TASKFORCE: MAINTAINING A QUALITY ENVIRONMENT IN GEORGIA GEORGIA OFFICE OF COMPREHENSIVE HEALTH PLANNING GEORGIA DEPARTMENT OF PUBLIC HEALTH 1971 1280 WEST PEACHTREE STREET ATLANTA, GEORGIA 30309 MAINTAINING A QUALITY ENVIRONMENT IN GEORGIA REPORT OF THE ENVIRONMENTAL HEALTH TASK FORCE TO THE GEORGIA COMPREHENSIVE HEALTH PLANNING COUNCIL Compiled by the OFFICE OF COMPREHENSIVE HEALTH PLANNING GEORGIA DEPARTMENT OF PUBLIC HEALTH January 1971 Members of the GEORGIA COMPREHENSIVE HEALTH PLANNING COUNCIL While the Environmental Health Task Force was in Existence Thomas J. Anderson, M.D., Chairman Atlanta Mrs. J. Mac Barber Athens Ernest Napier Moultrie J. Gordon Barrow, M.D. Georgia Regional Medical Program Jack P. Nix Georgia Department of Education Louis C. Brown, M.D. Atlanta Glen P. Robinson, Jr. Atlanta A.E. Burell Smyrna Jack Runninger, O.D. Rome Norman Burkett Hamilton Memorial Hospital Dalton Mrs. Hunter M. Clay Savannah John Cromartie Gainesville Mrs. R. M. Hair, Jr. Buena Vista Boisfeuillet Jones Atlanta Dr. Eugenia Lee Medical College of Georgia Augusta Ha ro1d Lurrnnu s Columbus George L. Simpson, Jr., ph.D. University System of Georgia J. V. Skinner Macon Horace Tate, Ph.D. Atlanta R. L. Tindol, Jr. Atlanta Miss Mary Webb Atlanta H. Oliver Welch Atlanta Jack Williams, Jr. Waycross Lewis H. Williams, D.D.S. Toccoa GEORGIA DEPARTMENT OF PUBLIC HEALTH 1280 West Peachtree Street Office of Comprehensive Health Planning Atlanta, Geargia 30309 Area Code 404 688-4033 February 3, 1971 John H. Venable, M. D, Director Georgia Department of Public Health 47 Trinity Avenue, S. W. Atlanta, Georgia 30334 Dear Dr. Venable: On behalf of the Georgia Comprehensive Health Planning Council, I am forwarding to you the report of the Environmental Health Task Force, Maintaining a Quality Environment in Georgia. We thank the Task Force for its long hours of deliberations and the efforts it made to be truly comprehensive in its view. Mr. Robert Stiemke of Georgia Tech, the Chairman of the group, is to be commended for his work, as is each of the 24 members of the Task Force, three of whom were Council members. The Council unanimously adopted and urged implementation of the report, and requests that full consideration be given to the recommended prioritie s and one hundred sixteen sugge sted specific actions as a means of maintaining a quality environment in Georgia. Sincerely, ~O:~ Thomas J. Anderson, M. D., Chairman Georgia Comprehensive Health Planning Council ENVIRONMENTAL HEALTH TASK FORCE Robert E. Stiemke, Chairman Professor of Civil Engineering Georgia Institute of Technology Atlanta James H. Aldredge, Chairman Fulton County Commission Atlanta "i' 1000 persons/sq.mi. .)~"~J!L~~-<;'"' _ _ _ . _ . , ).... / \.' "YlTn "\ \ cown...,.\ - Io+[A"O \..i. -...,.._._~.~. . *r' \. \. ......) 1 '.( /~''''''...... .-.-' \ \ _.; .,A.~.-1.. '.Meou"."'" COLU"'" / , ~J'' I \ v\r' J".'. I, I PUTNA" \ / ) / i ~. 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However, with purchasing power comes an increase in wastes, and in environmental pollution. The relationship between population increase, per capita consumption and waste is demonstrated by comparing Figure 5 to Figure 4 on Page 59, depicting the consumption of water--which makes possible production of hydroelectric power and the manufacture of goods--and Figure 7, showing the rapid increase in per capita solid waste production. Another example of how population increase, greater consumption of goods, and the result--production of wastes--are related is illustrated by Figure 8, showing the rate of increase of urban populations, of automobiles and of increased pollutants in the urban environment. Per capita land available is an important factor in the environmental picture, as land supplies the human needs not only for food, but also for natural purposes and for artificial uses such as highways and cities. Figure 9 notes that the per capita land available to Georgians was cut in half in the first 70 years of this century, and will probably be halved again resulting in a little over four acres per person, in the next 30 years. Notably, ecologists have estimated that a minimum of five acres per person is needed to maintain a quality environment, at the present standard of living. An additional problem is that, while such amounts of land may presently be available, they are not in fact usable by Georgians in the recommended amounts. (See Appendix, Pages 157 and 159). Although there are many agencies and organizations in Georgia with demographic capabilities, there is not standard population estimate for the years between census counts, nor is there a standard method for determining population distribution between census years, or for projecting population. There are many sources of measures of environmental pollution, but there is little activity specifically relating environmental pollution to population distribution and density, with population characteristics or with population growth. 