Environmental Health Risks and Public Policy: Decision Making in Free Societies (Jessie & John Danz Lectures)

Modern industrial societies have created not only the goods and services that add productivity and pleasure to modern life, but also hazardous and unlooked-for side effects. Many significant technological advances - automobiles, fire retardation, durable paints, electrical appliances - have a dark side, their proven or putative implication in major risks to public health.

How democratic societies discover and deal with such health hazards is the theme of Environmental Health Risks and Public Policy. Often frightening in its direct recitation of medical evidence, always compelling as a work of a medical man deeply concerned with human health, it examines the ways in which science and public policy interact, sometimes to protect the public, sometimes to thwart prompt action.

A major concern of this book is air pollution, which has now been linked to chronic illness and loss of healthy lung function in all those who live in large cities. Cigarette smoking - the only self-inflicted health hazard covered here - has been responsible for an enormous burden of disease. The book’s discussion of asbestos deals with the difficulty of risk assessment when exposures are low, as is the case with current environmental levels. The public health hazards of lead - from paint ingestion by young children and from airborne lead emitted in automobile exhaust - and the disturbing figures linking exposure to electromagnetic fields to a variety of childhood and occupational cancers are described in detail.

As society’s awareness of environmental effects on public health has grown, scientists (especially epidemiologists) have been increasingly drawn into the public arena. The design of studies, the manipulation of statistics, and additional risk factors influence the acceptance of “hazards” as clearly causing certain diseases. In addition, the often major economic effects of reducing these health hazards make formulation of public policy concerning their control a fractious business. Environmental scientists, the media, lawyers, and politicians have difficulty dealing with multifactoral disease, and are still learning how the questions should be framed for an informed public debate on issues raised. This book compares decision making in Canada, Britain, and the United States, and the impact of different political traditions on the process. The place and limitations of formal risk assessment are discussed.

The book offers conclusions about the central role of environmental epidemiology as the “detective” science in elucidating health effects of human technological advances, and examines the different, often conflicting, sometimes colluding roles of government, industry, and the general public in the debate over public health hazards.