:I: I...-.. w 0:: 0 u.. C) zz~ .<.... ~ ~ I- Z :::> ~ ~ u0 0 Z < I- :::::; 0 ~ 0 0:: IW ~ <~ z<~=s ~ 00 ~ ~ 0 U I\ METROPOLITAN, URBAN AND COMMUNITY PLANNING FOR ENVIRONMENTAL HEALTH This course is designed for all persons-health and planning personnel, public officials, and lay citizens-who are interested in the planning of a more healthful urban environment. The course covers three general areas-basic environmental health problems, methods of attacking the problems, and approaches to> the solution of the problems. This training course Manual has been specifically prepared for the trainees attending the course, and should not be cited as a bibliographical reference. Conducted by: Georgia.Department of Public Health Environmental Health Branch. Co-Sponsored by: The University of Georgia Institute of Community and Area Development Institute of Law and Government Center for Continuing Education The U. S. Public Health Service Athens, Georgia 1964 ENVIRONMENTAL HEALTH BRANCH Roy J. Boston, Director J. P. Gibbs, Training Coordinator General Engineering-Sanitation Service William A. Hansell, Director John B. Black, Engineer James c. Burgoyne, Engineer J. R. Culp, Chief Milk Technologist Robert A. Dean, Engineer G. H. DeHart, Sr., Food Technolo- gist R. O. Duitman, Environmental Gen- eral Technologist W. A. Fountain, Sr., Food Tech- nologist J. P. Gibbs, Chief Food Technologist W. C. Hamilton, Shellfish Technolo- gist C. J. Jessup, Refuse Collection & Disposal Consultant Fred E. Johnston, Engineer Fred C. Lovell, Sr., Food Technolo- gist S. M. Major, Env. Technologist- School F. O. NeSmith, Env. Technologist- General C. C. Russell, Env. Technologist- General R. E. Smith, Env. Technologist- General M. H. Trippe, Sr., Food Technologist Housing Hygiene and Accident Prevention Service A. Faegin Parrish, Director W. Mason Adams, Housing Hygiene Technician Miss Helen Ronayne, Safety Consultant "V. S. Sprinkle, Housing Hygiene Consultant Industrial Hygiene Service Hugh L. Parker, Director Juli~n Bradberry, Radiation Tech- nICIan T. S. Britton, Radiochemist E. H. Brown, State Bedding Inspector Robt. H. Collom, Jr., Industrial Hygienist Donald Deese, Jr., Ind. Hygienist Richard Fetz, Chief, Radiological Section E. F. Gunter, Electronics Service Technician M. J. Hickey, Chief, Electronics Service Unit H. C. Karp, Jr., Ind. Hygienist E. "V. Leslie, State Bedding Inspector R. P. Lewis, Chief, Air Pollution Section Weymond H. Madden, Electronics Service Technician John W. Pierce, Radiation Technician R. M. Stevens, Sr., Ind. Hygienist Jesse A. Thornton, Electronics Service Technician lVater Resources Service Robert H. Byers, Director A. \V. Ferguson, Public Health Engi- neer Freddie O. Finley, Sr., Chemist Warren O. Griffin, Public Health Engineer Miss Elizabeth McEntire, Chief, Wa- ter Laboratorv Felix C. Pickron, P. H. Engineer J. D. Stevenson, P. H. Engineer A. F. Sweetland, P. H. Engineer 11 THE METROPOLITAN PLANNING AND DEVELOPMENT PROGRAM United States Public Health Service I. Brief Review of PHS Activities to Date A. Developmental Activities on Standards and Guides B. Field Technical Assistance II. Long-Range Implications of Problem for PHS Programs and Policies A. Federal-State Relations B. Inter-Program Aspects C. Inter-Agency Aspects III. Projections of PHS Activities A. Developmental Activities on Standards, Guides, and Manuals B. Training-Short Tenn and Support of Academic Courses C. Technical Assistance to States and Communities D. Relation with Professional and Technical Voluntary Organizations 111 .: ,,' CONTENTS Environmental Health Branch 11 The Metropolitan Planning and Development Program 111 The Future Problem in Urban Areas 1 The Water Problem 5 The Sewerage Problem 10 The Refuse Problem 14 The Air Pollution Problem 28 The Housing Hygiene Problem 30 The Radiological Health Problem 37 The General Sanitation Problem 46 Role of the Local Health Department 55 Role of the State Health Department 61 Role of the Universities 66 Role of City and County Planning Commissions 73 Planning the Community for the Advent of the Nuclear Industry _ 77 Effective Public Relations 82 Future Steps in Environmental Health Planning 85 Environmental Health Survey (Lexington, Kentucky, 1963) 87 Organization of the Georgia Department of Public Health (Chart) Between pages 45 and 46 v 1 THE FUTURE PROBLEM IN URBAN AREAS I. Introduction Charles Kettering once said, "I'm interested in the future because I plan to spend the rest of my life there." The future is important then. What can we expect in the future and what problems will the future present to us? How will these future problems affect us individually, or collectively as a community? How will these problems relate to our thinking in urban planning? How will we approach these problems with a sincere desire to solve or prevent them? These and a multitude of other questions merit our most astute consideration in any concerted effort toward "Urban Planning for Environmental Health." II. The Present Envirollmemal Health Problems Each of these problems will be discussed as a separate entity, so for the moment just a cursory view of the present dilemma in each of the environmental health facets will suffice to introduce us to the impact of the over-all situation. A. Water (see Figure 1). During the past five years we have exhibited no gain percentage wise. B. Sewerage. The measure of success in this important standard can be readily determined by the consideration of the number of septic tanks in metropolitan areas. Here we discover an alarming condition (see Fig. 2). In the past 15 years we have increased from 9% to 21 % (estimated). (Also see Fig. 3). C. Refuse Collection and Disposal. It is sufficient to say that it is estimated that 140,000,000 persons in urban areas should receive at least weekly pick-up, but of these there are 40,000,000 who do not have this modem convenience. D. Air Pollution. The last free item that God has given man is now becoming quite a subject of attention when we consider what we are doing to our clean air. Consider that each time we bum 1,000 gallons of gasoline we belch another 3,590 pounds of contaminants into the air. In Los Angeles this amounts to over 3,400,000 pounds per day. This is only one of the sources of contamination. E. Housing. It is currently estimated that there are over 15,000,- 1 ~oo homes in the United States that are in a state of dilapidatIOn below our acceptable standards; and further, that it would cost over $125 billion to bring them up to desirable ~onditi?ns. Each year, in spite of our efforts, this number is mcreasmg. F. Planning. In 1959 we discovered that there were 90 Clues having a population of over 10,000 that spent less than $1,000 per year on planning. Another 114 cities having over 5,000 popUlation spent nothing. And, of 2,563 cities having over 5,000 population only 302 or 11.8 % have full time planning personnel. Of the nearly 1,000 cities with over 10,000 population, only 30% have planning proficiency. G. General Health. There are some interesting statistics on the health coverage by health departments and sanitary engineering staff which shall be covered completely in a subsequent discussion. H. Governmental Maze. (See Fig. 4). III. The Population Explosion A. Expected Growth. The year 2026 is designated by Dr. Heinz Von Forrester of the University of Illinois as the year world popUlation will reach infinity. (See Figs. 5 and 6). IV. Conclusion . When one considers the present conditions of our over-all environmental health problems' with the expected population growth data, there leaves no room for doubt as to the seriousness of our present dilemma. Couple these facts with the apathy and complacency of our citizens; the inactivity and lack of leadership 'of our governmental officials; the confusion of our jurisdictions, particularly in the fast growing urban areas; and, finally, the financial crisis of nearly all governmental entities in metropolitan areas-there is no doubt as to the urgency of the situation. The future problem must be attacked now, and the health and planning agencies will carry one of the most vital roles. Their cooperation will be mandatory. 2 INDIVIDUAL WATER SUPPLIES COMMUNITY POPULATION lO~OOO,OOO 11&,00(\000 126,000,000 137,000,000 Community Population USillCJ Individual Water Supplies: l~ooqOOO l~OOO,OOO l~, 200, 000 l~400. 000 1945 1950 1955 1960 Figure 1 SEPTIC TANK INSTALLATIONS IN METROPOlITAN ARAS a.tt ~ POPULATION tI METROPOLITAN AREAS 75,000,000 84,000.000 94,000,000 109.000,000 J2 OVER. n POPULATION USING SEPTIC TANKS (est) 6,7SO,000 IQooo.ooo 15,000,000 900,000 1945 1950 1955 1960 (ESt) Figure 2 of the SOIL in the U.S. is UNSUITABLE for Septic Tank Systems Figure 3 A GOVERNMENTAL MAZE UNITS OF GOVERNMENT FEDERAL STATES COUNTIES MUNICIPALITIES TOWNSHIPS SPECIAL DISTRICTSQ LOCAL SQ100L DISTRICTS .l2a 1 48 3,047 17,183 17,198 14.415 50.443 TOTAL 102,335 , AVERAGE PER STATE = 2,13' Figure 4 PRESENT 1 50 ? _.. ~ WORLD POPULATION "0. .0 0 - ~ ~ ~; =~ z 0 ! . . z 2 ~ ~~, Figure 5. - U. S. vs Russia 4.0 1.0 o.So~~~::::::;~:::::;::::;;~~::"+.!:-:--""""'b6- '00 GOD tlOO 2000 2 00 VI.. IS Figure 6. The World Population Graph BABIES PER YEAR 10 1960 fEMAU '3 .sO_S04 '-l--+-+++-rlI ~ to. '-l--+-++4J Figure 7. Babies UNOEl' o2 6 10 POPUlATION (MIlliONS) Figure 6. The 1960 Census Data THE WATER PROBLEM I. Introduction When is there a water problem? Normally it is assumed that a problem exists when there is a restriction on water usage; or, in other words, when the demand exceeds the supply at any time for any reason. Demand is a function of domestic, commercial, industrial, and public needs on both a quantity and quality basis. Supply is function of rainfall potential through the hydrologic cycle, the availability of water due to restrictions placed on it by geography, geology, and time distribution. Urban supplies can also be restricted by other water uses. II. Demand A. Quantity The size and variation of the demand can best be judged by past records of water consumption, taking into account the various factors that will affect it at the present and in the future. The demand is normally expressed in terms of use rates, gallons per capita per day, million gallons per day, or as a per cent of the average daily use. A study of the population growth is an important factor for determining future demand rates. 1. National average water uses Use Domestic Industrial Commercial Public Waste Total Amount 60 g.c.d. 32 g.c.d. 21 g.c.d. 15 g.c.d. 22 g.c.d. 150 g.c.d. Per cent 40 21 14 10 15 100% Boulder, 1959 234 g.c.d. 2. Variation in rates of usage Rates will vary with the time of day, day of the week, and seasons of the year. Normally, the peak demand will take place in the late summer, primarily because of lawn sprinkling. 5 National Average Variations Maximum Month 125% of Average Maximum Week 150% of Average Maximum Day 180% of Average Maximum Hour 265 % of Average (Taken as 150% of Maximum Day) R. O. Goodrich suggested the following formula: p =l!Q to. 1 Where "p" is in per cent of average daily use and "t" is in days. 3. Population growth a. National growth b. Regional growth c. Past growth of the community d. Future industrial development 1) Regional 2) Community 4. Factors affecting average demand a. Size of the community g. Percentage of services metered b. Location of the community h. Community pride c. Characteristics of population i. Air conditioning d. Pressure in distribution system j. Commercial establishments e. Quality of water k. Industrial needs f. Cost of water 1. Quantity available B. Quality 1. Domestic - must be potable, i.e., must be safe to drink, palatable to the taste, and usable for domestic purposes. 2. Industrial - varies with the type of industry. III. Supply A. Source The original source is the ocean. The water evaporates into the atmosphere; the vapor is carried overland by prevailing winds, precipitates out, and falls as rain, snow, etc. A portion of this precipitation flows overland, providing a possible source of surface supply. Some of the precipitation percolates down through the soil to join the underground water reservoir where most of it becomes available as a possible source of ground water supply. The remaining portion of precipitation is lost back to the atmosphere through evaporation and transpiration. 6 1. Precipitation The form of the precipitation is important. Water in the form of snow accumulates over the winter months and is released in the spring thaw. Normally most of this water is lost to municipal use. However, the rate of release is a function of the rate of melt. Thus, watersheds in the mountains furnish stored water long after the snow has left the plains. a. Average rainfall for U.S. is 30 inches per year. b. Annual Denver rainfall is 14 inches. c. Average Boulder rainfall is 18 inches per year. d. Boulder watershed rainfall is 20 inches per year. 2. Runoff The total runoff equals rainfall minus losses. For a gentle short rain the losses can approach 100%. On a national basis they average out to be 72 % annually. Total runoff can be divided into surface runoff and ground-water flow. The greater the rainfall rate, the greater the percentage of surface runoff. a. Surface runoff - 2570 of total yearly runoff Major source of surface supplies 1) Streams 2) Lakes 3) Reservoirs .b. Ground water - 75% of total yearly runoff Major source of ground supplies 1) Wells 2) Springs 3) Galleries B. Quantity If all the fresh water was spread over the land's surface it would flood it to a depth of 13.2 feet. 1. Surface supply a. Approximately 75% of the population in the United States uses surface water as a source of supply. b. Normally, minimum stream flows govern surface supply. Surface supplies can be increased by building a reservoir and saving water from periods of high flow. c. Surface runoff from a drainage area is able to concentrate large volumes of water into a single stream, making it easily available as a source of water supply. 2. Ground water a. The major share of the fresh water is stored underground. b. Because of the slow rate at which ground water flows (measured in feet per day) it is difficult to obtain large volumes of water. 7 c. Ground water is the source of water supply for the majority of small towns. C. Quality The quality of a municipal water supply is governed by domestic needs. However, industrial needs, both present and future, should be looked into. 1. Relative safety of raw water supply a. Ground water b. Surface water; protected watershed c. Surface water built up 2. Relative palatability of water source a. Ground water b. Surface water 3. Relative usability of water source a. Surface water b. Ground water D. Unusual sources of water supply 1. Ice - Greenland 2. Rain water - British West Indies, Gibraltar 3. Saline water conversion - not an important factor now or in the near future. Cost $1.00 to $2.50 per 1,000 gal. of water produced, compared to 3 to 20 per 1,000 gal. of fresh surface and ground supplies. a. Re-use of polluted water - good possibilities here, especially where industry is concerned. E. Other factors to consider in choice of water supply source 1. Reliability 2. Cost 3. Legal considerations F. Multipl'e use of water Only a small portion of the water is actually consumed. Most of it can be put back in the stream for re-use. However, economic considerations should decide the primary use of water when there is a conflict in interests. The following study shows the economic worth of water in the Casper, Wyoming, area. Use Power Recreation Irrigation Municipal Worth $ 0.20 to $1.27 per acre-foot 3.50 per acre-foot 12.67 to $135.00 per acre-foot 14,800.00 per acre-foot IV. Supply-Demand Relationship With adequate tr~ated water storage the raw supply need be only 120 to 150% of average daily demand. 8 1 V. Conclusions A. There is enough fresh water to take care of water problems provided the public is willing to pay for it. B. Water may be re-used, and therefore more than 100% utilization of runoff can be obtained in the future. C. A municipality will always have a water problem or potential water problem because of the increasing demand. D. The water problem must be kept under control or it will affect the public health and economy of a municipality. References 1. Black and Veatch, Consulting Engineers, Preliminary Design, Memorandum on Water Works Improvements for Boulder, Colorado. Kansas City, Missouri, 1961. 2. Hirschleifer, Jack et al. Water Supply. Chicago: University of Chicago Press, 1960. 3. Linsley, Ray K, Jr., et al. Hydrology for Engineers. New York City: McGraw-Hill Book Co., Inc., 1958. 4. Schroepfer, G. J. and Johnson, W. K Lecture Outline for Water Supply. Minneapolis: University of Minnesota Bookstore. 5. Steel, Ernest W. Water Supply and Sewerage. 4th Ed. New York City: McGraw-Hill, Inc., 1960. 6. U. S. Department of Health, Education, and Welfare. Municipal Water Facilities in Cormmmities of 25,000 Population and Over. United States and Possessions. PHS Publication No. 661, Washington, D. C. 1960 Edition. 7. United States Senate, 86th Congress, Select Committee on National Water Resources, Water Resources Activities in the United States. Prints 1, 12, 32. U. S. Govt. Printing Office, Washington, D. c., 1960. 8. Williamson, Arthur E. and Weers, Walter A. "Criteria for the Economic Evaluation of an Acre-Foot of Water." Unpublished paper. Cheyenne: Wyoming State Health Department. 9. Wolman, Abel. "Impact of Desalinization on the Water Econo- my." J. Am. Water Works Assn. 53: No.2, February 1961. 9 THE SEWERAGE PROBLEM I. Introduction A. The American way of life requires that sewage be removed from communities in such a way that health is protected and that all legitimate uses of water are preserved. B. The second requirement places vast new responsibilities on the sanitary engineer without in the least reducing his responsibilities to environmental health. C. The Federal Water Pollution Control Act directs the Secretary of the Department of Health, Education and Welfare to develop cooperative comprehensive programs to improve the sanitary quality of water (surface and underground) and to conserve the quality for public water supplies, propagation of fish and aquatic life and wildlife, recreational purposes, and agricultural, industrial, and other legitimate uses. D. Under present philosophy the pollutor is required to control or remove pollutants at the source to the extent of his ability. The cost of reducing the remaining pollution so that beneficial water uses are restored and preserved is then transferred to the general public. II. Elements of the Problem (This discussion will encompass all of the works necessary to collect, treat, and dispose of sewage. Rational analysis of the sewerage problem usually considers the maj or elements in this order: disposal, treatment, collection.) A. Disposal opportunities are usually limited. 1. Disposal opportunity will set important objectives and place limitations on the type of treatment required. 2. Common disposal opportunities include: a. Rivers and streams b. Lakes c. Coastal waters and estuaries d. Surface runoff without continual dilution e. Soil f. Atmosphere g. Re-use of water with or without reclamation of solids B. Control and treatment of pollution at the source is a requirement of our time. 10 1. The type of treatment will be dictated to a large extent by the disposal opportunity under consideration. a. Beneficial uses that treatment is to protect are sensitive to different bodies of water, the soil, the atmosphere, or the re-use situation. b. Although the type of process will be chosen to make the effluent most compatible to the final disposal, the pollutor is still required to control or remove pollutants to the best of his ability. c. Proper operation of a treatment plant is necessary and a scheme should not be accepted if there is reasonable doubt about the adequacy of existence of legal, administrative, and technical factors required for dependable operation. d. In selecting between possible acceptable alternatives, costs of operation, maintenance, and periodic replacement (if any) should be considered along with first costs. e. If the community is required to vary policing or administrative activities, an appropriate cost should be added to each proposed scheme. C. Collection has not received the emphasis it deserves. 1.. It is the most costly element, i.e., capital cost, maintenance and property damage. 2. Storm-water overflow and other losses from the collection system are a major factor in water-pollution control. 3. Problems associated with the collection system often form a major deterrent to otherwise rational urban development plans. III. Special Problem of Urban Development A. Within a half-century the sanitary engineer has moved from the challenge of sewering established cities, to providing treatment for established collection systems, to providing both facilities for rapidly expanding metropolitan areas. B. The new challenge is the most complex problem ever faced by the sanitary engineering profession. It is to provide for safe and proper collection, treatment, and disposal of sewage in an expanding suburban area, with minimum expenditure, minimum risk, and maximum service from the time the first house is built on raw farm land until the area is completely developed. C. The technology is developing slowly for efficiently pra- II viding a sewerage system-house by house and subdivision by subdivision-in the transition of farm land to complete urbanization. D. In the meantime costly errors can be avoided by careful observation and analysis. 