74 8.0 7.0 6.0 5.0 r~ o Q H (]) P; ....r..o.... r0o.. 4.0 U H (]) P-i C1l '0 ~ ~ 3.0 0 P; 2.0 1.0 ,tI t 1970 Projection t f f1J. ~~ " " .., Previous Projection 20 30 40 50 60 Year 70 80 Figure 7 - The National Average of Per Capita Refuse Production 75 FIGURE S-AUTOMOTIVE HYDROCARBON AND CARBON MONOXIDE EMISSIONS IN URBAN AREAS 1c-o1 (J) :>"1-1 1-1 co (J) (J) 0.:>" rn 1-1 os:: (J) 0. .u rn os:: s:: .,-l .0u ::::: s:: s j .,-l 0 s:::;:l .B s n rnn ~ .,-l ac 2 oos~::,oc1(-o)1 ~ ,oco:":CO:>:.. c1-o1 U IlS 16 14 12 10 S 6 4.~~ 2 ~ A 2SO 240 I I 200 160 120 SO 40 0 rn os:: rn s:: .,-l 0 .--l .,-l .--l .--l .,-l.--l s S .,-l n Q) n .--l rn o0.1-c1o Q) U P-< cco,sco:o: ,0 1-1 I-I:=> :=> 1960 1970 19S0 1990 2000 Source: "Health, Education, and Welfare Indicators, U. S. Department of Health, Education, and Welfare, November 1965. 76 16 14 ~ 12 ;J> ~ ~ 10 ~ w~ ~ 8 ~ ;J> \.l '":i (j) Cf.l '--.... 6 ~ '":i Cf.l 4 2 '.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.", 1900 10 20 30 40 50 60 70 Time (Year) 80 90 2000 "" Figure 9 - THE DECREASE IN AVAILABLE LAND AS A RESULT OF INCREASING POPULATIONS POPULATION RECOMMENDATIONS 1. A separate study should be made of the problem of population in order to better define the problem and to offer further recommendations for dealing wLth it. Although it recognized the severity of the population problem, the Task Force was unable to fully define its scope because of the complexity of the problem. Further study should determine if the nature of the problem is numbers, density, distribution, excess fertility, economic level of the population, or other factors. The Task Force recognized that the study should be done by an independent group, that would be coordinated wLth the Georgia Office of Comprehensive Health Planning, the Bureau of State Planning and Community Affairs, and all other groups having a major interest in this area. 2. A state-level activity should be initiated that would conduct and/or stimulate basic research into particular aspects of population that would provide the background information needed for determining the effects of population on the quality of the state's environment. The Task Force was made aware that the surface has barely been scratched in determining the effects of population on the environment. Funds and coordination of effort are needed to enable research in many areas, including the specific environmental effects of population density, of populations having certain health, social or economic characteristics and of population growth; the effects of family planning activities on population growth; and optimum populations for all sectors of Georgia-urban, suburban and rural. A determination might also be made of the advisability of attempting, through tax incentives, etc., to encourage development of regional cities as an alternative to "megalapolis.'l 2. Allocation of funds should be made on the state level to educate the public on the known environmental effects of population densities, population characteristics, and populatLon growth, through innovative uses of mass media and through effective use of junior and senior high school curricula. As more information is made available through such research as that which is recommended above, the known effects should be made known in the mass media and should be incorporated in school curricula. 4. Present activity in family planning education and services should be en- hanced and supplemented, in recognition of the vital role that such acti- vity plays in balancing population growth. Family planning activity in Georgia has been shown to be effective in limiting the number of unwanted pregnancies among target (high risk for economic and health reasons) populations. Effectiveness of existing agencies and organizations could be increased through additional funds for education and services. 79 The State is fortunate in having two organizations, the Georgia Voluntary Family Planning Council, and the Atlanta Area Family Planning Council, which can effectively coordinate the activities of the agencies and organizations involved in family planning activity. A major goal of these programs is making methods of family planning freely available to all Georgians regardless of age, sex or income level and having this availability widely known. 5. Standards and frequent data estimates should be developed on a state-level basis for current population, population projections and population distribution. The Task Force found that, while estimates are made by various agencies and organizations as to current population, population projections and distribution, there are no commonly accepted and available standard estimates. The State Bureau of Planning and Community Affairs has authority to develop standard estimates, but the Task Force noted that such estimates should be developed with the help of concerned agencies and organizations in order to have estimates that are truly "standard." Still another problem is obtaining valid population estimates between U.S. Census years. There has been strong support for a mid-decennial census of population, and it is still possible that there will be one in 1975. 