had a far-reaching influence on the way society perceived itself relative to the environment. Perhaps no one is more responsible for translating its aspirations into environmental public policy than John Muir (1838-1914), a Scottish-born immigrant who was heavily influenced by Emerson’s writings (it is said that the young Muir carried with him a copy of Nature from Scotland). The two first met in 1871 during a camping trip to the Sierra Mountains of California. Upon learning of Emerson’s planned departure, Muir wrote to him on May 8, 1871 hoping to convince him to stay longer, “I invite you join me in a months worship with Nature in the high temples of the great Sierra Crown beyond our holy Yosemite. It will cost you nothing save the time & very little of that for you will be mostly in Eternity” (Chou, 2003).

Muir was a naturalist, author, organizer (founder of the Sierra Club), and as it turns out a remarkably effective political activist and lobbyist. His association with Theodore Roosevelt (1858-1919, 26^th president of the United States), began with a 1903 campaign visit by Roosevelt to California, where he specifically sought out Muir, whose reputation was by then well known, as a guide to the Yosemite area (see Image 15.3).

Image 15.3. Roosevelt and Muir. Theodore Roosevelt and John Muir at Yosemite National Park in 1906. Source: “Theodore Roosevelt and John Muir 1906” via Wikimedia Commons is licensed under CC0 1.0.

It was one of Muir’s special talents that he could bridge across their rather different views on the environment (he a strict preservationist, Roosevelt a practical outdoorsman). By all accounts they had frank but cordial exchanges; for example, upon viewing the giant Sequoias, Muir remarked to Roosevelt, “God has cared for these trees…but he cannot save them from fools – only Uncle Sam can do that.” Roosevelt was so taken with his companion that he insisted they avoid political crowds and camp together overnight in the mountains.

The subsequent legacy of the Roosevelt administration in the name of conservation, even by today’s standards, was significant. Known as the “conservation president,” Roosevelt was responsible for 225 million acres of land added to the U.S. Forest Service, and the creation of 50 wildlife refuges and 150 national forests representing, in total, 11 percent of the total land area of the 48 contiguous states.

The Role of Industry

Today the behavior of industry toward the environment is often portrayed as either indifferent or hostile, whether true or not, and it was no different during the formative period of American conservation. The industries of the day – agriculture, timber, and mining – enabled by the major transportation sector – railroads and steamboats – had little incentive to manage their emissions to the environment responsibly, or to use natural resources wisely. Regulations were few, the science underpinning environmental impacts was nascent, the commons itself was viewed as essentially infinite, and however misguided, exploitation of resources and the generation of a certain amount of waste was seen as a necessary byproduct of expansion, job creation, and social well-being. And yet, as human-created organizations go, industries are extraordinarily sensitive to economic conditions. If the sustainability paradigm is to be believed, then economic viability is of paramount concern and the engagement of industrial forces must of necessity be part of its enactment. These are the engines that provide employment, and that control large quantities of capital for investment. Further, viewed from the life cycle perspective of the flow of materials, products that turn raw materials into mostly waste (defined here as a quantity of material that no one values, as opposed to salable products) are simply inefficient and reduce profitability.

As noted in Resource Efficiency above, industrial activities during this time were responsible for significant environmental degradation. Policy reformers of the day, such as Carl Schurz (as secretary of the Interior) turned their attention in particular to land reforms, which impacted the expansion of railroads, and forest preservation. And yet, industry played an unquestionable role as enablers of societal shifts occurring in America by making goods and services available, increasing the wealth of the emerging middle class, and in particular providing relatively rapid access to previously inaccessible locations – in many cases the same locations that preservationists were trying to set aside. Reading, hearing stories about, and looking at pictures of landscapes of remote beauty and open spaces was alluring and stirred the imagination, but being able to actually visit these places firsthand was an educational experience that had transformative powers. Alfred Bierstadt’s The Oregon Trail (Image 15.4), painted in 1868, depicts the westward migration of settlers via wagon trains, on horseback, and simply walking – a journey, not without peril, that took about six months. The next year saw the completion of the transcontinental railroad, and within a few years it became possible to complete the same journey in as little as six days in comparative comfort and safety.

Image 15.4. The Oregon Trail. The painting, dated 1869, depicts the westward migration of settlers via wagon trains, on horseback, and by foot. Source: “Oregon Trail” by Albert Bierstadt via Wikimedia Commons is licensed under CC0 1.0.

The movement to designate certain areas as national parks is an illustrative example of the role of industry in promoting land conservation, thereby setting in motion subsequent large conservation set-asides that reached their zenith during the Roosevelt administration. It began, in 1864, with the efforts of several California citizens to have the U.S. Congress accept most of Yosemite, which had been under the “protection” of the State of California as a national preserve. The petition cited its value “for public use, resort, and recreation,” reasoning that already reflected the combined interests of the resource efficiency group, preservationists, and business opportunists. Frederick Law Olmsted (1822-1903), the landscape architect most well known for the design of New York’s Central Park, and an ardent believer in the ability of open spaces to improve human productivity, oversaw the initial efforts to manage the Yosemite area. Although the effort was infused with renewed vigor after John Muir’s arrival in the late 1860s, it wasn’t until 1906 that the park was officially designated.