1. Identify the time-growth rate situation a. Scattered homes on large lots b. Isolated commercial establishments c. Nucleus of continual development with both resi- dences and commercial establishments d. Isolated island of high population density with or without commercial establishments 2. Identify location with respect to terrain, disposal op- portunities, and plans for eventual development of the area. 3. Examine legal restrictions and administrative factors bearing on the choice of a sewerage system. 4. Determine how the provisions of the Federal Water Pollution Control Act or sources of Federal, State, or local assistance apply to the situation. 5. Identify the possible acceptable choices and make a cost analysis including at least: first cost, maintenance and operating cost, future replacement or transition costs, administrative and policing costs. 6. Final selection should insure that major expenditures are invested in permanent works and that desirable actions are also reasonable actions from the standpoint of the residents and voters. a. Pav careful attention to hidden subsidies and cost- transfers. References 1. PL-660 - 84th Congress as amended by PL 87-88. Federal Water Pollution Control Act. 1961. 2. "Proceedings of the National Conference on Water Pollution (1960)." Public Health Service Publication No. 819. 3. Thomas, H. A., Jr., Coulter, J. B., Bendixen, T. W., and Ed- wards, A. B. "Technology and Economics of Household Sewage Disposal Units." Sew. and I17d. Wastes 32: 2: 1I 3. Feb. 1960. 4. Ludwig, H. F. "Feasibilitv of Curvilinear Alignments for Residential Sanitary Sewers." FHA Contract No. HA C------) Th-775. June 1959. 5. Coulter, J. B., Bendixen, T. W., and Thomas, H. A., Jr. "Metro- 12 politan and Sewage Handling Technology." Sew. and Ind. Wastes 31:8:90. August 1959. 6. Kraus, L. S. "Combined Treatment of Industrial and Domestic Wastes." Sew. and Ind. Wastes 30:2: 199. Feb. 1958. 7. McCallum, G. E. "Formula for Economy: Combined FederalCity-Industry Action." Wastes Engineering. Oct. 1961. 13 THE REFUSE PROBLEM I. Introduction A. The storage, collection, and disposal of solid wastes is one of the major problems of urban areas. B. Present expenditures usually exceed those made for water or sewer service by the average home owner. Ex. Washington Suburban Sanitary District Rates: $40.20 per year for water and sewer charge, $30.00 per year for refuse service (43 % of total). C. The American Public Works Association (August 1960) estimated that the cost of collection and disposal of community solid wastes amounted to about $1,500,000,000 annually, one of the substantial financial burdens of our municipalities. D. Commercial, trade, and manufacturing refuse, demolition, debris, agricultural solid wastes, and some other special classes of solid wastes are often not the responsibility of the regular refuse collection agency. E. Urbanized areas are finding that solutions to local solid waste problems are becoming increasingly difficult and costly. Not only has the public constantly demanded ever higher levels of sanitation, but the commonly used methods have appeared to be so simple that in many instances insufficient records are kept to determine unit costs of present methods or to realistically plan for future needs. II. Reasons for Public H ealtlJ Concern A. Flies not only feed on refuse, but also use it for a breeding medium. Garbage was found by Schoof, et al.,1 to be the most important fly source in Charleston, \Vest Virginia. In other studies, Silverly and Schoof2 found that as many as 70,000 flies were produced per cubic feet of garbage that was exposed to ovapositing flies. B. Other insects are sometimes troublesome at refuse storage points and at disposal sites. Mosquitoes, cockroaches, earwigs, ants, scavenger beetles, and crickets are most frequently the cause of concern. C. Rodents feed on refuse and use it for harborage. Rodent 14 control efforts are ineffective when quantities of refuse are accessible to rats and other rodents in each backyard or at disposal sites. D. Air pollution studies have shown that refuse disposal activities contribute significant quantities of contaminants to the ambient air of our metropolitan areas. Such disposal activities include burning dumps, municipal incineration, backyard burning, household incineration, apartment house incineration, and commercial incineration. Domestic incineration is widely practiced. Thousands of communities without adequate refuse collection facilities force their citizens to resort to backyard burning of paper, leaves, and other refuse. E. Water pollution results when refuse is dumped directly into water or at landfills where ground or surface water intercepts the deposited refuse. Since this problem has long been recognized by all levels of government, it is the subject of restrictive legislation in most places. F. Aesthetic considerations (including unsightliness, odors, and noise) are frequently found to be the basis for objections raised by property owners. While sometimes difficult to evaluate, they are often associated with other objections, such as harborage of rats. G. Fire hazards are commonly associated with both poor storage conditions and disposal operations. "Trash fires," which destroy lives and property in our communities, the occasional spectacular forest fire that has been kindled by a burning dump, and the hospital fire at Hartford, Connecticut (12/8/61), are all examples of the hazards associated with handling combustible refuse. III. Definitions and Classifications A. Based on Character of Materials 1. Putrescible (garbage) 2. Non-putrescible (rubbish) a. Organic (combustible) b. Inorganic (non-combustible) B. Based on Source of Material 1. Public refuse (street sweepings, leaves, dead animals, catch basin cleanings, and contents of litter receptacles) 2. House refuse (garbage, including small dead animals, rubbish, and ashes) 3. Market refuse 4. Trade refuse (solid industrial wastes) 5. Demolition debris 15 C. Based on Separation Practiced 1. Mixed refuse or combined refuse (garbage and rubbish) 2. Garbage 3. Rubbish (combustible, non-combustible, and yard) D. American Public Works Association's Classification 1. Refuse materials are grouped by kind and composition, and sources are indicated. These definitions are widely used in the technical literature, to avoid the inevitable confusion involved in using local legal definitions. IV. Quantities and Their Variations A. Quantities Vary Widely According to Local Practices 1. Total refuse production is 18-4.63 lbs./capita/day (45-50% moisture content). 5 lbs./capita/day-average 2. Garbage production: 20-25 % of total 3. Non-combustible rubbish: 20-25 % of total 4. Combustible rubbish: 50-60% of total B. Variations from Average are Influenced by: 1. Geographical location of municipality 2. Season of the year 3. Characteristics of the community 4. Personal habits of the populace 5. Financial status of the community 6. Efficiency of collection service 7. Influence of war (approximately 15% reduction III quantities) 8. Size of community (size and type of industry) V. House Treatment (handling of refuse before it is taken by collector) A. Separation 1. Garbage 2. Combustible rubbish 3. Non-combustible rubbish (may include ashes in some systems) 4. Yard rubbish (tree trimmings, grass clippings, and may include dirt, rocks, and masonry) 5. Ashes B. Other Preparations Practices 1. Exclusion of hospital and sickroom refuse 2. Draining excess water from garbage 3. Wrapping of garbage in newspaper 4. Cutting large objects to suitable length so that they can be placed in storage container or cut and tied so they can be handled easily 16 C. Storage 1. Receptacles a. Material 1) galvanized metal cans 2) rubber or plastic cans 3) Kraft paper bags 4) wooden bins 5) masonry vaults b. Shape 1) cylindrical 2) tapered 3) rectangular c. Size 1) mixed refuse 28-32 gallons (40-50 lbs. max.) 2) garbage 3-16 gallons 3) combustible rubbish (cans or burlap bags) 4) non-combustible rubbish (usually cans or boxes) 2. Special use receptacles a. Attachable containers for use with mechanical loading trucks b. Canvas or burlap bags (fire hazard) c. Single service Kraft paper bag holders 3. Container protection a. Racks or posts b. Underground cans c. Concrete slab d. Draining and wrapping of garbage c. Can washing f. Lining can with paper 4. Requirements for satisfactory storage containers a. Tight-fitting covers b. Sturdy, water-tight construction c. Adequate size d. Corrosion resistance e. Suitable handles f. Smooth surfaces for emptying and cleaning g. Small enough so one man can handle it easily 5. Location of container a. Alley b. Near back door c. Curb or house line D. On-Site Disposal 1. Garbage grinding 2. Incineration a. Indoor domestic incineration b. Commercial incineration c. Backyard burning 3. Salvage (volunteer organizations and junk dealers) 4. Garden compositing VI. Collection of Refuse A. Steps Involved in Refuse Handling 1. Transportation of refuse from point of aggregation to a location accessible to the collection vehicles 2. Loading a. Lifting and placing refuse in the collection vehicle b. Arranging and/or distributing the refuse during the collection so as to utilize the full capacity of the vehicle 17 3. Dumping the refuse at the transfer or disposal site B. Methods of Refuse Collection 1. Curb (or alley) service a. Residents carry refuse to curb b. Collection by crew c. Residents return empty containers 2. Set-out service a. Set-out crew carries containers to curb b. Collection by separate crew c. Residents return the empty containers 3. Set-out and set-back service a. Set-out crew carries containers to curb b. Collection by separate crew c. Set-back crew returns empty containers 4. Back-yard carry service a. Collection crew travels with truck, transfers refuse to tubs or baskets in backyard b. same crew loads refuse directly into collection truck-refuse containers remain in backyard 5. Attachable or bulk containers for use with special trucks 6. Shovel service for yard rubbish, bins, or masonry vaults 7. Can exchange system 8. Single service Kraft paper bag collection C. Factors Affecting Refuse Collection 1. Containers a. Type b. Size (volume and weight) 2. Degree of separation 3. Density of population 4. ClaSs of residence 5. Frequency of collection 6. Collection vehicles used a. Loading height b. Packers c. Unloading method 7. Mandatory collection 8. Pavements and grades 9. Climate 10. Length of haul D. Types of Collection Agencies (for additional information see Hering and Greeley5) 1. Public (municipal or special district) a. Advantages 1) sanitation, not pro-fit, is primary consideration, and supervision is more readily effected 2) greater flexibility of the service is secured to meet evercbanging conditions of season, weather, population, etc. 18 3) work is directly under control of public officials, whose chief object is to render public service, at the house and on the street, at reasonable cost, thus eliminating the not unnatural tendency among some contractors to do, within the terms of the contract, as little as practicable and with the least expenditure of money by themselves 4) direct responsibility to the public produces quicker results 5) is less expensive, generally, because the eqUipment investment is permanent; no fund is necessary to meet emergencies, no profit is included, and no operating taxes are included b. Disadvantages 1) business principles are sometimes sacrificed to political machinery, when it demands unnecessary changes in appointments, methods, etc. 2) operation of refuse collection may fall into hands of incompetent and untrained officials 2. Contract a. Advantages 1) application of business principles is more readily effected 2) elimination of politics from the operation removes some chances for unsatisfactory changes in working force 3) simplification of the work of the municipality is advantageous, chiefly in smaller towns 4) a definite sum of money is fixed in advance for the work 5) borrowing funds for construction and purchase of supplies is obviated, as the contractor must raise the capital b. Disadvantages 1) profit, not sanitation, is the predominating influence-the contractor's criterion is the least sanitation permissible at least cost 2) operation is less elastic, and contract profits may be reduced by sudden unforeseen occurrences 3) response to unforeseen occurrences is less rapidbreach of contract may produce unsanitary service 4) as usually no records of details are kept, it is difficult for the city to make estimates of cost and efficiency of service 19 5) there are uncertainties in ascertaining the approximate quantities of refuse to be collected 6) lack of concern for public welfare invites failure to give full service 7) lack of direct responsibility to the public causes hindrance to expeditious action 8) uncertainty of contract renewal causes excessive charge for use of equipment 9) the apparently frequent difficulties 10 letting a contract for a long term, partly 10 view of strikes, panic, or war 10) in view of the foregoing uncertainties, the contract system, especially in large cities, is frequently more costly 3. Private (scavenger) a. Under license or regulation with franchise-similar to contract, except mandatory collection not required b. Unregulated 1) overlapping of collection routes is expensive 2) competition for customers results in price cutting, minimum sanitation, and minimum service 3) special pickups, such as for yard rubbish, are expensive E. Separation and Frequency of Collection 1. Systems commonly used a. Separate collection (R)-residential (C)-commercial 1) garbage: (R) 2/wk.; (C) daily 2) non-combustibles: (R) 1/wk.-1/m; (C) as needed 3) combustibles: (R) l/wk.; (C) daily b. Combined collection 1) mixed refuse: (R) 2/wk.; (C) daily 2) commercial garbage: daily 2. Factors affecting a. Disposal methods b. Climate c. On-site incineration d. Local custom F. Collection Vehicles 1. Open (includes canvas or woven wire covered) a. Garbage (low-loading height) b. Mixed refuse (high-loading height) 2. Rigid covers (sliding-door type most commonly used for garbage) 3. Top loaders 4. Load packers (mixed refuse or rubbish) 5. Special trucks for use with attachable containers 20 G. Methods of Financing Collection 1. Taxes 2. Service charge 3. Separate fee H. Essentials of Satisfactory Collection 1. Sufficient funds 2. Efficient organization 3. Sanitary and economical methods of work 4. Cooperation on the part of the public VII. Supplemental T'ransportation (transfer stations) A. Systems Used 1. Refuse is transferred from the collection truck to trucktrailer, railroad car, or scow 2. Specially designed vehicle body, fully loaded, is transferred to another vehicle or railroad car B. Factors Affecting 1. Cost of hauling 2. Cost of transportation by supplemental methods 3. Available locations for transfer stations 4. Available locations for final disposal 5. Quantities to be handled VIII. Disposal A. Requirements for Satisfactory Disposal 1. Absence of danger to public health 2. Minimum nuisance to the public 3. Minimum expense that will effect a sanitary disposal of all refuse materials B. Methods of Disposal 1. Natural methods a. Dumping into large bodies of water (generally now illegal) 1) requirements (a) wharf and unloading facilities (b) scows 2) advantages (a) separation not required (b) no limit on quantities 3) disadvantages (a) water pollution (fouling of beaches) (b) interruption by weather b. Open dumping on land (illegal in many cities and counties) 1) requirements 21 (a) waste or lo,v land within an economical hauling distance (b) access roads (c) isolated site 2) advantages (a) low direct cost (b) separation not required 3) disadvantages (a) flies and other insects are commonly produced in large numbers (b) rodents, if uncontrolled, become numerous (c) air pollution-obnoxious odors are commonly associated with open dumps (d) aesthetics-the operation invariably is like a festering scar on the countryside (e) water pollution is a threat unless the site is carefully chosen, considering the possible pollution of both surface and ground water c. "Sanitary landfill is a method of disposing of refuse on land without creating nuisances or hazards to public health or safety, by utilizing the principles of engineering to confine the refuse to the smallest practical area, to reduce it to the smallest practical volume, and to cover it with a layer of earth at the conclusion of each day's operatio'n or at such more frequent intervals as may be necessary." Definition by A.S.C.E.G 1) types (a) trench method (b) area method (c) ramp method (moving trench method) 2) requirements (a) waste or low land within an economical hauling distance (b) earth moving equipment (c) access roads (d) cover materiaF 3) advantages of sanitary landfill (a) isolated site is unnecessary (b) separation is not required (c) ab~ence of danger to public health, or of nUIsances (d) the variety of uses of the resulting land 4) disadvantages of sanitary landfill 22 (a) bulky articles are difficult to incorporate into the fill (b) good operation is essential or the landfill soon becomes little more than an open dump (c) many communities cannot use this method because a suitable site is not within economic hauling distance (d) deposited material decomposes slowly over long periods of time d. Plowing into soil (European practice, not commonly used in this country because of objectionable odors and the nuisance of windblown papers) e. Burial (European practice, not commonly used in this county because it is limited to the disposal of garbage) f. Feeding to hogs 1) types (a) hog farms feeding swill, garbage, or food processing wastes (b) landfills where hogs are allowed to feed on the dumped material (usually mixed refuse) before it is covered (omitted from the discussion below) (c) open dumps where hogs are allowed to feed on the dumped material 2) requirements (a) isolated site with well-drained sandy soil (b) suitably-designed concrete feeding platforms, barns, and pens (c) an adequate water supply for drinking and cleaning (d) good management (e) suitable method of disposal for uneaten garbage and hog manure 3) advantages (a) utilizes the food value of the garbage (b) produces fertilizer as a by-product (c) provides a small income which partially defrays the collection cost 4) disadvantages (a) flies and other insects are commonly produced in large numbers (b) rodents, if uncontrolled, become numerous 23 (c) obnoxious odors make it difficult to find suitable sites for hog farms (d) water pollution is a threat unless the site is carefully chosen, considering the possible pollution of both surface and ground water (e) careful separation by the householder is essential to the success of this method of disposal (f) more frequent collection is necessary so that the garbage is fresh when fed (g) cooking is generally required to prevent and control hog diseases (vesicular exanthemia) (h) aesthetics-in many areas the presence of a hog farm is sufficient to cause complaints and depreciation of property values 2. Artificial methods a. Sorting and salvage 1) requirements (a) materials handling equipment such as conveyors and other special equipment (b) reasonably isolated location 2) advantages (a) reclaims for use material that would be buried, burned, or simply destroyed (b) conserves disposal facilities 3) disadvantages (a) the market for salvaged materials fluctuates widely (b) dust, noise, and odors are nuisance problems in the immediate neighborhood and to the workers b. incineration 1) types (a) basket-grate (for wet materials or mixed refuse) (b) multiple-cell, mutual-assistance type (several burning hearths located side by side in one large burning chamber) (c) single-hearth (circular, using the rabble arm for mechanical striking) (d) rotary kiln (inclined rotary drum) (e) traveling grate, cone grate, and other types 2) requirements 24 ;. { '\ (a) costly incinerator, stack fly ash traps, and materials handling facilities for charging and removing the ashes (b) skilled operation (c) centrally located site 3) advantages (a) no separation necessary and the collection is generally easy and clean (b) hauling costs can be reduced because good incinerators can be built in the center of a city (c) the process is thoroughly sanitary and destroys all organic material and pathogens (d) by-products of incineration (waste heat and clinker) provide some revenue 4) disadvantages (a) high cost (b) dust is produced within the incinerator building during operation (c) air pollution cannot be prevented without careful and skilled operators (d) all the refuse is not consumed by the incineration process, so that facilities for the disposal of the ash residue must be provided c. Reduction of garbage 1) requirements (a) costly special equipment (b) highly skilled operators (c) fairly isolated site (d) careful separation by the householder 2) advantages (a) the reduction process converts organic material into grease (b) provides an economical method for the disposal of dead animals 3) disadvantages (a) odors and nuisances are produced by the process which are difficult and costly to suppress (b) the market value for grease and tankage fluctuates widely, making it hazardous to invest large sums in the expensive machinery required d. Central garbage grinding 25 1) requirements (a) central grinding station (storage pit, conveyor system, sorting tables, grinder, and settling basin) (b) central location near a trunk sewer 2) advantages (a) much of the organic content of the garbage can be salvaged at the sewage treatment plant where fertilizer-humus can be produced (b) savings can be made because of shorter hauls 3) disadvantages (a) separate collection of garbage is necessary (b) does not handle all putrescible refuse e. Compositing 1) essential steps, as given by Gotaas: 8 (a) shredding to increase surface area (b) moisture control by adding water or dry material (c) aeration to keep process aerobic (d) mixing to uniform compost all the material being treated 2) requirements (a) separation or sorting of the compositable material is essential (b) grinder or shredder (c) source of fresh water (or sludge) and dry material (d) special equipment for aeration and mixing (e) materials handling equipment (f) fairly isolated site 3) advantages (a) reclaims for use organic material that would be largely wasted (b) conserves disposal facilities (c) high temperatures destroy insects in all stages of development (d) the finished product is unattractive to flies 4) disadvantages (a) no established market exists for compost in this country (b) separation or sorting is necessary (c) not more than one-half the production costs are paid for by the sale of the end-product (Netherlands) 26 f. Dehydration (food processing wastes) 1) requirements (a) materials handling, dehydrating, and grinding equipment (b) reasonably isolated location 2) advantages (a) reclaims for use organic material that would be largely wasted (b) high temperatures kill insects in all stages of development (c) the resultant material is unattractive to flies 3) disadvantages (a) high cost of specialized equipment (b) market value of final product varies according to the price of natural feeds References 1. Schoof, H. F., Mail, G. A., and Savage, E. P. "Fly Production Source in Urban Communities." Journal of Economic Entomology. 