6. Programs designed to control environmental hazards should utilize in their plans all available information on the effects of population densities on the environment, on the effects of population having certain health, economic or social characteristics on the environment, and on the effects that projected population growth will have on the environment. This recommendation is contingent upon preceeding ones. Population estimates are difficult to project, hence many agencies find it difficult to plan for future population growth. In addition, there are few accurate formulae which can help estimate the impact that population growth will have on the environment. Implementation of Recommendation 2 would contribute to solving this planning problem. 7. There should be a state-level activity concerned with educating local zoning commissions on the effects of population on the environment and encouraging them to plan land use accordingly. Zoning activity is essential to planning uses of land that will be beneficial and not detrimental to Georgia's population. Zoning operations are currently feasible only on the local or areawide level, but often zoning commissions are not aware of the full implications of their actions. For instance, it is often assumed that a factory will be an economic boon to an area. However, if there are many such facilities polluting the air already, such an addition may not be such an economic asset, but may further limit the area's ability to provide a healthy, aesthetically pleasing atmosphere, which is an attracting factor for many needed professionals such as doctors, lawyers, teachers, etc. Planning and community development experts have recommended that cities not try to compete in population growth rates, as population growth is not always the best thing for a city, particularly one that cannot provide adequate services to its present population. 80 8. The State should consider creating a land use plan to serve as a guide for wise development of the state's land resources, in the interest of the overall quality of life for Georgia's population. Initial studies have begun which indicate land needs for the Georgia population's food, clothing, shelter, natural area, and artificial systems requirements (See Appendix, Page 157). Such studies should lead to development of a plan to insure that the population's needs are met through wise use of the great quantity of land in Georgia. Such a plan might encourage overall development of the state's land in the same way that the coastal wetlands are being developed; that is, utilizing ecological principles by allowing some areas to be developed commercially, and leaving other parts of the area in their natural state. Depending on the results of further study, part of the plan may include acquisition of more private land for public use, and development of incentives to encourage private land owners to establish scenic easements and industry to create "environmental parks" as a way of preserving more land in its natural state. 81 .oa...:. I- oZ u ~ ~ z~ BACKGROUND: INJURY CONTROL One might question why injury control should be classified as an environmental health problem. A few statistics, as distasteful as they might be, may answer the question and may point up the need to provide more emphasis on this area. In Georgia, accidents kill the most persons between ages one and 44 and represent the fourth leading cause of death for all ages. Last year, over 3,100 persons were killed in this state by accidents of all types. Over 100,000 were injured seriously enough to receive medical attention. The human suffering and financial loses are staggering. The National Safety Council estimates the economic loss per highway death to be $185,000. This factor alone, then, costs Georgians over $300 million per year, not including loss due to injuries. Total loss, in terms of human suffering and loss,can hardly be estimated. At the state level, the Department of Public Safety has primary responsibility for highway safety. The efforts of the State Patrol have been commendable, but shortages of manpower and equipment limit their effectiveness. The Georgia Department of Public Health is concerned primarily with home safety, poison control, institutional and recreational safety, employee safety and emergency medical services. Its total budget for the injury control program is under $100,000. Public apathy is probably the greatest obstacle to be overcome. The "accidents will happen" philosophy must be combatted through the development and use of better methods of communication between the professional and lay groups who should be served by the appropriate agencies. The complexities of the problem are many, but this fact should not discourage efforts in research, study, applications of research findings, or control. 