In the meantime, similar interests had grown to name Yellowstone as a national park, with the same basic justification as for Yosemite. Since there were no states as yet formed in the region the pathway was more straightforward, and was made considerably easier by the lack of interest by timber and mining companies to exploit (the area was thought to have limited resource value), and the railroads who, seeing potential for significant passenger traffic, lobbied on its behalf. Thus the first national park was officially designated in 1872, only three years after the completion of the transcontinental railroad. Indeed, in relatively rapid succession the Union Pacific Railroad got behind the Yosemite efforts, and the Northern Pacific Railroad lobbied heavily for the creation of parks at Mount Rainier (1899) and Glacier (1910). By 1916, when the National Park Service was formed, sixteen national parks had been created. States too began to see value in creating and, to a degree, preserving open spaces, as evidenced by New York’s Adirondack Park (1894), still the largest single section of land in the forty-eight contiguous states dedicated to be “forever wild.”

Results of the American Conservation Movement

With the advent of the First World War, and subsequent political, social, and economic unrest that lasted for another thirty years, actions motivated by the conservation movement declined. The coalition between the resource efficiency group and those wishing to preserve nature, always uncomfortable, was further eroded when it became clear that the main reason Congress was “setting aside” various areas was mainly to better manage commercial exploitation. And yet, the period from 1850 to 1920 left a remarkable legacy of environmental reform, and laid the foundation for future advances in environmental policy. In summary, the conservation movement accomplished the following:

• Redefined the social contract between humans and the environment, establishing a legacy of conservation as part of the American character, and a national model for the preservation of natural beauty.
• Invented the concept of national parks and forests, wildlife refuges, and other sites for commercial and recreational uses by society.
• Developed the first scientific understanding of how the environment functioned, integrating the scientific approach to resource management into government policy.
• Pioneered technological practices to improve resource management.
• Established the major federal institutions with responsibility for land and resource conservation.
• Communicated the impact of pollution on human health and welfare.
• Through publications and travel, exposed many to the beauty of the natural environment and the consequences of human activities.
• Finally, although sustainability as a way of envisioning ourselves in relation to the environment was still many years away, already its three principal elements, imperfectly integrated at the time, are seen clearly to be at work.

Environmental Risk Management

General Definitions

For most people, the concept of risk is intuitive and, often, experiential; for instance most people are aware of the considerably greater likelihood of suffering an injury in an automobile accident (116/100 million vehicle miles) versus suffering an injury in a commercial airplane accident (0.304/100 million airplane miles). Environmental risk can be defined as the chance of harmful effects to human health or to ecological systems resulting from exposure to any physical, chemical, or biological entity in the environment that can induce an adverse response. Environmental risk assessment is a quantitative way of arriving at a statistical probability of an adverse action occurring. It has four main steps:

1. Identification of the nature and end point of the risk (e.g. death or disability from hazardous chemicals, loss of ecological diversity from habitat encroachment, impairment of ecosystem services, etc.)
2. Development of quantitative methods of analysis (perturbation-effect, dose-response)
3. Determination of the extent of exposure (i.e. fate, transport, and transformation of contaminants to an exposed population), and
4. Calculation of the risk, usually expressed as a statistical likelihood.

Risk management is distinct from risk assessment, and involves the integration of risk assessment with other considerations, such as economic, social, or legal concerns, to reach decisions regarding the need for and practicability of implementing various risk reduction activities. Finally, risk communication consists of the formal and informal processes of communication among various parties who are potentially at risk from or are otherwise interested in the threatening agent/action. It matters a great deal how a given risk is communicated and perceived: do we have a measure of control, or are we subject to powerful unengaged or arbitrary forces?

The Beginnings of Modern Risk Management

The beginnings of environmental risk management can be traced to the fields of public health, industrial hygiene, and sanitary engineering, which came into prominence in the latter decades of the 19^th century and beginning of the 20^th. The spread of disease was a particularly troublesome problem as the country continued to urbanize. For instance if you lived your life in, say, Chicago during the period 1850-1900 (a typical lifespan of the day), you had about a 1 in 100 chance of dying of cholera (and a 1 in 2000 chance of dying of typhoid), of which there were periodic epidemics spread by contaminated drinking water. Chicago’s solution was to cease polluting its drinking water source (Lake Michigan) by reversing the flow of its watercourses so that they drained into the adjacent basin (the Mississippi). The widespread chlorination of municipal water after 1908 essentially eliminated waterborne outbreaks of disease in all major cities (with some notable exceptions—the outbreak of chlorine-resistant Cryptosporidium parvum in Milwaukee’s drinking water in 1993 resulted in the infection of 403,000 people with 104 deaths).

Parallel work on the effects of chemical exposure on workers (and poor working conditions in general) were pioneered by Alice Hamilton (1869-1970), who published the first treatise on toxic chemical exposure “Industrial Poisons in the United States” in 1925. Hamilton is considered the founder of the field of occupational health. In 1897 she was appointed professor of pathology at the Women’s Medical School of Northwestern University, and in 1902 she accepted the position of bacteriologist at the Memorial Institute for Infectious Diseases in Chicago. Dr. Hamilton joined Jane Addams’s Hull House, in Chicago, where she interacted with progressive thinkers who often gravitated there, and to the needs of the poor for whom Hull House provided services.

Environmental Contamination and Risk

Events during the period 1920-1950 took an unfortunate turn. Global conflicts and economic uncertainty diverted attention from environmental issues, and much of what had been learned during the previous hundred years, for example about soil conservation and sustainable forestry, ceased to influence policy, with resultant mismanagement on a wide scale (see Image 15.5).

Image 15.5. Texas Dust Storm. Photograph shows a dust storm approaching Stratford, TX in 1935. Source: NOAA.