47(2): 245-253. 1954. 2. Silverly, R. E., and Schoof, H. F. "Utilization of Various Production Media by Muscoid Flies in a Metropolitan Area. II. Seasonal Influence on Degree and Extent of Fly Production." Annals Entomological Society of America. 48(5): 320-324. 1955. 3. American Public Works Association, Committee on Refuse Collection. Refuse Collection Practice. 2nd Ed. A.P.W.A. Research Foundation Project No. 101. Chicago: Public Administration Service. 562 pp. 1958. 4. American Public Works Association, Committee on Refuse Disposal. Municipal Refuse Disposal. A.P.W.A. Research Foundation Project No. 104. Chicago: Public Administration Service. 522 pp. 1961. 5. Hering, Rudolph, and Greeley, Samuel A. Collection and Disposal of Municipal Refuse. New York: McGraw-Hill. 666 pp. 1921. 6. American Society of Civil Engineers, Committee on Sanitary Landfill Practice. Sanitary Landfill: ASCE Manuals of Engineering Practice No. 39. 62 pp. 1959. 7. Black, Ralph J., and Barnes, Allen M. "Effect of Earth Cover on Fly Emergency from Sanitary Landfills." Public Works. 89(2): 91-94. February 1958. 8. Gotaas, Harold B. Compositing-Sanitary Disposal and Reclamation of OrJ{anic Wastes. Monograph Series No. 31. Geneva: World Health Organization. 205 pp. 1956. 27 THE AIR POLLUTION PROBLEM I. Public Health Defined A. "Old" Definition 1. Absence of disease 2. Freedom from epidemic B. New Definition 1. The World Health Organization definition, "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."l C. Definition of Sanitation 1. "Sanitation is a way of life. It is the quality of living that is expressed in the clean home, the clean farm, the clean business and industry, the clean neighborhood, the clean community. Being a way of life it must come from within the people; it is nourished by knowledge and grows as an obligation and an ideal in human relations." The National Sanitation Foundation. II. Significance of Changing Definition of Public Health A. Planners may expect answers from the public health profession regarding such questions as: 1. What levels of air pollution cause detrimental health effects? 2. What air quality conditions promote health? B. The changes in definition of public health provide: 1. A new tool for: a. Prevention of air pollution b. Development of healthful communities in terms of WHO as well as "old" definition of public health 2. A basis for those people in environmental health work to meet the responsibilities placed on them by an affluent society C. The change in defining public health requires that environmental health people: 1. Understand the basic principles of community development 2. Develop public health objectives which allow for promoting community best interest 3. Develop positive environmental health programs which 28 delineate clearly between "absence of disease" and "state of complete physical, mental, and social well-being" III. Air Pollution Effects (Problems) A. Episodes Involving Acute Attacks of Air Pollution 1. Meuse Valley fumigation, Belgium, 1930 2. London, England, fumigation, 1952 3. Poza Rica, Mexico, fumigation, 1950 4. Donora, Pennsylvania, fumigation, 1948 B. Chronic Health Effects 1. Increasing data are being gathered by medical researchers which tend to link air pollution with increased mortality and diseases of the cardio-respiratory system, increased susceptibility to respiratory diseases, and interference with normal respiratory function C. Plant and Animal Effects IV. Air Pollution Defined A. Legal B. Physical and Biological C. Conservation D. Community Development E. Composite - Specific Application V. Air Pollution Control - Under New Definition of Public Health A. Air Resource Management B. Air Quality Standards C. Emissions Reported D. Prediction of Air Pollution Levels by Computer E. Planning - Land Use Cards with Emission Factors F. Basic Grid for Computer Analysis of Problems Reference 1. Constitution of the World Health Organization. Geneva: WHO, Basic Documents, Ed. 12. 1961. 29 THE HOUSING HYGIENE PROBLEM I. What is Neighborhood Conservation? Neighborhood conservation is a program to maintain the economic and social values of the neighborhood, and where desirable, to improve those values. Neighborhood conservation accomplishes its aims by maintaining and improving the physical standards of the neighborhood, both private and public. Its aim is to maintain and improve the quality of the area's housing and public projects. Its approach is neighborhood improvement-not just the improvement of a single structure-and it is concerned with basically sound neighborhoods-neighborhoods that are worth saving. Of major importance in this definition is the neighborhood approach. Although it is possible to conserve a single structure ,or a group of structures, effective and lasting conservation is undertaken on a neighborhood or planning area basis. A prerequisite for a conservation program, therefore, is the existence of a plan for the neighborhood. A. What is Property Rehabilitation? Property rehabilitation is the remodeling or renewing of an existing structure. Property rehabilitation is essential in a neighborhood conservation program. B. What is Codes Enforcement? Codes enforcement is the enforcement of a comprehensive system of codes regulating the use, construction, alteration, and maintenance of private property within the community. Such codes and ordinances include the building, plumbing, electrical, fire prevention, housing, zoning, and related codes and ordinances. It is important that these codes and ordinances be administered as a coordinated system of enforcement. Codes enforcement is an all-important tool in carrying out a city-wide neighborhood conservation program. II. Why is C071nmt1lity-wide Conservation of Existing Homes and Neighborhoods Necessary? A. Sub-standard dwelling units and neighborhoods are a nationwide problem, as indicated by the 1960 Census data: Ac- 30 cording to the 1960 Housing Census, there were 58.3 million dwelling units in the United States. Out of these, 3 million are dilapidated, 8.4 million are deteriorating, 4.3 million are sound but lacking some or all plumbing facilities. The data classified 8.4 as deteriorating because of deficiencies which will require repairs if the units are to continue to provide adequate shelter. B. Only city-wide effort can succeed. C. Many older existing neighborhoods have deteriorated or are deteriorating. Some of the factors possibly responsible for the deterioration of existing neighborhoods are the lack of: 1. Strong, alert citizens organizations to spot and report code and ordinance violations, and to encourage home maintenance and improvement 2. Adequate physical environment and amenities, playgrounds, streets, open spaces, etc. 3. Adequate and/or continuous city services, such as garbage and rubbish collections, street cleaning, tree trimming, etc. 4. Adequate and/or continuous zoning enforcement 5. Adequate and/or continuous health and housing code enforcement 6. Adequate and/or continuous high standard police enforcement 7. Positive, comprehensive, educational, and social service programs to train children and adults in urban ways of living 8. Proper maintenance standards on the part of many residents-both recent and earlier migrants 9. Available money on the part of residents to maintain or improve property 10. Knowledge of how to budget available money for all family needs, including home maintenance and improvement 11. Knowledge of how aesthetically and economically to maintain property or to improve it 12. Adequate legislation to handle removal or nonconfonning uses, assay dwellings, substandard housing 13. Neighborhood cohesion 14. Incompletely developed zoning ordinances 15. Legalized violation of zoning ordinances 16. Indifference or an exploitation tendency on part of some absentee owners of property 31 Some of these factors are the responsibility of local governments, others are the responsibility of various com- munity agencies, and others are the responsibilities of private citizens, owners, and renters. D. There are many values worth saving. 1. In community properties: streets, large shade trees, schools, cultural institutions-libraries and churches 2. In private properties: shopping centers, larger houses 3. In other values of in-city living: less travel time to work, close to downtown, close to transportation, good traffic routes to all parts of the city 4. Social III. What Can Be Done to Prevent the Decline of Existing Neigh- borhoods? A partnership of citizens, private enterprise, and governmental agencies working together can analyze the problems, develop a plan to resolve these problems, and to carry out a long range action to prevent slums and blight, through neighborhood conservation and rehabilitation of individual properties. IV. How Do You Start to Develop a Comprehensive City-wide Neighborhood Conservation Program? A. Find the facts-make an inventory of housing conditions. 1. Obtain perspective on your city'S housing problems-see your home, neighborhood, and city as a whole. Identify and measure in broad terms the needs of each neighbor- hood in your city. B. Identify neighborhoods which are basically bad: in need of cleatance and redevelopment. C. Identify neighborhoods which are basically sound, with home and community values worth conserving and capable of restoration to a long-term sound condition. D. Relate these problems to the resources available to the community to resolve them. V. How Can a Basic Fact-Finding Study of Housing Conditions be Used To: A. Create community concern? B. Develop long-range plan and city-wide program for neighborhood conservation action? C. Establish work priorities? D. Implement action program? E. Bring about concurrent operation of conservation activities fitted and appropriate to the needs of each neighborhood? VI. What Tools Are Available for Developing and Carrying Out a Neighborhood Conservation Progrcrm? A. Local: - 32 1. Community organizations 2. Code enforcement 3. Private initiative-voluntary property improvement and modernization B. Federal: 1. 1960 Housing Census Data - can be very useful in making screening type of evaluation of housing conditions. These data contain information on housing conditions on a block basis for all cities with a population of 50,000 or more. It is also available for the over 250 cities with less than 50,000 population who contracted with the Bureau of the Census for the collection of housing conditions data. 2. Urban renewal aids a. Community Renewal Program for comprehensive city-wide blight analysis b. Non Assisted Conservation-assistance limited to FHA Mortgage Insurance and FHA purchase of mortgages c. Assisted Conservation (Title I) - eligible for full scope of Title I aid d. Assisted Redevelopment (Title I) - eligible for full scope of Title I aid e. FHA Home Mortgage Insurance 1) 220 and 221 within appropriate urban renewal areas 2) 221 outside of urban renewal areas 3) New Home Improvement Loans (a) 203(k) - outside urban renewal areas (b) 220(h) - inside urban renewal areas f. FHA insured short term Title I Property Improvement Loans g. Eligible project costs for assisted conservation activities 1) staff or consultant services for: (a) carrying out or coordinating eligible project services or activities. For projects involving conservation or reconditioning of 100 or more dwelling units, the hiring of a project coordinator, and staff assistants when required, for organizing, scheduling, and directing project activities, including the coordination of related local governmental activities, is an eligible project cost. 33 (b) coordinating social services available in the community to serve the needs of project residents in connection with carrying out the project. (c) establishing and maintaining neighborhood organizations for property owners and residents in the project area. (d) working with existing neighborhood organizations to develop their understanding of and their participation in project activities. 2) provision for office space, equipment, and services to assist organizations included in 1) (c) and (d) above. 3) rental of space for holding neighborhood meetings sponsored and arranged by the LPA. 4) preparation of educational materials, such as models, where warranted by the size of the project, photographs and other exhibit materials, pamphlets, and rental or purchase of films, slides, and projector equipment. 5) general guidance to property owners in solving common problems involving finance, design of structures, legal matters. Eligible project costs include: (a) hiring a finance advisor or counselor to establish continuing liaison with and develop support of participating lending institutions, to advise individual property owners of the financing available, and to expedite the processing of loan applications for individual properties. (b) hiring an architectural consultant to provide general guidance to property owners in solving common problems on the design of properties and to coordinate exterior property improvements block by block. 6) design services, but not including working drawings, to assist property owners in improving their services. 7) design services, including working drawings and specifications, to improve public rights-of-way functionally and from the standpoint of appearance, such as redesign and relocation of street signs, lighting, and wiring; design of pedestrian 34 service facilities, such as benches; design of surface treatment for unpaved spaces, and for landscaping. 8) design services, including detailed drawings of typical properties, for guidance purposes in a demonstration home and information center. 9) establishment, rental, and remodeling of a project office to provide educational and other services to property owners and residents in the project area. In effect, all of the activities essential to establishing a one-step home improvement center to assist property owners and tenants are eligible project costs. VII. How Can These Tools Be Employed in a Comprehensive Overall Approach to City-wide Neighborhood Conservation? A. Here is the spot for the schematic presentation of how these tools can be used to delineate the neighborhoods in the city on the- basis of condition and develop objectives and a program for the major kind of renewal treatment or treatments required to improve them. 1. Sound and stable neighborhoods a. Examples of typical problems b. Principal elements of voluntary self-help program to maintain and improve these neighborhoods 1) neighborhood organization 2) self-inspection of home and neighborhood 3) group involvement of tenants and owners 10 area-wide improvement projects 4) establishment or improvement of communications on problems and projects through neighborhood newspaper or newsletter 5) continuing information and education program on: (a) master or general plan (b) codes and their enforcement (c) responsibilities of individual citizens to maintain and improve home and neighborhood (d) how individual owner and tenant can cooperate with his local government 2. Neighborhoods just beginning to deteriorate a. Examples of typical problems (see draft of T. G. 9) b. Principal elements of Non-Assisted Conservation Treatment 35 3. Deteriorating neighborhoods-basically sound, with ma- jority of individual properties sound, with physical surroundings definitely declining or lacking in basic amenities a. Examples of typical problems b. Principal elements of Assisted Conservation 4. Deteriorated neighborhoods (between basically bad and basically sound areas)-majority of individual properties in need of major repair, environment in need of major improvement 5. Dilapidated neighborhoods-basically bad, beyond sal- vage, need to be cleared and rebuilt a. Examples of typical problems b. Principal elements of Assisted Redevelopment Treat- ment VIII. How Can the City Finance the Work It Must Undertake in Connection with a Conservation Program? A. Local B. Federal IX. How Can the Individual Finance the Improvement or Re- habilitation of His Property? A. Conventional Short-term Loans B. Conventional Long-term Loans C. FHA Long-term Home Mortgage Insurance 1. 220 and 221 within appropriate urban renewal areas 2. 221 outside of urban renewal areas 3. New Home Improvement Loans a. 203 (k) - outside urban renewal b. 220(h) - inside urban renewal areas D. FHA Insured Short-term Title I Property Improvement Loans X. What Are the Prerequisites to Obtaining Federal Aid? A. Before and After Examples of Successful Programs 1. New Haven, Connecticut 2. Philadelphia 3. Clinton Park, California 4. Little Rock, Arkansas 5. Dayton, Ohio B. Other Accomplishments . C. Extent of Current Participation 1. 150 cities 2. 200 urban renewal projects involve conserva- tion treatment 3. In over 100 projects conservation is pre- dominant treatment XI. What Are the Benefits of Neighborhood Conservation to: A. Individual Property Owner? B. Neighborhood? C. City? D. Nation? XII. Where Help and Information May Be Obtained A. Local B. Federal 36 THE RADIOLOGICAL HEALTH PROBLEM I. Introduction The nuclear age has had unprecedented impact upon virtually all scientific fields. In medicine, industry, and research, both radiation-producing machines and radionuclides have become tools for progress, and provided considerable savings in costs today estimated in terms of hundreds of millions of dollars per year in industry alone. These benefits to mankind cannot be experienced, however, without some consideration for health protection. The purpose of this lecture is to point out sources and levels of radiation exposure, methods of radiation, hazard assessment, and the need for periodic evaluation of the over-all radiation stress placed upon man. From such knowledge, those sources of radiation which are of greatest concern from a control standpoint should become apparent. II. Sources of Radiation Exposure Rather than explore the exposure potentialities of all radiation sources only those sources wherein large population groups are involved will be considered. A. Natural Background! The magnitude of background radiation is of significance for comparison with the radiation exposure burden being superimposed by man. 1. Cosmic radiation Primary cosmic rays are high energy positively charged particles, primarily protons. Their distribution varies somewhat with latitude. a. External exposure The primary rays interact with the earth's atmosphere, producing particles and x-rays. Essentially no primary particles are present below 50,000 feet and the dose received at sea level is less than at higp altitudes. For example, at 5,000 feet, the dose is about twice that at sea level; at 15,000 feet, more than five times that at sea level. b. Internal exposure 37 The reaction of cosmic rays and secondary neutrons with atmospheric materials causes transmutation of certain elements. Of particular importance is the production from nitrogen of carbon-14 and tritmm. About 1 in every 108 carbon atoms and 1 in every 101,8 hydrogen atoms are made radioactive. When metabolized, these radionuclides constitute a portion of the internal exposure received by man. 2. Terrestrial radiation Radioactivity in the earth's crust consists mainly of the uranium, thorium, and actinium series plus about twelve singly occurring radionuclides. On the average, a square mile of earth one foot deep contains about 50 curies of these materials. Another component of terrestrial radiation is that due to housing materials containing earthen matter. a. External exposure Whole-body gamma doses in the U.S. vary widely depending upon local conditions of the earth's crust. Dose ratios vary approximately as follows: 1. for sandstone and limestone areas 2. for basalt areas 3. for granite areas b. Internal exposure The radionuclides, originally present in the earth's crust, are gradually leached into waters, evolved into the atmosphere, or taken into foodstuffs. B. X-ray2 X-ray machines are finding widespread use in medicine, industry, commerce, and research. All such uses are potential sources of external exposure. 