83 INJURY CONTROL RECOMMENDATIONS 1. Adequate resources, including funds and personnel, should be provided for all activities designed to control accidental injury and death. Despite the great loss of life and tremendous costs accrued by Georgia's public due to accidents of all types, the resources allocated for their control are very limited. For instance, the State Health Department has only one person and a small budget with which to conduct a "statewide" injury control program. State Patrol efforts to control highway accidents are also limited by the lack of personnel. Thought should be given to placing accident prevention specialists in district health departments in order to provide more coordination to accident control efforts, and to increasing the capability of the State Patrol to control highway injury and death. 2. Additional training in the basics of accident prevention should be provided to all health personnel? whether or not they are specifically involved in accident prevention programs. Most local health departments, which would be appropriate locations for accident prevention programs, do not have personnel who are adequately trained to carry out such programs. State-level accident prevention personnel are also in need of further training. In addition, accident prevention training should be given to all health personnel, as there are many opportunities for them to prevent accidents, if they are alerted to these opportunities. An example is a local sanitarian on an inspection visit to a restaurant, where he is in a unique position to observe activities and recommend precautions for greater safety. 3. Research should be conducted to further identify high risk individuals and groups and to develop more evidence concerning the etiology of accidents. The information already available and that obtained from further research should be used to solve the problems at their source. Surveys indicate that alcoholics, aged and handicapped drivers and other groups are responsible for a great number of automobile accidents. More knowledge of these should be sought through cooperative efforts by health and safety agencies and organizations. Coordination should be made with health department programs, voluntary agencies, driver's licensing authorities and other groups dealing with high risk persons to make them more aware of the role their efforts have to play in preventing accidents. For example, efforts should be made to further identify the hazard of persons driving under the influence of drugs, including prescribed drugs. Cooperation of medical societies should then be sought in bringing this hazard to the attention of all physicians. 85 4. Research should be conducted and applied that would reveal the psychology of accidents and offer more insight into ways that behavior can be modified to bring about more responsible personal actions which will result in fewer accidents. Attitudes can be changed, as they have been in the anti-smoking campaign, through application of modern advertising techniques. These techniques are based on careful research that determines what people respond to and identify with. An objective in all environmental programs, but especially in accident prevention, is to make those who create the problem feel that they are personally responsible for the situation and that they can do something about it. While more research is needed, more coordination between those implementing accident control programs and those already researching accident psychology is also needed. 5. Increased guidance and support should be given to communities in order to improve their capability for providing emergency health services. A quick and trained response to emergency situations--whether accidents or natural disasters--can limit personal injury and death to their victims. Communities should improve their readiness through thorough planning in order to prevent fragmentation of efforts, duplication of services and isolated planning, which are particularly likely to happen in areas where there is more than one hospital. The State Health Department's Emergency Health Service is active in helping organize local Emergency Medical Service Councils which can improve on or provide: a) broad-based training of the public for on-the-spot aid; b) a communications system which assures prompt response to the need; c) ambulances staffed by attendants trained and equipped to provide life-sustaining care; and, most importantly, d) an organizational structure capable of guiding and coordinating the efforts of all concerned, including health, fire, and police activities. Attempts to organize such Councils and to coordinate activities in communities should be encouraged and supported as a means of reducing the harm that springs from environmental conditions. 