In the aftermath of the World War II, economic and industrial activity in the United States accelerated, and a consumer-starved populace sought and demanded large quantities of diverse goods and services. Major industrial sectors, primary metals, automotive, chemical, timber, and energy expanded considerably; however there were still few laws or regulations on waste management, and the ones that could and often were invoked (e.g. the Rivers and Harbors Act of 1899, which prohibits the construction of any bridge, dam, or causeway over or in U.S. navigable waters without Congressional approval) were devised in earlier times for problems of a different nature. Here we recount the circumstances that eventually resulted in the promulgation of environmental risk as a basis for public policy, with subsequent passage of major environmental legislation.

If there were any doubts among American society that the capacity of the natural environment to absorb human-caused contamination with acceptably low risk was indeed infinite, these were dispelled by a series of well-publicized incidents that occurred during the period 1948-1978. Image 15.6 Zinc Smelter shows a local smelter in a small valley town in Pennsylvania with, essentially, uncontrolled emissions. During periods of atmospheric stability (an inversion, see Chapter 20), contaminants became trapped, accumulated, and caused respiratory distress so extraordinary that fifty deaths were recorded. Image 15.7 illustrates the dramatically poor air quality, in the form of reduced visibility, during this episode. Such incidents were not uncommon, nor were they limited to small American towns. A well-documented similar episode occurred in London, England in 1952 with at least 4000 deaths, and 100,000 illnesses resulting.

Image 15.6. Zinc Smelter. Photograph shows a local smelter in a small valley town in Pennsylvania with, essentially, uncontrolled emissions. Source: The Wire Mill, Donora, PA, taken by Bruce Dresbach in 1910. Source: Library of Congress.

Image 15.7. Noon in Donora. Photograph, dated October 29, 1948, illustrates the extremely poor air quality in the Pennsylvania town at the time. Source: NOAA.

The generally poor state of air quality in the United States was initially tolerated as a necessary condition of an industrialized society. Although the risks of occupational exposure to chemicals was becoming more well known, the science of risk assessment as applied to the natural environment was in its infancy, and the notion that a polluted environment could actually cause harm was slow to be recognized, and even if true it was not clear what might be done about it. Nevertheless, people in the most contaminated areas could sense the effects of poor air quality: increased incidence of respiratory disease, watery eyes, odors, inability to enjoy being outside for more than a few minutes, and diminished visibility.

Environmental degradation of the era was not limited to air quality. Emissions of contaminants to waterways and burial underground were simple and common ways to dispose of wastes. Among the most infamous episodes in pollution history were the periodic fires that floated through downtown Cleveland, Ohio on the Cuyahoga River, causing considerable damage (Image 15.8), and the discovery of buried hazardous solvent drums in a neighborhood of Niagara Falls, NY in 1978, a former waste disposal location for a chemical company.

Image 15.8. Cuyahoga River Fire, 1969. Photograph illustrates a 1969 fire on the Cuyahoga River, one of many fires during the time period. Source: NOAA.

Risk Management as a Basis for Environmental Policy

Environmental scientists of the day were also alarmed by the extent and degree of damage that they were documenting. The publication of Silent Spring in 1962 by Rachel Carson (1907-1964), about the impact of the widespread and indiscriminate use of pesticides, was a watershed moment, bringing environmental concerns before a large portion of the American, and global, public. Carson, a marine biologist and conservationist who initially worked for the U.S. Bureau of Fisheries, became a full-time nature writer in the 1950s. She collected scientifically documented evidence on the effects of pesticides, particularly DDT, heptachlor, and dieldrin, on humans and mammals, and the systemic disruption they caused to ecosystems. Silent Spring is credited with bringing about a ban on the use of DDT in the United States, and setting in motion a chain of events that would ultimately result in the transformation of environmental public policy from one based on the problems and attitudes that brought about nineteenth century conservation, to one based on the management of risks from chemical toxins. The U.S. Environmental Protection Agency was established in 1970, just eight years after the publication of Silent Spring. The same year Earth Day was created.

The National Environmental Policy Act of 1970 (NEPA) provides a legal basis for U.S. environmental policy, and lays out its terms clearly and unambiguously. NEPA established a national goal to create and maintain “conditions under which [humans] and nature can exist in productive harmony, and fulfill the social, economic and other requirements of present and future generations of Americans [emphasis added]” (NEPA, 1970). Further, NEPA saw the need for long term planning, to “fulfill the responsibilities of each generation as trustee of the environment for succeeding generations,” for equity “to assure for all Americans safe, healthful, productive, and esthetically and culturally pleasing surroundings,” and for economic prosperity as we “achieve a balance between population and resource use that will permit high standards of living and a wide sharing of life’s amenities” (NEPA, 1970). Although the exact word “sustainable” does not appear, NEPA is in all major respects congruent with the goals of the Brundtland Report (written 17 years later), retains the character of American conservation, and anticipates the need to integrate environmental quality with social and economic needs.

NEPA is considered one of the foundational pieces of environmental policy that provides the opportunity for citizens to be involved and participate in the assessment of federal agencies’ environmental impacts. Read through this Citizen’s Guide to NEPA to understand the NEPA process, Environmental Impact Statements (EISs), and how citizens can be involved in the policy process.

