Public Health Feature - September 2008
Tex Med. 2008;104(9):33-36.
By Crystal Conde
As gas prices skyrocket, the nation's leaders look to alternative energy sources to fuel the future. And, as scientific research increasingly connects the dots from air pollution to disease, physicians look to lawmakers to rein in the amount of toxins patients breathe.
With the 2009 legislative session just a few months away, organized medicine, along with the business and legal communities in Texas, hopes to have a hand in creating effective clean air policy.
"We've reached the tipping point where suddenly environmental pollution and energy sufficiency are the No. 1 issues," said Robert W. Haley, MD, professor of internal medicine and director of the Division of Epidemiology at The University of Texas Southwestern Medical Center at Dallas. "We're already getting the message from legislators that they want to do something. Access to good, well-thought-out information is what they need. They're looking to the professionals of the state to help them evaluate that information."
Dr. Haley is a key member of a new partnership of professionals from the business, law, and medical sectors of the state. They're collaborating to facilitate strategic research as the basis of sound legislative policy that ensures clean air and energy sufficiency while stimulating economic growth from clean energy industries. Founding members of the partnership include the Dallas County Medical Society (DCMS), Texas Business for Clean Air (TBCA), and environmental lawyers with the Dallas Bar Association.
The partnership has authorized three studies to accomplish its legislative goals.
Margaret Keliher, former Dallas County judge and TBCA executive director, has been recruiting additional partners to strengthen the coalition and help cover the cost of the three studies, which she estimates will total about $80,000.
The first phase of the partnership's research, which consists of a comprehensive environmental engineering study, aims to document the nature and extent of the clean air problem and the future for sustainable energy in the state. Experts at Rice University and Houston Advanced Research Center will study the status of air pollution and electricity generation in Texas, the impact of air pollution, the cost-effectiveness of potential emission controls, best practices from other states and countries, and options for Texas.
The second phase involves a legal analysis of the future effects of current and pending legislation and litigation on air pollution and energy generation in Texas. Legal experts will prepare a report that outlines unfolding legal tenets that will affect the profitability of polluting energy-generation businesses and the future costs of these resources to Texans.
The final phase is an economic analysis of the costs of the energy-generation options for Texas and the economic return in growth and tax revenue.
The Texas Medical Association has policy pertaining to clean air. At TexMed 2008, the House of Delegates adopted a resolution asking TMA to urge Texas government leaders and legislators to reduce pollution from coal-fired power plants and diesel engines. Scientific research links many public health concerns to air pollution from these sources.
The resolution lists the following as steps lawmakers might take to reduce air pollution:
- Require the immediate installation or retrofitting of technology highly efficient in reducing all forms of air pollution, including ozone-causing pollutants, particulates, carbon dioxide, and mercury on all existing and future coal-fired power plants;
- End state subsidies for polluting coal-fired power plants and levy a tax on coal, equivalent to that on natural gas, sufficient to pay future federal levies on pollution damage;
- Place a moratorium on approval of old-technology coal-fired power plants; and
- Require an addition to the state diesel retrofit program to include particulate controls.
Public's Health Up In the Air
Among the hazardous substances coal-fired power plants emit into the atmosphere is mercury. A recent study conducted by researchers at The University of Texas Health Science Center at San Antonio shows a statistically significant relationship between pounds of industrially released mercury and increased autism rates.
In the study, published in the journal Health & Place , researchers looked at school district data from the Texas Education Agency and industrial mercury-release data from the U.S. Environmental Protection Agency (EPA).
For every 1,000 pounds of environmentally released mercury, on average, the rate of special education services increased 43 percent, while the autism rate increased 61 percent. The study also found that community autism prevalence decreased by 1 percent to 2 percent every 10 miles from the pollution source.
At TexMed 2008, Dr. Haley gave the Council on Public Health documentation demonstrating the detrimental impact air pollution has on the health of Texans.
"It's well-known that mercury crosses the placenta and enters the brains of unborn children of mothers who are exposed to mercury during pregnancy," Dr. Haley said. "We know there are greater neurological consequences when exposure occurs in utero as opposed to after birth."
In 2006, Texas utility companies proposed constructing 17 new coal-burning power plants and one petroleum-coke power plant in a four-year span. TXU Energy planned to build 11 of the new plants.
But last year, TXU agreed to reduce the number of planned coal-fired power plants in Texas from 11 to three, after facing opposition from environmental groups.
Coal-fired power plants and diesel exhaust spew particulate matter air pollution, a mixture of substances including carbon-based particles, dust, and acid aerosols formed in the atmosphere from gaseous combustion by-products such as volatile organic compounds, sulfur dioxide, and nitrogen oxides.