1. Medical and dental use Currently, approximately 200,000 x-ray units are being used in the United States for diagnosis and therapy. It is predicted the number will reach 370,000 by 1970.3 Some 80,000 to 100,000 of these units are being used by dentists, with approximately an equal number being employed by general practitioners, radiologists, and in hos- pitals and clinics. It is assumed that another 10,000 to 15,000 units are used by osteopaths and chiropractors. It is estimated that 300,000 - 400,000 medical-tech- nical personnel are occupationally exposed to radiation in the use of these machines. This may be whole body radiation in some cases. In addition to these personnel, a considerable portion of the general population is also 38 exposed to radiations from x-ray machines used in medicine and dentistry. A large portion of the 2,500,000 persons seen daily by physicians have some x-ray diagnostic procedure performed upon them. Estimates indicate there are approximately 38 million roentgenographic and 25 million photofluorographic films, and 13 million fluoroscopic examinations being taken or given annually. When properly conducted, these examinations cause only partial body radiation exposure to the patient. 2. Industrial uses Industrial x-ray devices include primarily (a) radiographic and fluoroscopic units used for the determination of defects in castings, fabricated structures, and welds, and (b) fluoroscopic units used for the detection of foreign material in, for example, packaged foods. At present, there are approximately 1,500 industrial radiographic installations in the United States with more than 5,000 persons potentially occupationally exposed in the use of the equipment. Use of these units may result in whole body exposure to the operators and people who are nearby. The total number of industrial x-ray units in the United States exceeds 2,000. 3. Commercial uses The largest commercial use of x-ray machines is in shoefitting. In the operation of the approximately 6.000 shoe-fitting fluoroscopes in the United States, 30,000 to 40,000 sales people are exposed to radiation. The exposure received by the public in the operations of these machines is unknown. Many health authorities consider such exposures completely unnecessary. As a result, the use of this type of radiation device has been banned or restricted in about half of the states. 4. Research uses High-voltage x-ray machines are becoming familiar features of research laboratories in universities and similar institutions. Other x-ray equipment used in research includes some 1,500 diffraction units and approximately 500 electron microscopes. Still other research units which are sources of machine-produced radiation include the particle accelerators. In 1941, there were only 16 cyclotron laboratories in the United States. Today, more than 250 cyclotrons, 39 synchrotrons, van de Graaff generators, and betatrons are in use.4 C. Radionuclides2 The uses of radionuclides in recent years have increased tremendously. Today, both naturally occurring and artificially produced radionuclides are widely used in medicine, industry, and research. 1. Naturally occurring The naturally occurring radionuclide most widely used in medicine and industry is Ra226 An important factor to remember when considering the health aspects of naturally occurring radionuclides is the fact that they can be purchased on the open market. No formal application or special facilities are required in order to obtain these materials. Approximately 1,000 curies of radium are in use in the medical field. In this use, many individuals besides the patient are potentially exposed to radiation. These include other patients, nurses, technicians, radiologists, and physicians. In industry, one of the principal uses of uranium is for radiography. It is estimated that 50 to 100 curies are currently being used for this purpose. Another important industrial use of radium is in luminous compounds. During World War II, several hundred curies were used for this purpose with approximately 2,000 per~ons being employed in this work. State eliminators, employing polonium or radium as the radioactive source, are widely used in industry. Typical of industries where they may be found are the textile and paper trades, printing, photographic processing, and telephone and telegraph companies. Static eliminators are also used with analytical balances and micro tomes. 2. Artificially produced Several thousand universities, hospitals, and research laboratories in the United States are using radionuclides produced by the Atomic Energy Commission for medical, biological, industrial, agricultural, and scientific research, and medical diagnosis and therapy. It is estimated that the approximately 5,000 physicians licensed by the U. S. Atomic Energy Commission to utilize r~dio nuclides diagnosed or treated illnesses of one million 40 people with these materials in the United States in 1958 alone. Possible exposure from such radionuclides is involved with their preparation, handling, and application, and with their transportation. At least 20,000 persons are estimated to be directly involved in such activities. Exposures, internal and external, might also arise through contamination of the environment by wastes originating from the use of these materials. A total of about 1,000,000 curies has been distributed since inception of the radionuclide sales program in 1946. Currently, some 15,000 shipments are made each year by the Oak Ridge National Laboratory, plus about 100,000 additional annual shipments by commercial suppliers. D. Nuclear Reactor Operations Sources of radiation exposure associated with nuclear reactor operations include the reactor itself, its ventilation and cooling wastes, procedures associated with the removal and reprocessing of its "spent" fuel and the resulting fission product wastes, and procedures associated with the mining, milling, and fabrication of new fuels. There are currently almost 150 reactors in operation in the United States with more in various stages of design or construction. Within the near future, it is expected that nearly all major colleges and universities will have reactors for research and instructional purposes. The use of reactors for the production of power is also expected to continue to increase with a total of at least 23 civilian power reactors in operation by 1964.5 Navy schedules call for increased numbers of nuclearpowered vessels, most of them submarines but including aircraft carriers, cruisers, and destroyers.6 Future construction plans of the Army, Air Force, and utility power companies also include a large number of power reactors. Concurrent with this increase will be the need for more land-based research facilities and reactor-powered research propulsion units. Some 10,000 workers are currently engaged in uranium mining and milling in this country. This work is carried on primarily in the New Mexico and Colorado plateau regions. The number of workers involved in the fabrication of new fuels and reprocessing of "spent" fuels is unknown. The predicted curiage of fission product wastes from such 41 operations is tremendous. Although the environmental levels are kept low, potentially everyone is subject to internal and external radiation exposure associated with the escape and release of reactor wastes to the environment. E. Weapons Tests In 1951, 12 nuclear devices were detonated at the Nevada Proving Grounds.7 The world-wide total of detonations to date is over 200. More important than the number of devices is their energy yield, which is an indication of the quantity of fission products produced. Information released at the 1959 Congressional "Fall-out Hearing" showed that 90 to 92 megaton fission yield equivalent had been released to that date. (see Table 1)8 TABLE 1. UNITED STATES, UNITED KINGDOM, AND SOVIET NUCLEAR EVENTS (Yield in Kilotons) Inclusive Years Air Burst Fission Yield* Total Yield Ground Water Surface Surface Air Surface Burst Burst Burst Burst 1945 - 1951 190 500 20 190 570 1952 - 1954 1,000 15,000 22,000 1,000 59,000 1955 - 1956 5,600 1,500 6,000 11.000 17,000 1957 - 1958 31,000 4,400 4,600 57,000 28,000 *A value of 50.,. has been arbitrarily selected for the fission to total yield ratio for all Soviet thermonuclear tests. As indicated in the tables, 50.,. is about the average fission to total yield ratio for all US/UK thermonuclear tests. As a result of detonations of nuclear weapons, large quantities of radioactive materials have been introduced into the atmosphere. Small amounts of these materials have been and are being deposited throughout the world. Such deposition is known as fallout. Generally speaking, fallout is currently the most important source of environmental contamination, and this source will continue to provide a reservoir of long-lived fission products for years to come even if international control of bomb testing is achieved. III. Genetic Dose to the Population In expressing to the general popUlation the radiation exposure arising from the sou~ces previously discussed, one must be careful to specify the part of the body being considered. Because 42 of genetic effects, the dose to the gonads or reproductive organs is considered by many to be of prime importance. IV. Radiation Hazard Assessment In evaluating the total radiation exposure from the various sources, on a whole body or individual organ basis, two general methods have been utilized. For purposes here, these will be termed assessment by "direct" and "indirect" (or "environmental") methods. A. Direct Assessment This method provides a reasonably accurate measure of external and internal health hazards but may be of limited value from a standpoint of controlling the internal hazard. 1. External hazard Air ionization measurements in terms of roentgens can be related to biological dose in rem units. Such measurements obtained with survey-type instruments are useful, for example, in surveys of x-ray installations. These surveys, which are designed to measure potential levels of external radiation exposure, are of value in establishing practical control measures and directly assessing the external health hazard associated with the use of x-rays. 2. Internal hazard The amount of radioactive materials in the body, from which the magnitude of radiation exposure in rem units can be calculated, may be determined by: 1) assay of body tissue, or 2) analysis of waste materials normally eliminated by the body. Techniques involved in the assay of body tissue include: a) radiochemical analyses of the organ or portion of the body under study, and b) external measurements such as are possible with whole body counters employing gamma scintillation spectroscopy. The analysis of exhaled air or of feces or urine has been employed to determine the amounts of various radionuclides, such as radium and plutonium, in the body. These measurements are necessarily accomplished after-the-fact and are of little value insofar as controlling the hazard is concerned. For example, they do not reveal the source of radiocontaminant nor the mode of intake into the body. To delineate these factors, an environmental assessment procedure is required. B. Indirect or Environmental Assessment The internal radiation exposure of the body or a portion thereof may also be approximated by a quantitative appraisal of the radionuclide contaminants in the air, water, and food 43 being taken in by man. Guides have been calculated for a number of radionuclides and represent that concentration which, if continuously ingested or inhaled over a long period of time, would result in whole body or organ doses equal to the appropriate maximum permissible dose (Radiation Protection Guide) for the portion of the body affected.9 10, 11 Thus, through comparison with such guides, it is possible to estimate the dose rate to any particular body organ provided the average intake values of the appropriate radionuclides in a particular environment media are known. This type of approach also reveals those specific radionuclides which pose significant hazards. To facilitate control of any of those hazards requires identification to pollution source(s). This is accomplished in part by knowledge of the material contaminated, that is, whether air, water, or a particular food. It is possible to establish further the source of contaminant by 1) geographic location of the sampling point, 2) knowledge of the release of contaminants, or 3) studies of the radioactive and/or physiochemical properties of the contaminant. The scope of the environmental assessment program, necessary in establishing realistic control measures of radiation exposure from environmental contaminants, considering all critical organs and radionuclides, represents a complex task. Present-day monitoring programs typically represent a measurement of the total radioactivity (i.e., total alpha and toral beta) present in air, water, and foods. When the levels of activity measured are sufficiently high, analysis of certain critical radionuclides (e.g., strontium-90, iodine-1 31, etc.) has been performed. With the majority of monitoring programs, it has been possible to establish the source of contaminant by the techniques mentioned above. V. Commentary To keep pace with the expanding uses of nuclear energy, public health personnel must cope with many radiation hazards which must be evaluated in terms of recommended maximum permissible levels of radiation exposure or Radiation Protection Guides.9 10. 11 Such Guides have been defined by the Federal Radiation Council as the radiation dose which should not be exceeded without careful consideration of the reasons for doing so. Simultaneous with the increase in number of sources of radiation exposure, the recommended maximum permissible levels have been decreased many fold. 44 As a matter of policy, every effort should be made to encourage the maintenance of radiation doses as far below the Guides as practicable. The challenge facing public health and other health-related personnel today is thus defined-maintain levels of radiation exposure as low as practical without imposing undue restriction on the uses of radiation and atomic energy. References 1. Lowder, W. M., and Solan, L. R. Background Radiation-A Literature Search, NYO-4712. July 1956. 2. Moeller, Dade W., Terrill, James G., Jr. and Ingraham, Samuel C. Radiation Exposure in the United States. Public Health Re- ports. 68: No. 1. Pp. 57-65. Jan. 1953. 3. Gloyna, E. F., and Rude, J. C. Radiatio Protection. Texas State Journal of Med. 52: No. 12. Pp. 853 60. Dec. 1956. 4. Behman, Gerald A. Particle Accelerators, . ibliography. II. List of Accelerator Installations. AEC Report -5050. Jan. 1, 1958. 5. Strauss, Lewis L. The U. S. Atomic Energy Program 1953-58. Atomic Energy Commission News Release No. A-162. June 30, 1958. 6. Kenton, John E. Navy Makes Great Strides. Nucleonics. 17: No.9. Pp. 73-81. Sept. 1959. ,. 7. Glasstone, Samuel, Ed. The Effects of Nuclear Weapons. f Prepared by U.S. Department of Defense. Published by U.S. Atomic Energy Commission. P. 552. Available U.S. Govern- ment Printing Office, Washington 25, D. C. Price $2.00. June 1957. 8. Joint Committee on Atomic Energy, Congress of the United States, Summary-Analysis of Hearings May 5-8, 1959. Fallout From Nuclear Weapons Test. U.S. Government Printing Office, Washington 25, D. C. P.12. August 1959. 9. National Committee on Radiation Protection. Maximum Per- missible Body Burdens and Maximum Permissible Concentra- tions of Radionuclides in Air and in Water for Occupational Ex- posure. Handbook 69. Published by The National Bureau of Standards. For sale by Superintendent of Documents, Govern- ment Printing Office, Washington 25, D. C. June 1959. 10. Federal Radiation Council, Report No. 1. Background Material for the Development of Radiation Protection Standards. May 13, 1960. 11. Federal Radiation Council, Report No.2. Background Material .' for the Development of Radiation Protection Standards. Sept. 1961. ~ 45 "1 i ORG GEORGIA DEPARTM I GENERAL AS Q I STATE BO I -E IA 1 DIVISION r " MENTAL HEALTH I " DIVISION PHYSICAL HEALT I "OSPITALS .0"'1. _MfA&,. M(ALTH tUTU ...aa:WOOO nATI ICI'tOOl. .. MO'''ITAL MILL.mI[VtU.( ITATI: . . . . . .TAL I SERVICE Al,COMCM.MO 'UMA'1L.ITATIOII COIUIUtIfTT Mt:JfTAL Nr..... - ......- .JfTA&.. HULTH 1'\." '''' "VITAL MTrJilDI,U:* .,rBRAHCH SPECIAL SERVICES SERVICE CHRONIC IL.L.NESS $. GEJUATlUCS MEDICAL. '.CllITIES UTTlY sTAn "O"ITAl .,IBRANCH PREVENTABLE OtS(ASlS SfRV'CE ,AROIOVASCULAR DISEASE CONTROL OCW,.ATIONAl "("lTH 5.f.K.5. s[eTlO" T.I. COJlUOl , ....Cl:" CONnOI,. Slc;.TION V. D. CONTROl SEcTION 1 BRANCH " DENTAL HEALTH SflllVICE MJtTAl,. ~811C H[ALTH .----- ~ ..iJ LOUL -A.M aUlD '--- .. '"a''''''M WIl OUlnl _AUM IlJtVlcn STATUS 7/1/63 - I. I LOCAL HE LOCAL HEA I . F P!JBLlC HEALTH 1 OF GEORG IA p .~ ~_. "I I I I j I 'l ;1 I .DIVISION EPIDEMIOLOGY I .DIVISION I: ADMINISTRATION , FINANCE :, I- .'I~ jL ~ .IIIRANCH [NVIRO""Ef,jTAl HEALTH S E: III V I C [ IEMfW. f"INf.[III. salUTATION HOUIINI HYlII:NE .NO ACCI)lNT PM:VENTlQN INDUSTfUAl.. NYIIENI WATER "uoull:cn .IIIRANCH HEALTH CONSERVATION S I: 1'1 V I C r "'........t:D CHILOf'U'S TEIUIAI. AND CHILD HIAL'T1t IU",n,OIl ICHOOl.. HEALTH .I,IRANCH U 1CIlOIIC IMSTJCAn_ SERVICE IIOLOGIC STUDIES SfCTlON OlUAS( AND DlSAltliTY STUDIES SECTION 'Ullle N[AL TN Y(T["IN"RY SECTION .IIRAHeH lAIIOIUTORIES SERVICE CENTRAL LAIOR.rOIllY 'I(LD lAIOlll"lOIllY REGIONAL. LAIORATO'UES '-- SIBY'GI ACtOUteTIM lIOITAT'ITI'1 . .IIUIL ITA" HI.&l.T" IDUGATIOtI ..-"...A. t_. "0 VITAL UClDltOl 'ATlUIl ACCOUNTS neT10" blSTRICTS :!PARTMENTS THE GENERAL SANITATION PROBLEM I. Introduction A. Problems 1. Our urban areas have s\vollen to vast organisms whose scale far transcends the possibility of study and control through the efforts of individuals. The environments of our urban areas are man-made. Solutions to urban environmental problems must be approached through group action. 2. The growth and movement of population are adding to the complexity and multiplicity of public health problems. It has been suggested that an inadequate supply of water may be the only factor that may limit the growth of our cities. In most other respects, a metropolitan area of 50,000,000 may be possible. Throughout history, man has increased to the extent that his manner of life and environment have allowed. Various experts have predicted a U.S. population of 225,000,000 by 1975; or 320,000,000 by 2000. Predictions indicate that onethird of this total will live in ten (10) super-metro- politan areas and that urbanities will compose 85 % of the total population in this country. 3. It is reasonable to expect a continued downward trend of the death rate, and age distribution curves will develop larger bulges at both ends. 4. The continued growth of urban and suburban areas requires not only rapid expansion, but almost a "crash" program of increasing all environmental health activities. Without the necessary planning and prevention now, the price for curative programs will be vastly increased in future years. Weare not only concerned with the community's health in future years, but also in future generations. 5. The population will continue to grow, age, have more leisure time, and congregate in urban areas. There are "musts" in every environmental health activity. Each :1 46 poses a problem and is a challenge for planning and improvement. We must increase environmental health activities as related to all age groups, working conditions, etc., whether at home, work, school, or play. Environ- mental health must encompass not only the dangers of dying, but the hazards of living. Our over-all environ- mental health needs are increasing more rapidly than available facilities and personnel. 6. Time and large-scale financing are required, but it has been difficult to convince governing bodies that programs of the necessary magnitude must be undertaken immedi- ately-and the average citizen often takes his public health services for granted, assuming that he is being protected when no such protection exists. It is difficult to compete for necessary financing with activities such as police, fire, traffic, engineering, and public works,. where lack of effort is indicated by immediate symptoms. A de- creased or insufficient environmental health budget is more insidious in that the adverse effects may not be apparent for years or generations. We must re-emphasize .1 that treating our environmental health problems too little, too late, not at all, or in a curative manner, will reap nothing but sorrow, expense, and increased mor- bidity and mortality for our metropolitan areas. Environ- mental health programs are a basic function of govern- ment that cannot be overlooked, sidetracked, or excused so that other immediate demands for governmental financing may be met. While we have inadequate environmental health services, millions are spent for other community health services which are not absolutely necessary or basic to the health, safety, and welfare functions of government. Too many governmental expenditures are not in tune with public needs and basic governmental functions. Many of these inconsistencies can only be explained historically, politically, or by understanding expediency. 7. Financial support for environmental health needs is available if governing bodies can be convinced as to the need and the priority. They must be shown that the benefits justify the expenditures. The governing bodies will find methods of supporting what seems to be of value on a priority basis. Opportunities for the applica- tion of knowledge will always be greater than the funds available; so priorities must be established at all levels ,~ 47 ;1 of government. And our approach to necessary environ- mental health services must be realistic and practical. 