Every four to six years the U.S. EPA releases its Report on the Environment, a collection of data and analysis of trends on environmental quality. It is quite comprehensive; reporting on an array of measures that chart progress, or lack thereof, on human impacts on the environment and, in turn, the effects of our actions on human health. It is difficult to summarize all the information available in a concise way, however most measures of human exposure to toxic chemicals, dating in many cases back to the late 1980s, show clear downward trends, in some cases dramatically so (for example DDT in human tissues, lead in blood serum, exposure to hazardous wastes from improper disposal, exposure to toxic compounds emitted to the air). In addition, many of other indicators of environmental quality such as visibility, drinking water quality, and the biodiversity of streams, show improvement. These are success stories of the risk management approach to environmental quality. On the other hand, other measures, such as hypoxia in coastal waters, quantities of hazardous wastes generated, and greenhouse gases released are either not improving or are getting worse.

Sustainability and Public Policy

Complex Environmental Problems

NEPA, both in tone and purpose, was in sharp contrast to the many environmental laws that followed in the 1970s and 1980s that defined increasingly proscriptive methods for controlling risks from chemical exposure (this is sometimes termed the “command-and-control” approach to environmental management). In many ways these laws and regulations are ill-suited to the types of environmental problems that have emerged in the past twenty years. Whereas the focus of our environmental policy has been on mitigating risk from local problems that are chemical – and media – (land, water, or air) specific, the need has arisen to address problems that are far more complex, multi-media, and are of large geographic, sometimes global, extent.

An early example of this type of shift in the complexity of environmental problems is illustrated by the phenomenon of acidic rainfall, a regional problem that occurs in many areas across the globe. Although the chemical cause of acid rain is acidic gases (such as sulfur dioxide and nitrogen oxides) released into the atmosphere from combustion processes (such as coal burning), the problem was made considerably worse because of the approach to problem solving typical of the day for episodes such as the Donora disaster (see Images 26.6 and 26.7).

In order to prevent the local accumulation of contaminants, emission stacks were made much taller, effectively relying on the diluting power of the atmosphere to disperse offending pollutants. The result was a significant increase in the acidity of rainfall downwind of major sources, with associated impacts on aquatic and forest resources. Figure 15.1 shows this pattern for the eastern U.S. in 2000. A more comprehensive solution to this problem (short of replacing coal as a fuel source), has involved integrated activity on many fronts: science to understand the impacts of acid rain, technology to control the release of acidic gases, politics in the form of amendments to the Clean Air Act, social equity that defined the role of regional responsibilities in the face of such large geographic disparities, and economics to understand the total costs of acid rain and design markets to spread the costs of control. Although acidic rainfall is still an issue of concern, its impacts have been mitigated to a significant degree and pH levels in rainwater in the eastern U.S. have been rising (Figure 15.2).

Figure 15.1. Hydrogen Ion Concentrations as pH of Precipitation for 2000. Depicted is the distribution in rainfall pH in the United States for the year 2000. Source: Source: National Atmospheric Deposition Program/National Trends Network.

Figure 15.2. Hydrogen Ion Concentrations as pH of Precipitation for 2019. Depicted is the distribution in rainfall pH in the United States for the year 2019. Source: National Atmospheric Deposition Program/National Trends Network.

Sustainability as a Driver of Environmental Policy

The level of complexity illustrated by the acid rain problem can be found in a great many other environmental problems today, among them:

• Hypoxic conditions in coastal regions of the world caused by excessive release of nutrients, principally dissolved nitrogen and phosphorous from artificial fertilizer applied to crops (in addition to the Gulf of Mexico and Chesapeake Bay in the United States, there are over 400 such areas worldwide)
• Stratospheric ozone depletion caused by the release of certain classes of chlorofluorocarbon compounds used as propellants and refrigerants (with increases in the incident of skin cancers and cataracts)
• Urbanization and sprawl, whereby the population density in urban areas, with its attendant problems (degradation of air and water quality, stormwater management, habitat destruction, infrastructure renewal, health care needs, traffic congestion, loss of leisure time, issues of social equality), continues to grow (for example eighty percent of the population of the United States, about fifty percent of global, now lives in urban regions)
• Global climate change, and its resultant impacts (increases in temperature and storm and flooding frequency, ocean acidification, displacement of human populations, loss of biodiversity, sea-level rise), caused by the human-induced emission of greenhouse gases

Problems such as these, which require highly integrated solutions that include input from many disciplines and stakeholders, have been termed “wicked” (Batie, 2008; Kreuter, DeRosa, Howze, & Baldwin, 2004). Wicked problems have certain key characteristics:

• There is not universal agreement on what the problem is – different stakeholders define it differently.
• There is no defined end solution, the end will be assessed as “better” or “worse.”
• The problem may change over time.
• There is no clear stopping rule – stakeholders, political forces and resource availability will make that determination on the basis of “judgments.”
• The problem is associated with high uncertainty of both components and outcomes.
• Values and societal goals are not necessarily shared by those defining the problem or those attempting to make the problem better.

Wicked problems are not confined to environmental issues, for example the same characteristics arise for problems such as food safety, health care disparities, and terrorism, but in the context of environmental policy they create the need to reassess policy approaches and goals, laws and regulations, as well as methods and models for integrated research.

Table 15.1 summarizes the major attributes of U.S. environmental policy as it has evolved over the past two centuries. To most observers it would seem to be true that advances in public policy, in any realm, are driven by problems, real and perceived, that require systemic solutions. Environmental policy is no exception. Early conservationists were alarmed at the inefficiencies of human resource management and the encroachment of humans on unspoiled lands. During the 20^th century many groups: scientists, economists, politicians, and ordinary citizens, became alarmed and fearful of the consequences of toxic pollutant loads to the environment that included localized effects on human health and well-being. And now, as we proceed into the 21^st century, an array of complex problems that have the potential to alter substantially the structure and well-being of large segments of human societies, calls for a renewal and reassessment of our approach to environmental policy. This has, thus far, proven to be a difficult transition. Many of these complex problems have multiple causes and impacts, affect some groups of people more than others, are economically demanding, and are often not as visibly apparent to casual observers as previous impacts, nor are the benefits perceived to be commensurate with costs. Devising a regulatory strategy for such problems requires an adaptive and flexible approach that current laws do not foster.

