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Surgeon
General: IAQ Warrants Federal Action
By Steve Sauer
The U.S. Surgeon General, addressing
a crowd of about 500 stakeholders representing many areas of health
related to all aspects of indoor environments, indicated last month
that he agrees more should be done at the federal level to
communicate to the public the health hazards posed by poor indoor
air quality.
Open discussions among organizers,
speakers and attendees of the Surgeon General’s Workshop on Healthy
Indoor Environment focused on a number of areas, including ways the
federal government could make citizens more aware of health issues
related to indoor air quality. Research initiatives and interagency
collaboration were among the most popular methods discussed.
The workshop, held Jan. 12–13 on
the campus of the National Institutes of Health in Bethesda, Md.,
focused mainly on indoor air quality but also touched on other
ergonomics issues related to indoor spaces, such as the effects of
light on student or worker performance in school and office
settings.
Organizers of the workshop are
preparing a report for Vice Admiral Richard H. Carmona, who has
served as surgeon general since 2002. The report is to propose a
plan of action for the federal government.
During the meeting, Carmona issued
a national health advisory on radon, emphasizing to citizens the
serious health risk of radon in homes. The colorless, odorless gas
kills more than 20,000 Americans in their homes every year, he said,
adding that radon test kits should be used at least once every two
years or after every move.
As for the overall issue of indoor
air quality, Carmona discouraged the idea of issuing an official
Surgeon General’s report on the topic due to the duration of
preparation time and high costs involved. He said such reports
generally take two to three years and require millions of dollars.
However, he said he will support a
more immediate approach that would take only months instead of years
to prepare and incur less costs. Described this alternative as
involving a group of experts, he expressed confidence in members of
his staff and other people who were involved in the workshop and
hinted they would be among those involved.
Researchers speaking at the
workshop included researchers Dr. Jack Spengler of Harvard
University’s School of Public Health, Dr. Thomas A.E. Platts-Mills
of the University of Virginia Health System, Dr. Clifford S.
Mitchell of Johns Hopkins University’s Bloomberg School of Public
Health and Dr. Eileen Storey of the University of Connecticut’s
Center for Indoor Environments and Health. Platts-Mills’
presentation also included information from Dr. Michael Hodgson of
the U.S. Department of Veterans Affairs, who also attended the
workshop.
Rear Admiral Robert C. Williams,
chief engineer of the U.S. Public Health Service, attended the
entire two-day workshop and seemed to be taking notes for Carmona
while the surgeon general was absent from the workshop to attend
meetings at the White House and other locations.
Carmona was there, however, to hear
calls from attendees Hal Levin and James Woods to make indoor air
quality an issue of national priority and to respond to it via a
multidisciplinary effort.
Several attendees did notice
certain professions largely missing from the invited speakers and
also poorly represented in the audience: indoor air quality
professionals, members of the cleaning industry, and building
scientists.
One presentation, by Dr. Jonathan
Samet of Johns Hopkins University, listed nine organizations that
deal with health issues including asthma in particular, facility
management, or indoor air quality. While Samet named the American
Academy of Allergy, Asthma and Immunology, the American Society of
Heating, Refrigeration and Air-Conditioning Engineers, the Building
Owners and Managers Association, and some governmental
organizations, his list was seen in the audience as incomplete.
Green cleaning expert Stephen
Ashkin, who introduced himself at an aisle microphone during
audience participation sessions, noted that Samet’s list failed to
incorporate trade organizations such as the U.S. Green Building
Council. In response, Samet referenced a disclaimer he had made
during the presentation that he knew he could not include every
relevant organization.
“The data clearly indicates the
need for this workshop,” Carmona stated at the workshop’s opening,
delivering prepared remarks. “In just the past 25 years, the
percentage of health evaluations that the National Institute for
Occupational Safety and Health at the CDC has conducted related to
indoor-air quality has increased from 0.5 percent of all evaluations
in 1978, to 52 percent of all evaluations since 1990. This means
that in those years, the evaluations related to air quality concerns
have increased from one of every 200 evaluations to one of every
two.”
Outlining three goals for the
workshop, he said the most important was to “build collaborations
around the common goal of improving our indoor environments.”
Offices of the federal government were well represented at the
workshop, with eight major government bodies offering officials for
presentations and a panel discussion.