8. Local interest, backing, control, and financing provide the basis for the most efficient and effective environ- mental health program. Most activities cannot be man- aged efficiently or economically from the state level. When this is attempted, one more incentive for local communities to support and manage their own health departments is removed. As more and more incentives are removed, the likelihood of our total population's living under the protection of effective environmental health services becomes more remote. The local health depart- ment is a necessary part of the total public health program and we must be adamant in insisting on a sound allocation of responsibility at all levels of govern- ment. E. State Role 1. The Nation's health is dependent on the State's health, and the State's health is dependent upon that of local jurisdictions. Too often only lip service is given to the need for solving health problems locally with personnel responsive to local needs and direction. Many are guilty at times of thinking that the state can do a better job. Often this is based on the reluctance to delegate authority or as a reaction to expediency. We need strong state and local health services. State health departments have the responsibility of providing strong leadership and of supporting, encouraging, and assistin~ in the development and improvement of local health services; technical assistance; consultation; methodology; demonstrations; training; and financial assistance. 2. We need considerable leadership in modernizing state laws to provide proper and necessary responsibility and authority for local health agencies. We must meet the environmental health needs of each specific community and provide benefits that the people consider worth the cost. To do this, we must understand the politics of public health, or the political process in relation to public health. C. Political Role 1. The political process is basic to community life and action. Health "'orkers cannot ignore it, and must under- stand it. Access to government, to public opinion. to vital I points in the power structure of each community is of " 48 crucial importance. The product is action. An understanding of the political process is as necessary to community public health administration as an understanding of the scientific basis for public health practices. Politics is an art based on experience and knowledge. It is the art of recognizing what is possible at a particular time and place and of mobilizing support and influence so as to achieve those aims which are considered desirable. It is the art of understanding the formal and informal community power structure. The political highway in the community is one that environmental health personnel must learn to travel despite its twistings, turnings, and ruts. Skill in avoiding its dangers and in mastering its geography will no doubt be reflected in the ability to deal effectively with the health problems of the modem community. 2. Any program is apt to become involved in politics and may become the weapon of politics. Look at the "Radiation in Milk" situation if you don't believe this. 3. Many public health workers have demonstrated their distaste for the political process whether it be good or bad politics. Perhaps this is one of the reasons other community service agencies have their feet more firmly l'lanted in the financial trough. We need professionalism 1U public health, but this should not rule out being practical. Perhaps too much public health professionalism, and security of position by virute of this professionalism has, in some cases, prevented necessary administrative changes and progress. D. Social Aspects 1. A working knowledge of social forces, the political process, and community organization may often be more important than any specified professional background. Environmental health problems transcend professional disciplines, and the talents of a vast array of specialists must be utilized to conduct a successful program. Environmental health practice is not the sole province of anyone specialty, and to think so is to think narrowly. Further the director of an environmental health program has as much need for administrative skills as for those involving technical and scientific knowledge. 2. It is important that the public be brought in as partners in studying, planning, budgeting, and executing environmental health programs if we are to receive the 49 1,. necessary public understanding and support. It is only honest to admit that the public, in many communities, exhibits apathy, disinterest, and lack of understanding with respect to environmental health. Perhaps this is a symptom of lack of environmental health leadership and administrative skills. We need greater citizen participation, and must put an end to "living in a professional shell," or existing on a totem pole because we are "Professionals." We must not only permit, but encourage, people to study their own problems and decide what must be done. We must seek and gain consensus and speak across professional boundaries to leaders in other fields as well as to the general public. 3. This obviously leads into the field of public relations. To me, any environmental health program is doomed for failure unless good public relations are a constant adjunct to it. The public can be vitally interested in, and knowledgeable of environmental health needs and achievements if we utilize good public relations as we go along. The various mass news media can be our most important allies if we will show the sincere desire to work with them. We must constantly remember that ultimately we must deal with people, not things. Environmental health personnel have a basic public relations problem within their own public health family which must be faced at all levels of government. Some of the greatest harm is done through the inadvertent ignorance of other public health personnel. 4. Another problem facing all levels of government involves the jurisdictional prerogatives of some 16,000 local governmental units in less than 200 metropolitan areas. Most metropolitan areas are a patchwork of governmental units which often cannot be justified logically, but can only be explained historically. There is no standard solution to this problem. 5. Environmental health specialists have had to revise their thinking with relation to goals in recent years. Formerly, we thought in terms of eradication of an undesirable environmental factor. But now, we must think in terms of "tolerance" for certain environmental factors instead of eradication. It is impossible and impractical to eradicate radioactivity, toxic chemicals, etc., but we can attempt to keep the levels of such contaminants within established maximums. 50 try. Such lack of uniformity is confusing to the citizens and indicates a questionable basis for the standards. Our programs should be based on needs and facts, not implications, inferences, suggestions, or economic pressures. 2. We must detail and justify our needs. It is becoming more difficult to obtain greater budgets by adding new programs. 3. Results of environmental health expenditures must be worth the money or we are not using our personnel economically and efficiently. However, the nature and effects of many of today's stresses are not reflected in explosive outbreaks like those characteristic of communicable disease and do not readily lend themselves to assessment in terms of vital statistics. Environmental health practice in the past was geared to communicable disease problems. Now, it is modified to embrace the impacts that are more subtle and long-range in their effects. The resolution of these problems is more involved and complex than those of communicable disease control. There is difficulty in measuring the effects as well as in precisely isolating and understanding the cause. 4. Thus, while the community wants to see the results of its assistance or expenditures, the results may often be difficult to demonstrate. A high degree of ingenuity is frequently necessary to convince people that they should pay to control environmental factors and stresses they can't see, or which are difficult to demonstrate through vital statistics. 5. Each of us has another problem with our "Public Health Vocabulary." Consider terms like ... Sanitation (A measure of cleanliness, or a garbage truck?) Environmental Health (Some say only an animate object can be healthy) Radiological Health (Wouldn't "radiation control" be more appropriate?) Sewer-connected Population Program (An Hour with "The Untouchables"?) Activity Let's try to speak in a manner that the public understands. 6. Every health agency has an obligation to engage in necessary environmental research. A myriad of problems, needs, and -answers are needed. Research funds are 52 II. General There is no lack of reports, articles, and quotations to document the critical environmental health problems of our urban areas. We will now discuss some specific environmental health prob- lems not assigned to other speakers. For purposes of simplicity, our environmental health contacts have been listed as Air, Water, Shelter, and Food. Other speakers have discussed aspects of all except the latter. A. Food Sanitation Food sanitation is one of the most important aspects of any comprehensive environmental health program. It takes a major bite out of our budget, and is actively desired by our citizens and governing bodies. B. Discussion of: 1. Food sanitation 2. Milk sanitation 3. Chemicals in the environment 4. Hospital sanitation 5. In- dustrial hygiene 6. Meat inspection 7. Nursing homes 8. Child care centers 9. Plumbing inspections 10. Insect and rodent control 11. School sanitation 12. Swimming pool control 13. Accident prevention 14. Recreational areas 15. Land-use planning and subdivision control C. Personnel 1. We have begun to detail the tremendous environmental health problems. Obviously, we could do a lot with money and personnel. But there is even a shortage of the necessary skilled personnel. There are 17,000 professional public health positions, but almost 9,000 persons in these positions are without the necessary professional training. Even the necessary training facilities and aids are not always available. 2. If we can't do the whole job, we must establish priorities in environmental health based on the problems in each community. We may have to curtail some services in order to provide others. The changes necessitating these priorities may be in the environment or in community demands and expectations. At any rate, a continuous re-evaluation of needs and efforts is required. The Public Health Service Environmental Health Planning Guide is a useful tool for such evaluations. We must study routine and accepted programs to determine if they are still needed. D. Other Aspects 1. We have another problem in arnvmg at reasonable uniformity of interpretation of various environmental health standards' and requirements throu .-h-o-u--t-t-h=e coun- 51 ,\,\\\.'. \,\-N,lI'\!!'i--'LL)"/>/~j'~ o ...-.._- ," L. I I (.) u h '.' .::;-.;-::: j'\ . :'.-..,.~) 'V) l!~ , F G[ 0HI~\ \ t\X'~ '>l .... ~-,.~..::;.;~ ' ularly in the minds of the taxpayer. To a degree, I feel that environmental specialists must definitely be concerned with ":. aesthetic problems in the environment, particularly if they are of concern to the taxpayers and the governing body. Basic findings of a recent survey conducted by the American Public Health Association, which sent questionnaires to all state and territorial health officers, as well as a sampling of directors of city and county health departments and regional directors of the United States Public Health Service, indicated that the most important need during 1960 was for an expansion of local health services. The effects of the trend toward metropolitan living and the newer environmental hazards presented by atmospheric pollution, ionizing radiation, and the protection of foodstuffs were reflected in the fact that en- vironmental health was most frequently mentioned as the most important "newly emerging health problem." There has been much progress in environmental health practices, but we still have much unfinished business. In this modern age, the image of environmental health has not always kept pace. There are still many who equate environmental health with communicable diseases and dead horses in the river and little else. Those who are truly interested in modern en- vironmental health must seek to demonstrate its importance, and to project it to those in responsible positions. It is our job, collectively, to present what is commonplace to us in a manner that will be exciting, create understanding, and stimulate the necessary support. To do this we must use the tools of education, information, consultation, research, demonstration, persuasion, and enforcement. 54 ',' available. But most local health agencies are so understaffed and so busy meeting problems of the day that they can't devote time and effort to planning, organizing, and administering a research project. III. Conclusion A good health department plays a dual role in promoting environmental health by: (1) stimulating interest in areas where it does not have primary responsibility, and technical expertness, and (2) by taking the leadership in those areas in which it has expertness or responsibility. With these principles in mind, some local health departments may have to take the leadership in promoting such environ- mental health-related activities as building codes, urban renewal, refuse collection services, planning departments, etc. Many of us feel that, nation-wide, there are too many en- vironmental health programs that are not administered by the health department. This has resulted in new agencies, dupli- cation, overlapping, confusion, etc. In some cases this has oc- curred because the particular governing body was not aware of the environmental health implications, the concern of environmental health workers, or the competence of environ- mental health personnel. Perhaps this could be abbreviated to state that there was lack of environmental health leadership. But regardless of this, environmental health officials must still be interested in such programs and have a working relationship with the departments to which such programs have been assigned. A great deal of time could be utilized in discussing proper salary scales for various environmental specialists. Too 1 many have arrived at an answer by making a "survey" of pay scales utilized by other health agencies. This usually only :i compares one under-paid position with another under-paid position and results in compounded and continuing error. A more realistic approach would be to compare pay scales with those paid by industry to comparable personnel in the same economic areas. A similar problem exists regarding personnel-population ratios. The American Public Health Association has suggested, for example, that we should have one public sanitarian for each 15,000 people. This figure is a guide and point of departure, but must be viewed critically in the light of community needs, problems, and expectations. I .] It is often quite difficult, even impossible, to adequately separate public health problems from aesthetic problems, partic- 53 ROLE OF THE LOCAL HEALTH DEPARTMENT I. The Concept of the Local Health Department A. "Local"-Local Coverage at Level of Government Closest to the Citizen A local health department represents that unit of government established to provide essential and desirable community health service, closest to the citizen. Ideally, a local health department is organized on a county or multi-county basis. The first county health units were established approximately fifty years ago and during the past half century there has been progressive coverage of the United States, so that today approximately three-fourths of the public has nominal provisions of service through a local health department. During the past decade, the rate of expansion of local health departments has diminished and the total personnel employed in local health departments has remained relatively stationary. The coverage of local health departments also varies greatly from state to state. In general the southern states have an almost complete coverage, whereas in the midwest and mountain states, the organization of local health departments has been spotty. In metropolitan areas the core city often is found to have a municipal health department as a charter requirement. In recent years there has been a trend toward combining the municipal health department with that of the county in which the municipality is located. Despite this desirable trend, perhaps one-half of the major metropolitan areas in this country still have a divided or even splintered pattern of organization as far as local health services are concerned. In many cases the effectiveness of local health services is weak because of inadequate appropriations, unrealistic salary schedules, lack of personnel standards, and hence a failure to provide for a non-political, career type of employment. Despite these problems, the local health department continues to be a highly desirable unit of local government. It provides public health services at the level of government closest to the citizen; thus it is quicker to recognize the ./ f 55 \ health needs of the community and to respond to those needs. Because the organization is local, it is possible to involve citizens more readily in planning and directing the work of the department. B. "Health"-Concerned With Broad Community Approach Toward Health An effective local health department is concerned with all phases of community health. Major divisions of the department ordinarily are concerned with environmental health, nursing services, disease control, statistical methods (including the collection and keeping of vital records), provision of laboratory service, and health education service. The department is flexible in composition of staff, and its structure is subject to some modification. The executive director of a local health department is ordinarily a public health physician. The professional staff of the department makes use of a broad variety of personnel from the health pro~ fessions. Ordinarily the division of environmental health is directed by a public health engineer, who in turn will be assisted by engineers and public health sanitarians. The numbers as well as the types of personnel reflect the nature of community health problems as well as the interest that the community has in seeing that an effective program is carried out. As a rule of thumb, the division of environmental health will probably require one professional person for each multiple of 15,000 persons served. Reference is frequently made to the team approach. This refers to the cooperative activity between the various types of professional personnel employed by the health department. The association of the Division of Environmental Health with the public laboratory, the statistical section, the health education section, and the nursing division, is readily apparent. C. "Department"-A Basic Unit of Local Government (often autonomous in local government) The organization of a local health department is not ordinarily mandatory, except in cities, where it is frequently required by charter. Many states have made provision for meeting a part of the cost of local health services through state grants, often made on a matching basis with local tax support. In municipalities the health department is frequently a line department of government. In counties it is more often established as an autonomous unit of government responsible to a Board of Health, made up of citizens appointed by the County Board. The legal powers of a 56 county health department usually derive from the state legislature, but provision is ordinarily made for the enactment of local ordinances, either by the Board or at the request of the Board of Health. II. The Local Health Department is an Essential Health Unit in Environmental Health Planning for Several Reasons: A. Type of Personnel Employed The philosophy of prevention, which is inherent in all public health activity, is closely allied to community planning, which may also be considered preventive in the sense of anticipating and providing for all community functions and needs. The type of personnel employed in a health department may be thought of as. health planners in that their purpose is to prevent situations which would be detrimental to individual and community health. Thus, to the commuiity planner, the type of personnel employed represents trained professional allies. Thus, the Public Health Engineer is concerned with the health aspects of the environment. He and his staff are trained to seek out, examine, and control all of the environmental contacts that bear upon the residents of the community. B. Legal Authority Inherent The legal authority invested in the Board of Health further enhances the role of the environmental health planner. Many of the health laws are derived by the police power of the state; thus the health department, for the sake of preventing health hazards, may invoke many types of restrictions that are unique to this field. Effective ordinances can be enacted to deal with water supply and sewage disposal, both individual and public. Other areas of legislation generally provided concern food, milk, solid waste disposal, housing, migrant labor, trailers, and residential housing codes. Still other legislation commonly found in health department codes is concerned with air pollution, radiological health, institutions, recreational facilities, and industrial hygiene. C. Public Image of Health The work of the health department is further