Table 15.1 The Evolution of U.S. Environmental Policy. A summary of the major attributes of U.S. environmental policy as it has evolved over the past two centuries. Source: T. Theis adapted from Fiksel, Graedel, Hecht, Rejeski, Saylor, Senge, et al. (2009).

Public Health and Sustainability

“Much discussion about sustainability treats the economy, livelihoods, environmental conditions, our cities and infrastructure, and social relations as if they were ends in themselves; as if they are the reason we seek sustainability. Yet their prime value is as the foundations upon which our longer-term health and survival depend.” (McMichael, 2006)

Ecological sustainability is more than just continuing the resource flows of the natural world to sustain the economic machine, while maintaining diversity of species and ecosystems. It is also about sustaining the vast support systems for health and life which could be considered the real bottom line of sustainability. Before examining the public health effects of non-sustainable development, we should define public health.

• The website for UIC’s School of Public Health says “we are passionate about improving the health and well-being of the people of Chicago, the state of Illinois, the nation and the world.”
• The Illinois Department of Public Health is responsible for protecting the state’s 12.4 million residents, as well as countless visitors, through the prevention and control of disease and injury.”
• The New Zealand Ministry of Health defines it as “the science and art of promoting health, preventing disease and prolonging life through organized efforts of society.”
• The National Resources Defense Council an NGO devoted to environmental action, states that public health is “the health or physical well-being of a whole community.”

Impacts of Non-Sustainable Development

We have built our communities in ways that are unsustainable from many aspects. Not only does development create urban sprawl, impact land use, and fuel consumption, we can identify negative health consequences related to these development trends.

Obesity

If our communities are not walkable or bikeable, we need to drive to schools, shops, parks, entertainment, play dates, etc. Thus we become more sedentary. A sedentary lifestyle increases the risk of overall mortality (2 to 3-fold), cardiovascular disease (3 to 5-fold), and some types of cancer, including colon and breast cancer. The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking (Wei et al., 1999; Blair et al., 1996).

Economic Segregation

Walkable and safe communities provide sidewalks, bike paths, proximity, and connections to community services such as grocery stores, schools, health care, parks, and entertainment. Community design that creates a segregated housing environment with only expensive housing and no affordable housing segregates people by socio-economic level (i.e. poor from non-poor) and this generally leads to segregation by race. Lack of physical activity will occur in neighborhoods with no good green and safe recreational sites. If we have poor public transit systems partly due to lack of density (only more expensive, low-density housing) and our love of the automobile, then we have increased emissions that contribute to global warming.

The Olympics as an Example

A natural experiment during the 1996 Summer Olympic Games in Atlanta shows the impact of car use on health. During the games, peak morning traffic decreased 23% and peak ozone levels decreased 28%. Asthma-related emergency room visits by children decreased 42% while children’s emergency visits for non-asthma causes did not change during same period (Friedman, Powell, Hutwagner, Graham, & Teague, 2001). We also saw that with the Beijing Olympics in 2008 where driving days were rationed, more than 300,000 heavy-emitting vehicles (about 10% of total) were barred from the city’s administrative area in order to decrease pollution for athletes and visitors This reduced the number of vehicles by about 1.9 million or 60% of the total fleet during the Olympic Games. Emissions of black carbon, carbon monoxide and ultrafine particles were reduced by 33%, 47%, and 78% respectively compared to the year before the Olympics. Frequency of respiratory illnesses during the 2008 games were found to be significantly less in certain populations compared to previous years and this was hypothesized to be related to the reduction of vehicles on the road (Wang et al., 2009; Jentes et al., 2010). Figure 15.3 shows the average time Americans spend walking a day. People who walk to and from public transit get a fair amount of physical activity related to using transit, thus the name given to modes of transit that do not involve driving: active transit. Those people who did not own a car or were not a primary driver had higher walking times (Besser & Dannenberg, 2005).

Figure 15.3 Minutes Americans Walk per Day. Source: National Household Travel Survey, 2001, USDOT.

Water Quality

Increasing numbers of roads and parking lots are needed to support an automobile transportation system, which lead to increased non-point source water pollution and contamination of water supplies (road runoff of oil/gas, metals, nutrients, organic waste, to name a few) with possible impacts on human health. Increased erosion and stream siltation causes environmental damage and may affect water treatment plants and thus affect water quality.

Social Capital

On the social sustainability side, we can look at social capital otherwise defined as the “connectedness” of a group built through behaviors such as social networking and civic engagement, along with attitudes such as trust and reciprocity. Greater social capital has been associated with healthier behaviors, better self-rated health, and less negative results such as heart disease. However, social capital has been diminishing over time. Proposed causes include long commute times, observed in sprawling metropolitan areas. Past research suggests that long commute times are associated with less civic participation; Robert Putnam suggests that every ten additional minutes of commuting predicts a 10% decline in social capital (Besser, Marcus, & Frumkin, 2008). Urban sprawl, where urban areas of housing, commercial development, and infrastructure increase around the areas of a city unrestricted, is considered the reason for most long commutes.