While the speakers at the panel
discussion representing the eight government bodies were quick to
agree that collaboration among them must occur, some attendees noted
in side discussions afterward that collaboration actually seems to
be a long time away. No one speaker seemed to want to “step up to
the plate” and initiate a collaborative agreement, they said.
Some attendees also bemoaned the
notable omission of the U.S. Department of Education at the forum.
Several of the presentations dealt strongly with the issue of
healthy indoor environments in schools, which gave credence to such
complaints as Claire Barnett’s.
Barnett, executive director of the Healthy Schools Network,
distributed fact sheets derived from a 2004 position statement by
the Coalition for Healthier Schools, signed by dozens of
organizations across the country.
Each double-sided sheet contains a
written reminder of a provision in the No Child Left Behind Act of
2001 that requires the Department of Education to complete “a study
regarding the health and learning impacts of environmentally
unhealthy public school buildings on students and teachers.”
The act, which President Bush
signed into law Jan. 8, 2002, required that the study “be completed
not later than 18 months after the date of enactment.” Barnett said
that an April 2004 study prepared for the department does not
adequately fulfill all requirements of the legislation.
Dr. Marion J. Balsam, who works in
the National Institutes of Health, said she was shocked that the
department was not represented at the workshop at all. However, she
indicated hope for the status of a nationwide research study
affecting schools.
Balsam, who acts as program
director for NIH research partnerships, said a project called the
National Children’s Study will include a major focus on indoor air
quality initiatives that would begin to solve a number of problems
inside schools around the country. The study was authorized by the
Children’s Health Act of 2000 and is sponsored by the Centers for
Disease Control and Prevention, the National Institute of
Environmental Health Sciences, and the EPA. It is also being planned
and conducted by the National Institute of Child Health and Human
Development. More information on this study can be obtained on the
Web at
www.nationalchildrensstudy.gov.
Making himself heard during several
audience participation periods was Joel Segal, the legislative
assistant responsible for writing the U.S. Toxic Mold Safety and
Protection Act that Rep. John Conyers, D-Mich., brought before
Congress, earning eventual support from Senate members Frank
Lautenberg, Hillary Clinton, Jim Jeffords and Ted Kennedy.
Segal’s first question was directed toward Noreen Clark and Peyton
Eggleston, members of the committee that last year issued a report
for the Institute of Medicine on damp indoor spaces and health.
Segal remarked that because a nationwide toll-free phone number for
mold victims to call is linked to Conyers’ office, he has seen
discrepancies between science and the numerous calls he fields on a
regular basis.
“I just returned from a town hall
meeting in Boston where I heard from one person after another who
all say toxic mold has ruined their lives,” he said. “And when I get
back to my office on Friday, I’m going to hear from a family of five
in Wyoming telling me the same thing.”
Further attesting to such phenomena
was Sharon Kramer, a California woman who says her daughter went
into “code blue respiratory distress” only two weeks after
qualifying for a school volleyball team. Kramer said she blames her
daughter’s illness on overexposure to a species of Aspergillus.
Since her experience with mold, she has read up on existing fungal
research and formed her own Web site,
MDawareness.com, dedicated
to promoting awareness of mycotic diseases.
Her site led the effort to bring
the issue of mold before Congress last summer, culminating in a
press conference and congressional briefing that brought human
rights activist Bianca Jagger to Washington, D.C.
At the workshop, Kramer accused
those speakers who were involved in the Institute of Medicine report
of intentionally downplaying the importance of such mycotic diseases
as aspergillosis, cryptococcosis and histoplasmosis. She also
challenged Clark and her fellow members of the scientific community
to stop referring to mold victims as “anecdotes.”
Segal said that mold is not viewed as an actionable issue among many
members of Congress. Instead, it is more of a laughing matter, he
said, simply because legislators say they would take no action on
such an issue without science warranting it.
He said that because the Institute
of Medicine report was unable to establish sufficient evidence for
an association between damp indoor spaces and some of the more
serious health effects considered, such as neurotoxic effects, many
in the legislative arena do not see the need for action.
Segal said he would welcome any
effort by the federal government to communicate more effectively the
immediate needs of thousands of people said to be suffering from ill
effects from molds and other indoor air contaminants.
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