enhanced because of the public interest and concern with the maintenance of good health. Although there has been controversy for the past three decades over the role of government in health, this has been primarily concerned with the relationship of government to medical care. The public generally desires to maintain the highest standards of en- 57 vironmental health. Opposition to the development of effective environmental health standards usually can be traced to vested interest groups. Sometimes the opposition is unwittingly aided by public health personnel who are unskilled in seeking and maintaining broad community support. D. Funds Available for Health Purposes The funds for local health departments are usually derived from local tax sources, and as indicated previously, are often supplemented by grants from the state health department. Estimates of the cost of a local health department offering a comprehensive service vary, depending upon the completeness of the program. In general, an expenditure of $2.00 per capita per year will provide an adequate basic program. If special services, such as the operation of a hospital, an effective school health program, or other direct service activities are carried out by the health department, the funds required are obviously increased. Thus, some municipal health departments may spend as much as $4.00 to $5.00 per capita. Within the health department budget the funds allocated for the divi- sion of environmental health probably represent about 35 % of the total budget, although if a full allocation of overhead cost is made this amount might be as great as one-half of the total budget. In some states the Board of Health is authorized to levy a specific tax for its support. In Illinois the maximum rate that the Board of Health may levy is set at .05 % mill. In addition to tax sources many health departments are authorized to charge for certain services performed and to license certain establishments, with the fee bearing a portion of the cost of consultation service. III. The Role of the Local Health Department in Environmental Health Planning may be Defined in the Following Terms: A. Survey of Environmental Health Needs Determine the environmental health needs of the community served. In the Lake County Health Department, which was established by referendum in November 1956, problems related to sewage disposal and the pollution of recreational lakes were the compelling reasons for organizing a health department. Even so, the staff of the health department found it desirable to assess the community's interest and needs in other ways as well. Prominent among the methods used was the use of the "Environmental Health 58 Guide" which was used as a tool to establish the pattern of service prevalent in the forty or more organized municipalities in Lake County. By interviewing responsible officials it was possible to determine existing activities, and also environmental health needs, and to interpret the philosophy of the health department. The interviewing process, in many cases, was the introduction of the health department staff to the community, which led to development of good will. In addition to this planned survey, more than 500 families were queried about personal and community health problems during the course of an immunization survey that was conducted county-wide about one year after the health department was established. In addition to these methods of determining community needs through interviews, additional studies have been made through technical studies, such as the sampling of streams for bacteriological analysis. B. Conducting of Specific Programs The health department moves rapidly from the survey of needs into the development of programs to cope with demonstrated problems. Reference has already been made to types of ordinances that are frequently found in a local health code. In our department we have found it desirable to institute programs concerned with individual sewage disposal and consultation to the operators of public and semi-public sewage treatment plants. Individual water supplies are inspected but are not yet subject to regulation. The department offers consultation to water treatment plant operators. A comprehensive food and milk program is conducted. Recreational sanitation problems are aimed at the inspection of camps and camp sites, including natural bathing areas. A comprehensive lake and stream sampling program is conducted because of the importance of these resources to the recreational activity of the county. Institutional sanitation requires periodic visits to hospitals, schools, nursing homes, and homes for the aged. There are still many activities in our department that are handled only on a request basis, but which eventually will be planned programs. This includes industrial hygiene, air pollution, inspection of radiological installations, and inspection of housing. Attention has already beeen directed to annual inspection of all migrant labor camps. An activity of more importance than it is frequently thought to be has been 59 the prompt response to requests from citizens for specific service. Often the handling of complaints is given low priority but we have felt that this has been an important activity, particularly in a new department. C. Consultation to Other Units of Local Government In addition to direct service activities of the health department, consultation to other units of local and municipal government is an important activity of the environmental health program. In cooperation with the planning department, a subdivision ordinance has been prepared. A representative of the environmental health division participates in each meeting of the Plat Committee of the County Board so that the requirements of the health department, relative to water and sewage, may be incorporated in every new plat that is approved. In cooperation with the Building and Zoning Department of the county, as well as the various municipalities in the county, provision is made for adequate sewage disposal before a building permit is issued for new construction. Plans for new school construction or remodeling are reviewed by the health department prior to the approval of final plans. D. Stimulating of Action . Still another role of the health department is to stimulate essential community action in the field of health and sanitation. This has been done effectively in many ways: the release of studies showing unmet community needs, public discussion before.. civic groups, council meetings, and the like. We have found it extremely effective to enlist the cooperation of community or subdivision associations. These groups are often the vanguard of an organized municipality. We have also called public meetings of officials and interested citizens to discuss a major community need, such as the provision of sewers to areas of the county that do not have this facility. In conclusion, the role of the health department may be summarized as surveying health needs, programming to meet these needs, and whenever possible, stimulating the community to action. NOTE: There are several excellent texts on environmental health. As a guide to future reading on the subject we recommend: "Administration of Community Health Services." (1961) Published by: International City Managers Association (Chicago) 60 ROLE OF THE STATE HEALTH DEPARTMENT I. Introduction A. The role of the state health department varies among the states, depending on authority vested in the department by constitution and legislation. Ohio and many northeastern states are handicapped by the home rule concept of local government. There has been some success in overcoming this concept as it applies to water conservation, water supply, and pollution control. (Belmont County Sewer Authority) A problem would exist if electric power, fuel gas, communication, and transportation were constructed, maintained, and administered by each local government. Yet in many states the provisions for other utilities, as well as vital health and sanitation functions, rest in local fragmentary communities. II. Powers of the State Health Department A. Organization of Ohio Department of Health and Division of Sanitary Engineering B. Direct Service-A Statutory Requirement 1. Ohio River Valley Water Sanitation Commission a. Eight signatory states 2. Water Pollution Control Board a. Division of Sanitary Engineering is technical arm 1) consults with engineers re: design of water and waste treatment plants (sanitary, industrial and solid) 2) reviews plans for these proposed installations 3) encourages communities to plan and build ahead 4) inspects periodically and recommends improvements and expansion 3. Plumbing inspection unit a. State Plumbing Code-plumbing In public buildings must be inspected b. Plumbing Advisory Board-evaluates new materials, methods, and their application c. Encourages adoption of plumbing inspection by local building and nealth departments 61 4. Nursing home sanitation a. Under direct supervision of state b. Regulations by public health council C. Statutory-State Supervised Programs of Local Health Departments 1. Swimming pools and bathing places a. Review plans of proposed installations b. Conduct training of sanitarians and operators c. Encourage good enforcement by local health departments by survey of program d. Represented on committee on National Sanitation Foundation to develop equipment standards e. Discuss new designs, equipment, and materials with manufacturers f. Establish standards for swimming pools g. Establish criteria for evaluating bathing places h. Public informational and educational materials 2. Trailer parks and organized camps a. Review plans of proposed installations b. Periodically revise and improve regulations which are enforced at the local level c. Cooperate with Mobile Home Association and manufacturers of house trailers d. Survey enforcement programs at the local level e. Issue publications to facilitate interpretation of laws and regulations 3. Food service operations a. Restaurants, etc. b. Food vending machines c. Slaughter houses-meat and poultry d. Milk sanitation e. Publications f. Health educator 4. Health mobilization a. Executive Order of Governor establishes duties and responsibilities b. Organized as unit in Administrative Division c. Table of Organization-each division has responsibilities D. Consultation Services 1. Refuse storage, collection, and disposal a. Advise townships, counties, communities in facing up to problem b. Refuse clinics conducted for tJublic officials c. Consider land use in establishing fills d. Consult on individual local problems e. Survey existing practices f. Issue publications for defining problem and its solution 2. Insect and rodent control a. Conduct schools b. Consult with local departments c. Assist Public Health Service in surveys d. Issue publications 3. On lot water supply and sewerage 62 department represented on Subdivision Review Committee III. Federal Grants for Planning A. Department of Industrial and Economic Development designated as agency to process applications from local communities and administer federal funds 1. Most recent figures indicate eight projects involving 34 communities are in effect in the Urban Planning Assistance (701) Program having a total investment of $466,000, of which over $272,000 is in Federal Grants. 2. Four projects, involving 13 communities, are pending. These projects total more than $170,540, of which $117,000 is in Federal Grants. 3. Categories of planning involve such studies as: a. Land use surveys and analysis b. Socio-economic study c. Land use and thoroughfare plan d. Subdivision regulation and control e. Zoning review f. Community facilities plan g. Master plan elements h. Control measures i. Zoning code j. Comprehensive master plan and report k. Others B. It can be appreciated that many of the current or proposed planning studies involve the environment, directly or indirectly. 1. Communities involved are being contacted by state health departments along with local health departments to assist in the program and insure that the important factors of environmental health are not minimized. 2. Other communities are being contacted to stimulate interest. IV. Summary A. More individuals and organizations are involved than most people realize (planning commissions, professional planners, zoning commissions, local health departments, recreational organizations, churches, schools, libraries, industries, service organizations, etc.). B. To establish direction and distance to move, present status must be determined. C. Environmental Health Planning Guide (PHS No. 823) has proved the most effective tool to date. D. Some subdivisions being built today are slums almost before they are completed. Complete cooperation among all agencies is a requirement to avoid this. E. Environmental-planning involves many agencies, not the 64 ,-' " a. Attempt of department to standardize (HB 240) b. Still function of local department in Ohio c. State established suggested criteria d. Consultation service to local department e. Cooperates and plans with highway department where roads are affected f. Publications for individuals and local departments 4. School sarutation a. Function of local health department, required by state statutes b. State surveys local programs and recommends improvements c. Publishes guides and suggested stand- ards d. Conducts custodian trairung courses 5. Accident prevention a. Urut consisting of engineer, educator, and nurse in Division of Sarutary Engineering b. Conduct seminars for state and local health department personnel c. Co- operate with and coordinate efforts of official and un- official safety orgaruzations 1) U.S.P.B.S. 2) Department of Highway Safety 3) National and local Safety Councils 4) Poison Control Centers 5) Fire Departments 6) Others d. Stimulate efforts of local health departments 6. Radiological health a. Potential nuclear war and increased peaceful uses of radiological energies demand strict control b. Surface waters in Ohio morutored since 1953 c. Sources of atomic energy must register d. X-ray machines are surveyed for stray radiation 7. Slaughter houses (including poultry) a. Consultation to local departments to establish sanita- tion program in this type of establishment b. Develop model ordinance for sarutation control 8. Recreation a. Important part of planrung b. Consult with Division of Parks to improve existing parks and develop new ones c. Maintain sanitary surveillance over parks d. Conduct schools on park sarutation for park superin- tendents and other personnel 9. Air pollution control a. Cannot be confined to a local area b. Department studies special problems c. Acts as consultant to local air pollution control agencies I 10. Regional planning a. Health department encourages formation b. Health 63 .-' ROLE OF THE UNIVERSITIES I. Introduction A. The mission of the University (originally defined as an association of teachers and scholars) is teaching, and research and inquiry. B. The uniqueness of the University lies in the fact that it provides a freedom of choice of interests on the part of the individual. It should provide a breadth of approach to problems of significance. C. Responsibility of the University to Society-Its Obligation to' Government 1. The great European Polytechnics, established by government decree in Switzerland, Germany, Holland, and Scandinavia in the 19th century, had as a primary objective "to enable continental countries to catch up and overtake British industry." 2. Rensselaer Polytechnic Institute (1824) had as a primary objective "the application of science to the Common Purposes of Life." M. I. T. (1859) was "intended for those who seek administrative positions in businesswhere a systematic study of political and social relations and familiarity with scientific methods and processes are alike essential." The Morrill Act of 1862, which established the 68 land-grant universities, was designed to provide a new kind of education: "to meet the needs of the people by applying to daily life the discoveries of science and advancing technology-and to promote the teaching of studies related to agriculture and mechanic arts." 3. Governments now contribute approximately 53% of the total annual cost of University education in the United States. 4. The University has a responsibility to society to provide leadership in the research needed to meet the changing needs of the country, and to produce the professional people capable of understanding and dealing with increasingly complex environmental problems. 66 least of which is the State Health Department. In many localities it would seem this department should accelerate its activities to bring about foresightedness and cooperation among other agencies when the law does not specifically give the department authority. If on occasions it is not prudent for the State Health Department to assume this leadership, then the local health department should be encouraged and even urged, to effect the cooperation of all planning agencies. 65 D. The Nation's Needs in the Fields of Urban Planning and Environmental Health 1. A better understanding of the health objectives of communities, in order that planning criteria and principles may be developed 2. Identification and evaluation of environmental health problems and a major concentration of effort on those amenable to technical solution through research 3. The development of new curricula in the environmental health-planning field making use of modern science, mathematics, and professional knowledge; the attraction and education of superior students II. The Growth of the Environmental Health Concept A. Environmental Health in Antiquity; Greek Theory of the Effect of Environment on Health (Figure 1). 1. Air 2. Fire 3. Earth 4. Water B. The top-level NSF-sponsored Commission on Engineering Education recently recommended 10 areas in engineering education requiring development on a national scale; the list includes Environmental Control. SUMMER FIRE YELLOW BILE '1 ',' ; BLOOD AIR SPRING BLACK BILE EARTH AUTUMN PHLEGM WATER WINTER ENVIRONMENTAL HEALTH - 5 TN CENTURY B.C. (EMPEDOCLES) AFTER SIGERIST. - fiGURE I 67 The Commission states: "The technology of treating certain engineering problems by a total environmental approach is beginning to emerge as a nation-wide, if not an international need. The development of the land, air, and water resources of a region or of an urban area to provide optimum conditions in such major concerns as transportation, water supply and waste disposal systems, atmospheric control, land development, and housing is a systems engineering problem of major magnitude and importance. It must be approached as an interdisciplinary problem involving economic, sociological, political, and human factors and must be solved by the application of mathematical, scientific, and engineering methods. The encouragement of studyresearch programs which recognize this emerging technology is urged." C. The Seventh International Conference on Science and World Affairs, held in 1961, stressed the need for cooperation in the Life Sciences, with specific reference to the Environment and its Modification by Man: "The exponential growth of human populations and the accompanying industrial, agricultural and scientific activities have given rise to a number of serious problems, including pollution of air and water resources-continued chemical pollution of the air (known as smog) is a characteristic feature associated with most metropolitan areas and, as such, constitutes a problem of world-wide importance. The great increase of industrial growth has brought about extensive water pollution-especially grave are the problems involving contamination of air, soil, and water with radioactive substances ...." D. The Environmental Health Concept in Practice 1. Recommendation of the National Advisory Health Council (NAHC) in 1958 to the PHS to devote greater resources to research and education in the environmental health field 2. The Bureau of Environmental Health as recommended in the Final Report of the Study Group on Mission and Organization of the Public Health Service (June 7, 1960) 3. Report of the Committee on Environmental Health Problems (Gross Committee), November 1, 1961 4. Recommendation of the ASEIB-sponsored Committee on Sanitary Engineering Education (American Sani- 68 tary Engineering Inter-society Board) to "equip the engineer to develop systems for management of the environment to promote the health and well-being of man" (June 27-29, 1960)-see Figure 2. III. The Inter-relationships Between Metropolitan Planning and Environmental Health A. The Pioneer Role of the U.S.P.B.S. 1. Study groups 2. Environmental Health Planning Guide ( CLIMATE CONTROL) WATER (WA~~T_6uRS~SC[RI;~~IA ) ENVIRONMENTAL SYSTEMS LAND (li::~u~:E C:~[f"A) (\lEC:HOyR,;IOCtOO";.,ROl) I ENGINEERING ANAL 'fSIS SYNTHESIS AND DESiGN I ENGINEERING SCIENCES I MATHEMATICS ./' "-.. lIHE SOCIAL SCiENCES THE PHYSICAL SCIENCES ENVIRONMENTAL HEALTH ENGINEERING THE DEVELOPMENT Of SYSTEMS FOR THE MANAGEMENT Of THE ENVIRONMENT TO PROMOTE THE HEALTH AND WELL-IEING Of "AN (1.8Z), B. The Northwestern Conference on Environmental Engineering and Metropolitan Planning (March 21-22, 1961), sponsored by the Northeastern Illinois Metropolitan Area Planning Commission, the U.S.P.B.S., and the Northwestern Technological Institute, brought together for the first time on a national basis some 300 planners, engineers, city managers, city officials, and interested laymen, to discuss the critical role of environmental health to the future of metropolitan areas. The following are representative of the recommendations made by the Conference Resolutions Committee (and approved by the delegates): 69 1. The Conference expressed the need for a greater degree of leadership to be provided by the State and Federal agencies in the solution of metropolitan area problems. The role of the State was not too well defined, other than in broad terms of providing specialized technical assistance to metropolitan areas for solution of problems of metropolitan area planning. Several approaches are open to the States in this regard. While the Committee did not feel that it had sufficient information to develop a specific recommendation, it does suggest that this problem be considered by the several States from the standpoint of providing assistance and technical guidance to the metropolitan areas. The various responsibilities could be assigned to existing State organizations such as State health departments, State planning agencies, or other appropriate agencies. 