As of 2011, Chicago commuting times are some of the worst – with Chicagoans spending 70 hours per year more on the road than they would if there was no congestion – up from 18 hours in 1982. They have an average commute time of 34 minutes each way. These drivers also use 52 more gallons per year per commuter, increasing their costs and pollution (Hilkevitch, 2018).

Residents of sprawling counties were likely to walk less during leisure time, weigh more, and have greater prevalence of hypertension than residents of compact counties (Ewing, Schmid, Killingsworth, Zlot, & Raudenbush, 2003).

While more compact development is found to have a negative impact on weight, we also find that individuals with low BMI are more likely to select locations with dense development. This suggests that efforts to curb sprawl, and thereby make communities more exercise-friendly, may simply attract those individuals who are predisposed to physical activity (Plantinga & Bernell, 2007).

Impacts of Climate Change

Public health studies have been conducted with regard to many of the predicted environmental effects of climate change. Thus, it is somewhat easier to examine the public health implications of this outcome of unsustainable behavior. Figure 15.4 describes the pathways by which climate change affects public health. To the left we see the natural and anthropogenic, or human-caused activities that affect climate change, which result in climatic conditions and variability; if we can mitigate those events we can reduce climate change. These activities first result in environmental impacts such as severe weather events, disturbed ecosystems, sea-level rise, and overall environmental degradation. Those impacts can then result in a broad range of health effects that we can adapt to, to a certain extent. These impacts are generally categorized into three areas: heat induced morbidity and mortality, infectious diseases, and impacts due to the effect of extreme weather such as flooding and drought on the social welfare of the population.

Figure 15.4. How Climate Change Affects Population. This Diagram summarizes the main pathways by which climate change affects population health. Source: Created by Cindy Klein-Banai, based on McMichael et al., 2006.

Measurement of health effects from climate change can only be very approximate. One major study, by the World Health Organization (WHO), was a quantitative assessment of some of the possible health impacts that looked at the effects of the climate changes since the mid-1970s and determined that this may have resulted in over 150,000 deaths in 2000. The study concluded that the effects will probably grow in the future (World Health Organization, 2009).

Extreme Weather

Climate change can influence heat-related morbidity and mortality, generally a result of the difference between temperature extremes and mean climate in a given area. Higher temperatures in the summer increase mortality. Studies on the effects of heat waves in Europe indicate that half of the excess heat during the European heat wave of 2003 was due to global warming and, by inference, about half of the excess deaths during that heat wave could be attributed to human-generated greenhouse gas emissions (see Haines, Kovats, Campbell-Lendrum, & Corvalan, 2006; Hellmann, Lesht, & Nadelhoffer, 2007; McMichael, 2006). Urban centers are more susceptible due to the urban heat island effect that produces higher temperatures in urban areas as compared to the near-by suburbs and rural areas. Lack of vegetation or evaporation, and large areas of pavement, in cities result in an “Urban Heat Island,” where urban areas are warmer than the neighboring suburban and rural areas (See Figure 15.5). Adaptation can help reduce mortality through greater prevention awareness and by providing more air-conditioning and cooling centers.

Figure 15.5. Sketch of an Urban Heat-Island Profile. Source: Heat Island Group.

The reduction of extreme cold due to global warming, could reduce the number of deaths due to low temperatures. Unlike for heat, those deaths are usually not directly related to the cold temperature itself but rather to influenza. Also, deaths related to cold spells would increase to a lesser extent by (1.6%), while heat waves increase them by 5.7%.

Since volatile organic compounds (VOCs) are precursors of ozone, and VOC emissions increase with temperature, this could lead to an increase in ozone concentrations. For fifteen cities in the eastern United States, the average number of days exceeding the health-based eight-hour ozone standard is projected to increase by 60 percent (from twelve to almost twenty days each summer) by the 2050s because of warmer temperatures (Lashof, & Patz, 2004). Pollen levels may increase with increased CO₂ levels since that promotes growth and reproduction in plants. This will increase the incidence of allergic reactions. Similarly, poison ivy will grow more and be more toxic.

Infectious diseases are influenced by climate as pathogen survival rates are strongly affected by temperature change. Diseases carried by birds, animals, and insects (vector-born) – such as malaria, dengue fever, and dengue hemorrhagic fever – may be influenced by temperature as mosquitoes are sensitive to climate conditions such as temperature humidity, solar radiation, and rainfall. For example, there has been a strengthening of the relationship between the El Nino global weather cycle and cholera outbreaks in Bangladesh. Increases in malaria in the highlands of eastern Africa may be associated with local warming trends. Temperature also affects the rate of food-born infectious disease. In general, however, it is hard to isolate the effects of climate change that affect the transmission rate and geographic boundaries of infectious disease from other social, economic, behavioral, and environmental factors (see McMichael et al., 2006). Increased precipitation from extreme rainfall events can cause flooding which, especially in cities with combined sewer and stormwater systems can be contaminated by sewage lines. This can happen when the deep tunnels that carry stormwater in Chicago reach capacity and untreated sewage then must be released into Lake Michigan. E. Coli levels in the lake then increase, forcing beaches to close to prevent the spread of infection.

Diseases are re-emerging and emerging infectious due to intensified food production in “factory” farms. Examples include mad cow disease (1980s in Britain); the encroachment on rain forest by pig farmers exposed pigs and farmers to the “Nipah” virus carried by rainforest bats that were seeking food from orchards around the pig farms – driven by deforestation and the drought of El Nino. This caused infection of pigs which lead to human illness and more than one hundred deaths. Poultry farming (avian influenza viruses) – crowded ‘factory farming’ may increase the likelihood of viral virulence when there is no selective advantage in keeping the host bird alive. Other food related issues are discussed in the next section.

