September 5, 2017
Statement of Mona Sarfaty, MD MPH, Director, Program on Climate & Health, George Mason University
Respected EPA panelists and fellow citizens. My name is Mona Sarfaty. I am a physician trained in family medicine and public health; I practiced primary care medicine and taught medical and public health students in three different academic medical centers over a 35-year period. Today, I direct a program in Climate and Health at George Mason University in Fairfax, Virginia. I am here today to speak in favor of maintaining the more stringent EPA fuel standard for light duty vehicles that was finalized after considerable public process and careful discussions with the auto industry. That decision is achievable and much better for public health.
Because we spend 75% of our national health budget on chronic disease, hospitals and health providers are under increasing pressure to achieve more with their budgets by improving quality outcomes. But better outcomes also require cleaner air in a more healthful environment. One of the academic medical centers I worked at for nearly a decade was Thomas Jefferson University in Philadelphia, which is today part of an Accountable Care Organization or an ACO. ACO’s are about better design, greater efficiency, and the right incentives. These objectives are appropriate for the health system. They are also appropriate for the auto industry.
I was part of the Family Medicine Department which had its own large family medicine group practice. The common wisdom there was that all patients who had moved to Philadelphia eventually developed asthma, a cough, or allergies. This was hard to understand until I learned about the poor air quality in Philly. You see, it is an EPA non-attainment zone, meaning that the air quality doesn’t achieve EPA standards. Auto emissions are a major contributor. My “ahah” moment about the importance of clean air started when I realized that I was working in a city that didn’t meet EPA standards for air quality. That started me on the path I am on today; I will say more on that in a moment. The effort of all five academic medical training institutions in Philly was being undermined because the local air quality report card showed poor grades.
The asthma rate amongst children in Philadelphia is 20%, or more than twice the national average. This is not unusual for urban environments. Areas of Florida, Georgia, Ohio, and many other states have similar asthma rates. Over the last decade, new evidence has strengthened our understanding of the many ways that air pollution affects the health of children. We know now that children who breathe poor quality air when they are growing up literally have less lung capacity. Their lungs don’t develop the way they would if they were breathing cleaner air. Another thing we have learned is that babies that are developing in utero while their mothers breathe poor quality air are more likely to be premature or low birthweight. Prematurity and low birthweight are predictive of higher rates of infant mortality—which is death of an infant before the age of 1. [I would be happy to provide the seminal publications that established this new knowledge.]
Poor air quality is damaging for people who have chronic heart and lung conditions. When air pollution intensifies, people with these conditions are more likely to end up in emergency rooms and the hospital. This is unfortunate for the affected individual and their family; but it is also a strain on the larger community. There are missed days from school or work, lower productivity, and the cost of emergency room visits and hospitalizations. These costs are shared by the entire community. It doesn’t always stop at hospitalization. Deaths do occur from these problems; this is the ultimate defeat for many families and for the health system.
Heat waves and warm days are increasing in number as the result of climate change. This will continue. As you know, each of the last few years has been the hottest on record. This is not an accident or part of the plan of the creator; it is a result of human activity that has produced more greenhouse gas than can be absorbed by the oceans. Even though air quality has improved in many areas thanks to the 1970 Clean Air Act and continued work of the EPA, hotter days cause the air quality to deteriorate again and we lose ground. Remember that heat + (plus) light + (plus) emissions produces ozone which irritates the lungs directly and produces symptoms in many people. This is easy to document. If you have a smart phone, download a State of the Air app and the next time the temperature exceeds 85 or 90 degrees in your zip code, check the air quality in that same zip code. If you live in a place with significant automobile traffic you are likely to see the AQI go into the Yellow or Orange zone or worse. While the yellow zone may not cause trouble for a person in perfect health, someone with asthma or another lung condition is likely to develop symptoms.
Throughout the country, the clinicians and staff work to prevent hospitalizations, emergency room visits, and worsening of chronic disease. But the help that comes from health care cannot fully compensate for poor air quality. This must be addressed at its source. The medical literature is full of publications demonstrating that cleaner air leads to decreases in emergency room visits and improvements in health status for people with lung conditions and chronic diseases.
We must take this opportunity to make progress toward cleaner air because we have a long road to travel. Moving forward as quickly as possible will help maintain and improve the health and well-being of Americans. If higher performance from existing energy sources and public health guide our decisions, we will be on sounder footing as a nation. The time to make these advances is now. Thank You.