2. At the Federal level, the Committee recognizes the assistance being provided by the several agencies involved in the problems of metropolitan planning. The Committee recommends that legislative proposals of these agencies, having responsibilities involving metropolitan planning and development, be reviewed in the light of providing assistance in the firm establishment of continuing programs in the field of metropolitan planning and development, rather than the categorized approach now being followed through specific project grants. Further, the Federal agencies should develop criteria in their respective areas of jurisdiction for use by metropolitan planning groups. The Conference notes with approval the concern being shown at the Federal level to urban and metropolitan problems and the proposals to strengthen and initiate various programs of leadership, aid, training, and research with respect to these problems. 3. It is recommended that the Public Health Service, because of the health implications in many of the activities involved in metropolitan planning, institute a more vigorous program directed toward the initiation of research activities on health-related problems of metropolitanism, the provision of technical assistance to State and local agencies, and the establishment of a training program to orient health and other personnel. 4. It was obVIOUS that there was some lack of understanding 70 between the professional disciplines regarding their respective roles in solving the problems of metropolitan planning. The Committee feels that some of this lack of understanding stems from certain inadequacies in academic training of planners and engineers. 5. The Committee recommends that Northwestern University be commended on the program that it has initiated in its Civil Engineering Department to broaden the background of the civil engineers so that they may better participate and apply their engineering competencies in the field of metropolitan development. Further, the Committee also commends the University on the establishment of a research program which will explore in depth the mechanisms, techniques, and procedures to be followed in furthering the program. 6. As a corollary, the Committee also recommends that the need for the expansion of academic curricula in civil engineering schools be called to the attention of the proper individuals nationally. The Committee also suggests that this problem be called to the attention of planning departments in universities and colleges to emphasize the need for better orientation of planners as to . the role of the engineer in solving the problems of planning. IV. The Need for an Integrated University-wide Approach to Environmental Health Education and Research A. The University is a "center" which has inherent in its organization the various special competencies necessary to tackle the metropolitan environmental health problem. This problem is not only complex in its over-all aspects; it is made up of a great many individual problems-financial, technical, sociological, epidemiological, etc., which need solution. Although a great deal has been said about "interdisciplinary cooperation," the actual accomplishments are still meager; in fact there are more indications of widening gulfs between the "cultures" of science and the humanities (and of individual disciplines) than there are of effective cooperation! B. It is obvious that metropolitan areas cannot continue to grow without over-all planning; problems of air pollution, water supply, refuse disposal, recreational areas, and urban blight and renewal cannot be resolved by individual political subdivisions. They are over-all community problems. C. Universities must re-orient their approach to education and 71 '. research to environmental health and metropolitan planning. Following the successful examples of developments in bio- engineering, biophysics, biochemistry, and the earth sci- -, ences, environmental health centers will have to develop: ~. 1. A systems-analysis approach to the over-all problem so as to have a better understanding of its components and their relative importance 2. Increasing use of instrumentation; highly specialized equipment made more generally available for the solu- tion of technical problems than can now be justified in individual departments 3. Use of the social sciences so that they may be more effectively used in the analysis and solution of metro- politan problems 4. A metropolitan planning approach that is inherent to the center philosophy 5. A new kind of environmental engineer, educated with depth in the physical sciences and mathematics and breadth in the social sciences (Men of this kind can- not be mass-produced; they will require careful selection and rigorous training and will demand a truly "learned" I profession. ) 1 V. Conclusion We now have the technical ability to achieve almost any kind of an environment that we want. Thus, a major issue for engineers and scientists-and for society as a whole-is to decide on the kinds of things that could and should be done. Unless engineers, scientists, and others are willing to give serious thought to this problem and to their social responsibilities, as Rene Dubos has said, "They may find themselves some day in the position of the Sorcerer's Apprentice, unable to control the forces they have unleashed. And they may have to confess, like Captain Ahab in Moby Dick, that all of their methods are sane, their goals mad." This presents a challenge and an oppor- tunity worthy of the efforts of our American university system! 72 ROLE OF CITY AND COUNTY PLANNING COMMISSIONS I. Organization and Objectives A. Purpose of City Planning as Practiced in Cincinnati To make long-range plans for improving the general physical environment of the city to. better serve the social and economic needs of its citizens (social needs include public health) 1. Clarification of terms a. To "make long-range plans" means that it is not the function of city planning to make engineering plans, for execution purposes, nor to carry out the plans. It is the function of other offices to execute the plans. b. "General physical environment" means that it is not the function of city planning to plan the social organization or educational needs, or to control the lives of citizens-but only to plan for the general physical facilities which serve the people. B. Methodology of City Planning 1. Research a. To obtain facts, establish trends b. To understand social and economic needs 2. Idea formulation a. To state goals and methods b. To provide a conceptual basis of plans 3. Idea testing a. By committee review, cltlzen partlClpation b. To select most practical alternatives c. Public relations 4. Proposal a. Drafting of plans, reports, reasons b. Submission, explanation, adoption 5. Implementation a. The work with executives and review of execution proposals b. Public relations C. Organization for City Planning in Cincinnati 1. City charter establishes City Planning Commission of seven members a. Appointment of 5 citizen members by Mayor; Manager ex-officio; city councilman b. Liaison with Chief Executive and Council c. Employment of staff, appropriation of funds 2. Duties a. Make plans for city and environs b. Recommend zoning controls c. Platting authority governing subdivisions d. Historic monument approval 3. Official process of implementation a. Public Works locations approved by Commission b. zoning ordinance and amendments approved by Commission c. Urban renewal plans made by and approved by Commission d. Capital Improvement Program men'lbership and staff shared by Commission II. Introduction: Regional Planning Commission A. Locally, as nationally, problems of the central city are quite different from those of the suburban and urban fringe areas. B. Urban development is much more rapid on the periphery. 1. 4,000 acres were absorbed for urban purposes in central city 1948-1960. 2. 9,000 acres were absorbed for urban purposes in 36 local suburban communities. 3. 19,000 acres were absorbed for urban purposes in unincorporated areas. . C. Only six municipalities have assessed community needs to the point of a most rudimentary plan. 1. Some of these are out-dated and not related to county needs. 2. 32 municipalities exercise zoning and subdivision control. D. New communities are being incorporated without particular thought as to inherent problems. E. There is a basic need for relating all planning activity to over-all need-not only of the county but to metropolitan area. III. Objective and Means of Realizing A. Create a structure where the complex social, cultural, and economic functions of the urban community are stimulated by suitable environment. 1. Means of realizing a. Cooperation is the essential ingredient, because of fractionalization of area. b. Establish the goals as to the kind of community the people want. 1) analysis of factors influencing development 2) proportions of needs related to adaptability of land 74 3) formulation of preliminary plan 4) discussion with all political subdivisions 5) plan adoption by the Commission B. Adopt or modify the tools available to both municipalities and the county. IV. Relationship of Regional Planning Commission to Municipalities and the County Government A. Effect of Plan Adoption 1. Plan is purely advisory with respect to municipalities or the county unless adopted by legislative bodies. 2. If adopted by county commissioners, public improve- ments covered in the plan must be referred. B. PI~tt:ing Authority Lodged in Regional Planning Com- ITIlSSlOn 1. Cities have three-mile extra territorial jurisdiction. 2. Regional Planning Commission acts as staff for most cities in this area. 3. Many problems are imposed by the fractionalization of control. C. Zoning Administration for Unincorporated Area Lodged with Rural Zoning Commission 1. Regional Planning Commission reports and makes rec- . ommendation on all zone changes as to conformity with plan. 2. Regional Planning - Commission recommends zoning plans for townships wishing to vote on zoning control. 3. Regional Planning Commission recommends new regula- tions. 4. Coordination is through joint Executive Director and Secretary of Zoning Commission. D. Staff Planning Function Provided to County Government V. Environmental Control A. Zoning 1. Zoning law, in most states, is a liberal interpretation of police powers exercised in the public welfare. 2. Zo~ng is a declaration of public policy related to services. 3. Based upon a plan, zoning can: a. Create desirable pattern of land uses based upon com- I patibility and service requirements b. Restrict urban development from undesirable areas (flood plain) '1 c. Maintain acceptable standards of density upon which I .1 75 ~.1 '. " other public facilities and services can be planned 4. Zoning techniques can encourage efficient land use. a. Density control zoning-community unit plan b. Planned district approach-permits best adjustment between proposed and existing uses 5. Board of Health vs. Zoning B. Subdivisions 1. Police power is not so broadly interpreted for sub- division control. 2. Regulations provide for access and certain improve- ments: water supply and its problems, sanitation and its problems, drainage and its problems. C. Other Considerations 1. Refuse collection and disposal 2. Private contractors, dumps, and incineration capacity 76 ,; PLANNING THE COMMUNITY FOR THE ADVENT OF NUCLEAR INDUSTRY I. Introduction In the past man has met most of his environmental health problems on a remedial basis. As necessity demanded he moved to correct an existing ailment. Such a technique has been only partially successful; and, with the rapid development for the potentiality of nuclear energy and its inherent and associated problems, the remedial approach is completely impractical. There now must be preventive planning. The successful community of tomorrow is the one who plans today for the advent of nuclear energy in whatever form it may arrive. II. Background Information A. Present Trends. A review of the growth and development of nuclear power production would stagger our imagination-particularly if we try to project current .trends into the years 1980 or 2000. A March 1959 report to the Surgeon General, entitled "The Control of Radiation Hazards in the U.S.," predicts that by 1965 we shall be producing 5 X 105 megawatts of nuclear power. B. Waste Products. A necessary evil of the growth in power production is the associated production of contaminated wastes. Again we are told that by 1995 there will be 2 X 109 gallons of high and intermediate waste products to be disposed of. No estimate of the tremendous quantity of low level wastes is made. This will be the problem of the local community. C. Maximum Permissible Concentrations. Concurrent with the rapid decrease in production of nuclear energy has been a rapid decrease in the MPC for human exposures. Basically this has shown a reduction from 30 rems/year to 0.5 rems/year over the past 20 years or so. D. Industrial Potential. One of the biggest reasons for the increased production of nuclear energy (other than for community electrical power consumption) is the increased industrial utilization. This is best shown by: 1. Increased 77 quantity shipments from ORNL. 2. Patents for new applica- tions, now exceeding 3,000 per year. III. Need for Future Nuclear Power Development -,5 " A brief view of the world energy supplies coupled with cur- ~i 'j rent and expected consumption rates will indicate the serious- I ness of nuclear power production. Estimates of present supplies reveal 36 Q's of natural energy sources. A Q is defined as 1018 BT.D.'s of heat production capability. Our present stock- pile is 30 Q's of coal and solid resources and 6 Q's of oil, gas, and other resources. With current and expected consumption these resources will become depleted by the year 2010. It is estimated we are now consuming 20 Q's per century and by the year 2000 A.D. we will be utilizing over 100 Q's per century. This is far beyond any possible natural resource of present fuels. Further, since oil will be a major use in transportation for many years to come, for example, some national management of fuels for specific future applications seems to be evident, especially where it is obvious that it will be a long time before nuclear energy can be applied economically to these specific uses. Consider also the ever-increasing cost of getting the coal and oil supplies to the consumer. IV. Community Interest The community concern over the advent of the nuclear age can be subdivided into four areas: A. Its responsibility for the health and safety of the public B. Concern for the industrial working conditions C. Promotion of atomic industry for the economic welfare D. Generation, transmission, and sale of electric power from nuclear sources V. Reactor Site Criteria If, then, nuclear power is rapidly descending upon us, and, if :1 the community is so vitally concerned, what are the criteria a community should apply for proper planning for this inevi- table advent? Such criteria are based upon two variables. A. Containment: reactor construction so as to retain or absorb leakage of radioactivity. We still assume 0.1'70 jday when attenuation is 10. B. Site distance: covered by AEC Regulation (10 CFR Part 100). Also, Technical Information Document 14844 "Cal- culation of Distance Factors for Power and Test Reactor Sites." Definitions apylicable to criteria are: 1. Exclusion zone: that area surrounding the reactor, 10 78 which the reactor licensee has the authority to deter- mine all activities including exclusion or removal of personnel and property from the area.... or, of such size that an individual located at any point on its boundary for two hours immediately following onset of the postulated fission product release would not receive a total radiation dose to the whole body in excess of 25 rem or a total radiation dose in excess of 300 rem to the thyroid from iodine exposure. 2. Low population zone: the area immediately surrounding the exclusion area which contains residents, the total number and density of which are such that there is rea- sonable probability that appropriate protective measures would be taken in their behalf in the event of a serious accident; or, of such size that an individual located at any point on its outer boundary who is exposed to the radioactive cloud resulting from the postulated fission product release (during the entire period of its passage) would not receive a total radiation dose to the whole body in excess of 25 rem or a total radiation dose in excess of 300 rem to the thyroid from iodine exposure. 3. Population center distance: the distance from the reactor 'j I . to the nearest boundary of a densely populated center containing more than about 25,000 residents; or, a dis- tance of at least one and one-third times the distance from the reactor to the outer boundary of the low population zone. 4. Exposure limits: The whole body dose of 25 rem corre- sponds numerically to the once-in-a-lifetime accidental or emergency dose for radiation workers. The low inter- nal organ dose such as 300 rem to the thyroid is intended to imply that these numbers constitute acceptable emer- gency doses to the public under accident conditions. They are reference values. 5.. Other considerations a. Meteorology b. Hydrology c. Topography d. Geology e. Seismology f. Seasonal variations g. Population shifts VI. Site Planning The steps necessary for the planner to employ may be summed up as follows: A. Project population densities and locations to the advent year. B. Determine expected or desired megawatt capacities of reactors. C. Initiate proper zoning now to provide for Low 79 "! Population and Exclusion areas. D. Maintain city boundary where applicable to provide for population center distance. E. Plan radioactive shipping routes. F. Develop municipal personnel training programs. G. Provide leadership in citizen educational programs. H. Purchase or option land. I. Plan radioactive cemeteries. J. Provide interim planning for acquired lands. K. Provide answers to applicable questions on "Nuclear Community Checklist." VII. Conclusion Dr. Glenn T. Seaborg, Chairman of the U. S. Atomic Energy Commission, at the 1962 Nuclear Congress in New York on June 4, 1962, stated, "... the short range goal [of the AEC] is to make large nuclear power plants competitive in high fuel cost areas by 1968 and the long range goal is broadening the areas in which this source of energy can be economically competitive. I continue to be optimistic in this regard and feel that we are actually within sight of the achievement of economic nuclear power. This is, of course, important, since the rate at which nuclear energy will be used to generate civilian electric power in the U.S., and in the world, will in the last analysis be determined by the rate at which it becomes economically competitive with power from the conventional fossil fuel sources." Another prognosticator has predicted that by 1975 over 1500 cities will have nuclear power reactors. If such is true, the planner has but a very minimum of advance notice of the responsibility that he must meet to morally respond to the future nuclear age developments. Now is the time to add a new Section to the Comprehensive or Master Plan-the Radiological Plan for the community that he serves. References 1. Joint Committee on Atomic Energy, Congress of the United States. Selected Materials on Federal-State Cooperation in the c.: Atomic Energy Field, p. 215. Washington 25, D. U. S. Government Printing Office. March 1959. 2. Sandbank, Harold. The Community Impact of Peaceful Applica- tions of Atomic Energy. Report for the U. S. Atomic Energy Commission by the American Municipal Association. Office of Technical Services. U. S. Department of Commerce. Washing- .1 ton 25, D. C. (TID 8202). Price $1.00. March 1960. 3. Kramer, H. P. Radiation Exposure Today. Basic Radiological 80 Health Course Manual. Robert A. Taft Sanitary Engineering Center. Cincinnati, Ohio. -4. Atomic Industry Reporter, News and Analysis. News Sections 1960 and 1961. Bureau of National Affairs, Inc. Washington 7, D. C. 5. Public Law 703-83rd Congress, Chapter 1073-2d Session, H. R. 9757. An Act to amend the Atomic Energy Act of 1946. 6. Public Law 86-373, 86th Congress, S. 2568. September 23, 1959. An act to amend the Atomic Energy Act of 1954 as amended, with respect to cooperation with States. 81 -I i EFFECTIVE PUBLIC RELATIONS 1. The Problem A. There exists a gap between the development of science and technology in the health area on the one hand, and the deliberate utilization and application of this development on the other. Science and technology have provided the know-how and the means for dealing with today's health problems far more effectively than is actually the case. The problem is the failure to use and apply what is known and available, by professionals, officials, community leaders, and the public at large. The most pressing problem is to find ways of influencing those who hold the key to the greater utilization of the health sciences and their technologies. 