Food Production

Climate change can influence regional famines because droughts and other extreme climate conditions have a direct influence on food crops and also by changing the ecology of plant pathogens (Patz et al., 2005).

There are likely to be major effects of climate change on agricultural production and fisheries. This can be both positive and negative depending on the direct effects of temperature, precipitation, CO₂, extreme climate variations, and sea-level rise. Indirect effects would have to do with changes in soil quality, incidence of plant diseases and weed and insect populations. Food spoilage will increase with more heat and humidity. Persistent drought has already reduced food production in Africa. There could be reduction in nutritional quality due to a reduction in the amount of nitrogen crops incorporate when CO₂ levels increase.

Malnutrition will be increased due to drought, particularly poorer countries. Increasing fuel costs also increase the cost of food, as we are already seeing in 2011. Again, this incremental cost rise affects those who already spend a large portion of their income on food and can contribute to malnutrition. About one-third, or 1.7 billion, of all people live in water-stressed countries and this is anticipated to increase to five billion by 2025. Frequency of diarrhea and other diseases like conjunctivitis that are associated with poor hygiene and a breakdown in sanitation may increase.

Various studies suggest that increases in population at risk from malnutrition will increase from 40-300 million people over the current 640 million by 2060 (Rosenzweig, Parry, Fischer & Frohberg, 1993). A more recent study said that today 34% of the population is at risk and by 2050 this value would grow to 64-72%. Climate change is associated with decreased pH (acidification) of oceans due to higher CO₂ levels. Over the past 200 years ocean pH has been reduced by 0.1 units and the IPCC predicts a drop of 0.14 to 0.35 units by 2100. This may affect shell-forming organisms and the species that depend on them. There could be a reduction in plankton due to the North Atlantic Gulf Stream (Pauly & Alder, 2005). With already overexploited fish populations, it will be harder for them to recover.

Natural disasters like floods, droughts, wildfires, tsunamis, and extreme storms have resulted in millions of deaths over the past 25 years and negatively affected the lives of many more. Survivors may experience increased rates of mental health disorders such as post-traumatic stress disorder. Wildfires reduce air quality, increasing particulate matter that provokes cardiac and respiratory problems. Sea level rise will increase flooding and coastal erosion. Indirect effects of rising sea levels include the infiltration of salt water and could interfere with stormwater drainage and sewage disposal. This could force coastal communities to migrate and create refugees with health burdens such as overcrowding, homelessness, and competition for resources. Air pollution is likely to be worse with climate change. It can also lead to mobilization of dangerous chemicals from storage or remobilize chemicals that are already in the environment.

Specific regional effects have may be more severe. Vulnerable regions include temperate zones predicted to experience disproportionate warming, areas around the Pacific and Indian Oceans that are currently subject to variability in rainfall, and large cities where they experience the urban heat island effect (Patz et al., 2005).

An evaluation of the reductions in adverse health effects that could be achieved by 2020 in four major cities with a total population of 45 million found that GHG mitigation would “reduce particulate matter and ozone ambient concentrations by about 10% and avoid some 64,000 premature deaths, 65,000 person-chronic bronchitis case, and 37 million days of restricted activities (Cifuentes, Borja-Aburto, Gouveia, Thurston & Davis, 2001). The cities’ ozone levels are estimated to increase under predicted future climatic conditions, and this effect will be more extreme in cities that already suffer from high pollution. The estimates of elevated ozone levels could mean a 0.11% to 0.27% increase in daily total mortality (Bell et al., 2007). Therefore, reduction of GHG emissions, along with actions to mitigate the effects of climate change are likely to reduce the public health outcomes associated with climate change.

Conclusions

The implications of climate change on public health are broad and vast. The interconnectedness of all of earth’s systems and human health is an area that is a challenge to study; the climate change scenarios are variable. Public health is directly tied to the human ecosystem that we create through our unsustainable activities. The deterioration of public health on this planet is perhaps the most important consequence of our own unsustainable choices. Without good public health outcomes, human life on this planet is threatened and ultimately our actions could cause significant changes in human health, well-being and longevity. It is not the earth that is at stake – it is humanity.

Review Questions

1. Think about the major sources of energy: coal, nuclear and petroleum. Name some health effects that are associated with each, as portrayed in recent world events. Find one popular and one scientific source to support this.
2. Describe three health impacts of climate change.
3. Modern farming practices are meant to increase productivity and feed the world solving the problems of malnutrition and starvation. How would you argue for or against this?
4. What are some outcomes that could be measured to determine if a community is healthy?

References and Further Reading

Batie, S. S. (2008, December). Wicked problems and applied economics. American Journal of Agricultural Economics, 90, 1176-1191 doi: 10.1111/j.1467-8276.2008.01202.x.

Bell, M. L., Goldberg, R., Hogrefe, C., Kinney, P. L., Knowlton, K., Lynn, B., . . . Patz, J. A. (2007). Climate change, ambient ozone, and health in 50 US cities. Climatic Change, 82, 61-76.

Besser L. M., & Dannenberg A. L. (2005, November). Walking to public transit steps to help meet physical activity recommendations. American Journal of Preventive Medicine, 29(4), 273-280.

Besser, L. M., Marcus, M., & Frumkin, H. (2008, March). Commute time and social capital in the U.S. American Journal of Preventive Medicine, 34(3), 207-211.