Particulate matter air pollution, according to a 2004 study by University of Southern California researchers, leads to reduced lung capacity in teenagers who grow up in areas with heavily polluted air. After tracking children living in Los Angeles communities with varying levels of pollution, researchers concluded that the lung capacity of about 8 percent of 18-year-olds was less than 80 percent of normal. The incidence dropped to about 1.5 percent for those living in areas with the least pollution.
"The concern is that people who live in areas of high air pollution may have reduced lung capacity for life and will be more susceptible to other diseases, such as chronic cardiovascular and pulmonary diseases," Dr. Haley said.
According to the American Lung Association's (ALA's) report Lung Disease Data: 2006 , the release of acidic particles, sulfur dioxide, and ozone may be connected to increases in patients' medication use, emergency room visits, and hospital admissions.
Texas has a particular problem with ozone pollution, formed when diesel exhaust emits nitrogen oxides into the atmosphere.
ALA ranks Houston fourth and Dallas-Fort Worth seventh among the top 10 U.S. cities most polluted by ozone in its State of the Air report released this year.
If that weren't bad enough, research demonstrates pollution from coal-fired power plants and diesel engines increases asthma attacks in some instances. A 2003 study published in European Respiratory Journal found that children living within 50 yards of roads where more than 33,000 vehicles passed by each day were nearly twice as likely to suffer from asthma as were other children.
Children at Risk: How Air Pollution from Power Plants Threatens the Health of America's Children , a publication prepared by Clean Air Task Force in 2002, states that pollution from coal-fired power plants causes more than 603,000 asthma attacks annually.
Jeffrey Levin, MD, MSPH, chair of TMA's Council on Public Health and an occupational medicine physician, says TMA can play a pivotal role in urging legislators to develop policies to reduce environmental pollution.
"It's very much like any public health issue in that it's often not just a direct medical care issue. But it's being aware and making others aware of these factors that alter our health, like the air we breathe," he said. "TMA can speak with a medical voice that says it's important to be aware of and participate in controlling the factors that adversely affect our patients' health."
Plan of Action
To have an impact on public health, Dr. Haley, DCMS past president, says the state needs to concentrate on making progress in three areas:
- Reduce consumption;
- Focus on renewable energy sources, such as solar and wind power; and
- Clean up current technologies through the sequestration of pollutants coming from coal-fired power plants.
He also says that the state's economy would benefit from attracting clean energy industries. Texas has advanced its use of wind energy sources.
Earlier this year, the Public Utility Commission of Texas (PUC) approved a plan that will eventually transmit a total of 18,456 megawatts of wind power from West Texas and the Panhandle to metropolitan areas of the state.
PUC estimates lines will be operational within four to five years. The cost to implement the plan is about $4.93 billion, or about $4 per month per residential customer once construction is complete.
Ms. Keliher recognizes the potential positive impact new legislation could have on the public's health and says Texas stands to benefit from a business standpoint, as well.
The state's major metropolitan areas face potential loss of federal highway construction funds and economic harm to businesses should they fail to meet federal standards for ambient air quality. According to the Texas Commission on Environmental Quality, four areas, classified as nonattainment areas, fail to meet the standards.
Those areas include El Paso, for carbon monoxide and particulate matter pollution; and Houston-Galveston-Brazoria, Dallas-Fort Worth, and Beaumont-Port Arthur, for eight-hour ground-level ozone. Vehicular emissions are a significant contributor to ozone excesses in these areas. (See " Texas' Nonattainment and Near Nonattainment Areas .")
Austin-San Marcos, San Antonio, and Northeast Texas are early action compact areas that developed state implementation plans to reduce emission standards to meet the eight-hour ozone standard by 2007.
Dallas-Fort Worth has taken action to clean up the ozone in the area. The EPA has approved the ozone cleanup plan just in time. Dallas-Fort Worth has until June 2010 to comply with federal ozone standards or face sanctions, including bans or stiffer limits on industrial expansion or loss of federal Air Pollution Control Program grant funds. The plan will reduce ozone pollutants by 88 tons per day.
Ms. Keliher says that with the input of medicine, law, and business stakeholders, Texas has a great opportunity to make a difference in the public's health and on the economy.
"The question is: Will the state of Texas step up and be a leader? We ought to step up and be leaders and have a lot of that industry come to Texas," she said.
The partnership planned to have all studies wrapped up and to have begun developing and implementing strategies for educating the legislature by the time of publication of this issue. Study results will be posted this month on TBCA's Web site .
Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at Crystal Conde .
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