1. Compulsion and legal enforcement have certain limitations. a. Some actions on the part of individuals are not subject to surveillance and control (e.g., sanitation in private homes). b. The enforcement of some actions, while possible, is difficult and uneconomical (e.g., enforcement of sanitary practices in public eating places). 2. The belief that an "informed public will act rationally" has been the basis of intensive and extensive programs to create a public knowledgeable in the health area, but such programs have not always resulted in the desired actions on the part of the public. 3. It has become increasingly obvious that the achievement of acceptance of our programs and objectives and of active support on the part of the public is not a simple job and requires more than printing pamphlets, making expensive movies, or placing TV and radio spots. We must understand why people act the way they do, and why they fail to act rationally even when they know it to be for their own good. We must understand and learn to use ways by which people's attitudes and behavior can be influenced. 82 B. What does "public relations" mean? It means that there exists on the part of the people we deal with an attitude to- ward us that makes them receptive to what we tell them and that predisposes them to listen to us sympathetically, to understand us, and to favorably consider our ideas, proposi- tions, problems, and objectives. The very word "relations" implies that this is a two-way affair: we must understand and consider the others if we are to find ways of making them understand and consider us. This is a very complex matter involving many aspects, but its core is the problem of effective communication to the public and to key persons and agencies. II. Limitations of the Mass Media of Communication A. Mass media appear as the most effective and most economi- cal means of reaching the largest number of people in the shortest possible time, but this is not necessarily true: the great success of commercial advertising and of the "hidden persuader" is more apparent than real. -I People tend to see and hear the kinds of things that they are interested in, believe, or favor, and not to see or hear other things. People effectively read and listen to material in which they already believe, and avoid seeing or reading material in which they are not interested or that is contrary to their present beliefs and motives. Even when exposed to material, they tend to accept what they already believe and reject what they do not believe. People forget, mis- interpret, and distort communications that are contrary to what they believe, so as to make them fit into their present ways of looking at things. Direct attempts at changing be- liefs and attitudes give rise to resistance on the part of an audience. B. Different segments of the popUlation respond differently to mass media. Different segments use different channels of communication. Different segments of the popUlation look for different things in the mass media. The effectiveness of mass media depends on the kinds of people to be reached; the existing attitudes, beliefs, expectations, and experiences of these people; and the purpose to be achieved. III. The Process of Social Influences A. Community powerfigures can be crucial for our program but they do not necessarily influence public attitudes. B. Informal communication patterns within social groups are decisive in influencing attitudes and behavior. Groups, such .~ 83 as PTA, Chamber of Commerce, bridge clubs, etc., can be utilized if one understands their specific role vis-a-vis the public. In addition, there are many not easily visible social groups that provide a key to public attitudes. IV. The Importance of Preparation and Timing A. It is important to create an atmosphere of susceptibility to our educational and promotional programs before they start. To do so must be a continuous effort, not one tied to a specific point in time. Our objectives, activities, and accomplishments must be made visible to the public. B. Action opportunity should be provided when motivation is at a peak. V. Planning a Public Relations Program Our efforts to create effective public relations must be geared to our audiences. Programs should not blindly use what has worked elsewhere. It is important to understand the perceptions, beliefs, and customs of people before planning a public relations program. .j 84 FUTURE STEPS IN ENVIRONMENTAL HEALTH PLANNING I. Principal Truisms Concerning Public Health A. The health and the welfare of the people in our modernday society are primary. B. Public Health was conceived to do with and for the people collectively that which the people cannot do individually. C. Government is called upon to do that which is not done, cannot be done, or cannot be effectively done, by individuals or unofficial groups. II. Principal Accepted Concepts of Environmental Health A. Environmental health is an integral part of the total public health movement. B. Environmental health deals with: 1. Prevention of disease 2. Promotion of a safe environment 3. Promotion of a high quality environment 4. Promotion of an aesthetically acceptable environment. C. Environmental health is the provision of the positive, complementary, and comfortable, as well as the control of negative or deleterious conditions. D. The environmental health concept is presently broad and is rapidly becoming broader with new modern technology. E. Consideration of the environmental health aspects of all phases of modern development is necessary. F. Environmental health interests are interwoven into every concept of modern industry, community life, and technology and is interdependent thereon. G. An acceptable future environmental status is available tomorrow only to the extent that it is planned today. III. The Official Public Health Agency's Opportunity and Responsibility as the Central Agency Involved in Environmental Health A. Leadership is analytical thinking and foresight. B. Leadership is planning for the control of the environment. C. Leadership is carrying out the plan. D. Leadership is accepting the challenge and exemplifying 85 necessary concepts of: 1. Know-haw-both in environmental health technology and planning principles 2. Enthusiasm 3. Communications 4. Constant evaluation, regrouping, and adjustment 5. Cooperation IV. Projected Georgia Program A. Initial field training phase-Macon B. Second field training phase during first year C. Two additional field training programs during 1963 D. Ten-year projection V. Conclusion Think, plan, and do~for action is needed now. 86 ENVIRONMENTAL HEALTH SURVEY Lexington, Kentucky, 1963 I. Introduction This part of the course is the practical exercise, for the student body to actually participate in the collection, assimilation, coordination, and writing of a report and the recommendations. This will be accomplished by groups, but it must always be remembered that this is a full class project. This survey will be conducted in a community of mediocre size, approximately 50,000 to 100,000. It is a growing community with problems. It will be your responsibility to prepare a full-fledged report with substantiating data that will be presented to the governmental officials of the area involved. This is no make-believe project. This is not hypothetical. This is the serious business of preparing an Environmental Health Survey to be used for the betterment of a serious and enthusiastic community. II. Mechanics of Operation A. Group Formation The class will be equally divided into the following groups: 1. Water 2. Sewerage 3. Refuse 4. Air Pollution 5. Housing 6. Planning 7. Radiological Health 8. General Health B. Group Structure Each group will consist of six or more students. The group will select the following: 1. Group Chairman. Responsible for all group activities 2. Liaison Officer. For contact with other groups and through whom all information to other groups is transmitted and obtained 3. Writer. Responsible for all writings and publications of the group 4. Driver. Responsible for transportation of group to and from survey site 5. Photographer. Responsible for all pictures and reproductions for report 6. Orator. Responsi~Ie for oral presentation to class C. Phase Activity 87 1. Phase I is the Data Collection phase. During this phase the group will act independently in obtaining the necessary data for the completion of their mission. Time is allowed from 9:00 A.M. on Friday for this purpose. If group has not finished, then arrangements may be made for additional effort on Saturday. Finally, time might be utilized on Monday afternoon if needed. 2. Phase II. This is known as the Data Evaluation Phase. Each group assembles and studies the data collected and prepares general outline of report. If insufficient data have been obtained, then they must be gathered at this time. No provision will be made for data collection beyond this phase. 3. Phase III. The report is now prepared and recommenda- tions are enumerated. The group must submit enough copies of their report for each member of the class and the Special Panel. SEC will be provided with 25 copies of each group report. It is expected that each group "I will work Tuesday evening to complete this important phase of Preparation of the Recommendations and the Report. 4. Phase IV. This is the Presentation and Discussion Phase of the Survey Reports. Each group has been allocated one and one-half hours to present its work to the class. Thirty minutes will be used by the Group Orator for oral presentation. The Group then acts as a panel to defend its report and its recommendations to the class. The final report and recommendations will be the result of the whole class contributing to the work of each group. A Special Panel of experts will supervise the Group and confirm technical decisions and resolve any conflicts of opinion of the class. Finally, the Group must now reproduce in quantity the corrected final report. One hundred and fifty copies are needed from each group. As each group completes its Section of the report, each student will be given a copy. By the end of the Course, each student will then have a completed En- vironmental Health Survey. Twenty-five completed copies are forwarded to the community for reproduc- tion and mass distribution. III. Conclusion Since time does not pennit each student to work in all eight facets of the Su~vey, the fact that the student has participated in one facet and has actively been a part of the final prepara- 88 .; tion of the other seven sections, he will be thoroughly familiarized with all aspects of a survey. It is each student's responsibility to be sure that all his questions are satisfactorily answered during the discussion phase. Upon completion of this practical exercise, each student should feel thoroughly competent to conduct a complete survey by himself. INITIATION AND PREPARATION I. Need for Broad Participation A. The initiative for organizing a study of environmental health problems, programs, and resources may be taken by any individual or organization in a" community. B. Invitations to participate in planning and carrying out the study should be extended to: 1. All agencies with responsibilities related to producing a more healthful environment (e.g., health department, planning agency, public works department) 2. Other interested groups (e.g., civic associations, industries, business associations, service clubs, women's organizations, voluntary health agencies, schools) 3. Persons who have special skills needed in conducting the study or in implementing recommendations that may grow out of the study (e.g., skilled interviewers, writers, representatives of local mass media, other opinion leaders) 4. Respected representatives of population groups likely to be affected by the study (e.g., elected officials, interested citizens) C. Environmental health is such a broad subject that a single organization usually does not have all of the necessary information or the technical specialists. Various combinations of individuals and groups, depending on problems, resources, and interests, could work together to give effective leadership. D. Since studies are not ends in themselves but are intended to stimulate action, participation by key representatives of the public is essential in addition to participation by technical personnel. E. Reasons for providing opportunities for participation by selected persons who have no special training in environmental health are as follows: 1. People have a right to be represented when decisions affecting them wiH be made. 89 " -1 2. People who are not health specialists often have useful talents not possessed by specialists. 3. People who play an active role in obtaining facts and making recommendations about environmental health problems are likely to take responsibility for helping solve the problems. F. The activities proposed in this guide and the implementation of findings would in no way supplant programs carried on by various agencies; instead, agency programs would be supplemented through promotion of a broad coordinated approach to environmental problems. II. Methods A. The structure of participation may develop in different ways. Some examples are: 1. A few interested persons may explore ideas in a preliminary fashion, then invite others to join them in planning and carrying out the study. 2. A large group consisting of representatives of all interested organizations may be called together for a general discussion, followed by establishment of working committees, and an advisory committee. 3. An already organized coordinating group (e.g., a community council) may take responsibility for conducting the study. B. The types of committees, if any, that are set up would depend on the local situation. 1. One arrangement would be to have a separate task force working on each of the sections listed in Chapter II of this guide, with representatives of these task forces forming an executive or steering committee. 2. Additional committees may be considered appropriate to provide such services as obtaining financial support, informing the public, providing liaison with certain groups, or conducting training courses for volunteers. C. These committees are most likely to be effective if: 1. Chairmen are respected and have skills at leading group discussion. 2. Members have a real desire to study and act on environmental health problems. 3. Objectives and methods are specific and clearly understood by all. 4. Consultants are called in when needed. D. Preliminary plans about how to put study recommendations into action should be made during the organizational 90 phase, since certain steps taken during the study process (e.g., keeping the public informed) may increase the probability of subsequent action. III. Resources A. Advice on methods of helping citizen groups study environmental health problems in a way that is likely to lead to action may be obtained from specialists in public health education, community development, community organization, or adult education. B. Besides manpower, other resources that may be needed include money and materials. C. Financial assistance may be available on a matching basis through the Urban Renewal Administration of the Housing and Home Finance Agency. (Information on this may be obtained from the HHFA Regional Director or from the local planning agency.) RECOMMENDATIONS AND IMPLEMENTATION I. Introduction The dictionary definitions of "recommend" and "implement" are noteworthy at this point. A. Recommend-to commend to the favorable attention of another; to make acceptable; to counsel, as to a course of action; to make attractive or acceptable; and, to give in charge. E. Implement-to carry into effect; fulfill; accomplish; originally, that which supplies a want; any means or agent for the accomplishment of a purpose. Therefore we might readily conclude from these definitions that, as relating to our survey activities, the recommendations and implementation could be described as "an action to be given in charge to be carried into effect." This stimulates us to consider (1) what kinds of actions (2) to be given in charge to whom, and (3) how to be carried into effect. Answer these questions and we will have devised the perfect set of recommendations combined with the ideal modes of implementation. II. Recommendations It is easy to find fault and identify errol'S; however, a recommendation for us means that we not only find an environmental error, but that we, if only by implication, are also providing a proposed solution. Let us review some standard recommendations. 91 " j 1 A. Fort Wayne, Allen County, Indiana B. Omaha, Douglas County, Nebraska C. Lake County, Illinois Pick a number at random to- discuss as to the why of the recommendations, the importance to the community, and the mode of correction-direct or implied. Examples of the types of recommendations we might suspect for each of the facets involved are explained in Chapter III, using the Data, the Environmental Health Planning Guide, under the caption of "Developing conclusions and recommendations." Some typical conclusions and probable recommendations are: 1. Suggestions for improved co-ordination between departments (such as health and planning) 2. Creation of new divisions in the health agency, to be responsible for new or unfilled program needs 3. Ordinances or regulations relating to various health and public works services 4. Creation of various types of sanitary district authorities 5. Extensions for water and sewer services into new areas 6. New or improved subdivision regulations 7. Stateenabling legislation needs 8. Recommendation for such items as frequency of refuse collection 9. Better co-ordination or consolidation of city and county health activities 10. Detailed long-range facility planning 11. Detailed engineering or economic studies of special community services beyond the scope of these studies 12. Appointment of new commissions or committees to handle special problems After a recommendation has been isolated, we are now ready to attack it. As with a disease, we have made a diagnosis and now we must treat it. Once, then, a recommendation has been diagnosed, we must prescribe the therapy to cure it. This means we now assess the responsibility for treatment, prescribe the action, and implement the program. III. Implementation This logically brings us to the implementation program. It might appear easy if we were to prescribe 41 implementation programs for 41 recommendations, and in essence this is what is ultimately accomplished. However, some system of grouping must be utilized. One system is commonly known as "Plan Execution" or "Plan Effectuation." . A. Theory of Implementation 1. The action required may be legal action, governmental action, Of" citizen action. 92 a. People are most likely to be interested in matters they understand. b. People are most ready to take action in matters in which they feel a sense of personal participation and responsibility. c. Many people are interested in different special aspects of development. 2. Timing of the implementation of the program must be planned carefully. The optimum timing for official action effectuating a recommendation is a matter of considerable importance. . 3. There will be certain powers needed for implementa- tion programs. These may be obtained by means of public opinion, petition, initiative, or recall. a. Eminent domain b. Police power c. Licensing power d. Penal power e. Noncoercive citizen action 4. There must be assessment of priorities. In establishing their relative importance utilize the following criteria: a. Protection of life b. Maintenance of public health c. Protection of property d. Conservation of resources e. Maintenance of physical property f. Provision of public services g. Replacement of obsolete facilities h. Reduction in operating costs i. Public convenience and comfort j. Recreational value k. Economic value 1. Social, cultural, or aesthetic value m. Promotional value through effect on future developments n. Relative value with respect to other services 5. Example: Proposed implementation program, Fort Wayne, Allen County, Indiana. IV. Conclusion In general a recommendation is identified and made public because a need exists. An implementation program is prescribed to facilitate action on the needed recommendation. More subtly, a recommendation and an implementation program put the finger on the failure of some agency or government for not accepting the responsibility for the adequate provision of those factors that would have prevented the need. This does not mean that the agency or government was unaware of the problem. It may only imply that because of lack of budget, trained personnel, proficiency, or for some other reason they have not acted. In some cases they may even welcome and cooperate in the publicizing of the need. In any event, more drastic action is now needed, especially if the recommenda- tion has earned a high priority. Therefore, the time has come for Citizen Action. The crux to many of our implementation programs is the aroused citizen. :. ~.' 93 .1, ACKNOWLEDGMENT The outlines in this Manual were reprinted, with permIssIOn, from the Training Course Manual, "Urban Planning for Environmental Health," Metropolitan Planning-Training Section, Training Program, Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio. April 1963. 94 '.'