Blair S. N., Kampert, J. B., Kohl III, H. W., Barlow, C. E., Macera, C. A., Paffenbarger, Jr, R. S., & Gibbons, L. W. (1996). Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. Journal of American Medical Association, 276(3), 205-210.

Carman, H.J., Tugwell, R.G., & True, R.H. (Eds.). (1934). Essays upon field husbandry in New England, and other papers, 1748-1762, by Jared Eliot. New York: Columbia University Press.

Chou, P.Y. (Ed.). (2003). Emerson & John Muir. WisdomPortal. Retrieved December 11, 2011 from http://www.wisdomportal.com/Emerson/Emerson-JohnMuir.html. 

Cifuentes, L., Borja-Aburto, V. H., Gouveia, N., Thurston, G., & Davis, D. L. (2001). Hidden health benefits of greenhouse gas mitigation. Science, 293(5533), 1257-1259.

Ewing, R., Schmid, T., Killingsworth, R., Zlot, A., & Raudenbush, S. (2003, September/October). Relationship between urban sprawl and physical activity, obesity, and morbidity. American Journal of Health Promotion, 18(1), 49-57.

Fiksel, J., Graedel, T., Hecht, A. D., Rejeski, D., Saylor, G. S., Senge, P. M., Swackhamer, D. L., & Theis, T. L. (2009). EPA at 40: Bringing environmental protection into the 21^st century. Environmental Science and Technology, 43, 8716-8720. doi: 10.1021/es901653f.

Friedman, M. S., Powell, K. E., Hutwagner, L., Graham, L. M., & Teague, W. G. (2001). Impact of changes in transportation and commuting behaviors during the 1996 Summer Olympic Games in Atlanta on air quality and childhood asthma. JAMA: The Journal of the American Medical Association, 285(7), 897–905.

Haines, A., Kovats, R. S., Campbell-Lendrum, D., & Corvalan, C. (2006). Climate change and human health: Impacts, vulnerability and public health. Journal of the Royal Institute of Public Health. 120, 585-596.

Hellmann, J., Lesht, B., & Nadelhoffer, K. (2007). Chapter Four – Health. In Climate Change and Chicago: Projections and Potential Impacts. Retrieved from http://www.chicagoclimateaction.org/filebin/pdf/report/Chicago_climate_impacts_report_Chapter_Four_Health.pdf

Hilkevitch, Jon. “Chicago No. 1 in Road Congestion.” Chicagotribune.com, 5 Sept. 2018, www.chicagotribune.com/autos/ct-xpm-2011-01-20-ct-met-traffic-congestion-0120-20110119-story.html.

Jentes, E. S., Davis, X. M., MacDonald, S., Snyman, P. J., Nelson, H., Quarry, D., . . . & Marano, N. (2010). Health risks and travel preparation among foreign visitors and expatriates during the 2008 Beijing Olympic and Paralympic Games. American Journal of Tropical Medical Hygene, 82, 466–472.

Kreuter, M. W., DeRosa, C., Howze, E. H., & Baldwin, G. T. (2004, August). Understanding wicked problems: A key to advancing environmental health promotion. Health, Education and Behavior, 31, 441-54. doi: 10.1177/1090198104265597.

Lashof, D. A., & Patz, J. (2004). Heat advisory: How global warming causes more bad air days. Retrieved from http://www.nrdc.org/globalwarming/heatadvisory/heatadvisory.pdf.

McMichael, A. J. (2006) Population health as the ‘bottom-line’ of sustainability: A contemporary challenge for public health researchers. European Journal of Public Health, 16(6), 579–582.

McMichael, A. J., Woodruff, R. E., & Hales, S. (2006). Climate change and human health: Present and future risks. Lancet, 367, 859-869.

National Environmental Policy Act of 1970, 42 U.S.C., 4321, et seq. (1970). http://www.epa.gov/compliance/basics/nepa.html.

Patz, J. A., Campbell-Lendrum, D., Holloway, T., & Foley, J. A. (2005). Impact of regional climate change on human health. Nature, 438, 310-317.

Pauly, D., & Alder, J. (2005). Marine Fisheries Systems. In R. Hassan, R. Scholes, & N. Ash (eds.), Ecosystems and Human Well – being: Current State and Trends . (Vol. 1). Washington, D.C., Island Press.

Plantinga, A. J., & Bernell, S. (2007). The association between urban sprawl and obesity: Is it a two-way street?, Journal of Regional Science, 47(5), 857-879.

Rosenzweig, C., Parry, M. L., Fischer, G., & Frohberg, K. (1993). Climate change and world food supply. Research Report No. 3. Oxford, U.K., Oxford University, Environmental Change Unit.

“Section 10 of the Rivers and Harbors Appropriation Act of 1899.” EPA, Environmental Protection Agency, 11 Apr. 2019, www.epa.gov/cwa-404/section-10-rivers-and-harbors-appropriation-act-1899.

Wang, X., Westerdahl, D., Chen, L., Wu, Y., Hao, J., Pan, X., Guo, X., & Zhang, K. M. (2009). Evaluating the air quality impacts of the 2008 Beijing Olympic Games: On-road emission factors and black carbon profiles. Atmospheric Environment, 43, 4535–4543.

Wei, M., Kampert, J. B. , Barlow, C. E. , Nichaman, M. Z. , Gibbons, L. W., Paffenbarger, Jr., R. S., & Blair, S. N. (1999). Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Journal of the American Medical Association, 282(16), 1547-1553.

World Health Organization. (2009). Climate change and human health. Fact sheet, July 2005. Retrieved from http://www.who.int/globalchange/news/fsclimandhealth/en/index.html.