86 -'"LLI C u i= '"LLI Q. BACKGROUND: PESTICIDES The use of pesticides for the prevention of disease and increase in food production has produced tremendous benefits, but recent evidence has also demonstrated the determental effect possible on wildlife and human health. If beneficial use is to be made of pesticides, then it is imperative to know the risks involved in its use, the potential benefits obtained and the alternate methods of pest control. There are approximately 200,000 living species in the United States and most of these are considered to be essential to the well-being of man. In most cases, pesticides applied to isolated species have a broad-spectrum biological effect and destroy non-target as well as target species. One major problem that has faced most pesticide users is the large number of pesticides available for use. There are now some 600 active pesticidal chemicals which may be formulated into more than 60,000 preparations. Keeping track of the proper formulation, storage, transport, use and disposal of such a wide variety of toxic materials is an awesome task. The problem is compounded even further by the mass of these materials praduced. In 1967, more than 400 million pounds of pesticides were produced in the United States. Half of these pesticides were organochlorines and 50 percent of this amount was DDT. The production of pesticides has generally increased approximately 15 percent per year, although there has been a reduction in the persistent varieties since 1957. The misuse of pesticides represents a dangerous hazard which must be eliminated. Not only does it destroy wildlife but it can kill and cause disabilities in human beings. In 1968, pesticides accounted for one-third of poisoning incidents in Georgia with 91 cases reported. Although it is impossible at this time to assess the long-term damage to human beings, this could be significant. 87 PESTICIDES RECOMMENDATIONS 1. An activity should be further developed in the state which would maintain an inventory of pesticides being used in the state, the amounts of each kind of pesticide, the purposes for which they are applied, and the areas of the state in which they are used in order to estimate the effects of these pesticides on the state food supply, and on the public health. The potential dangers of pesticides are such that use should be cautious until its ultimate safety is proven. In order to know what pesticides should be evaluated for safety, it is necessary to determine which ones are in use at the present time in Georgia. Because pesticides are so widely used, this survey would be a major activity, and the necessary resources should be devoted to it. A survey of pesticides use in the state is now in progress in the State Health Department pesticides program. Such a study, coupled with the activities mentioned above, would indicate areas where safeguards should be applied. Standards could be developed, in coordination with federal agencies which are primarily concerned with pesticides research, which would ensure that the most important sources of public health hazards were dealt with. Such an approach would be better than taking singleminded, and dangerous, action by dealing with the source that happens to get the most public attention, as has happened with the banning of DDT pesticides. Since DDT has been banned, compounds more immediately hazardous to the user, such as parathion--which has caused deaths in the nation--are being used. 2. Provision should be made for thorough and continuing review of the results of research on pesticides being used in Georgia, and for communication of the results of such research to the appropriate persons. It is presently estimated that there are approximately 600 active pesticidal chemicals, which may be formulated into 60,000 preparations. It is not fully known which are safe and unsafe, nor at what level they are not safe. A multi-million dollar research effort is presently being carried out by the U. S. Department of Agriculture, the Department of Health, Education and Welfare, the Department of the Interior, the National Science Foundation and industry. State efforts should be directed to surveying the results of this research and developing programs that would communicate the results to those concerned, including the State Department of Agriculture, which has responsibility for labeling pesticides for safe use, and local sanitarians, who investigate incidents of pesticides misuse. 89 3. The state should consider research to acquire detailed data on pesticide residues in the state's environment. While general environmental surveys are being conducted by the Federal government, the state should attempt to supplement these through investigations into the state's water, soil, fish and other forms of aquatic life, upland wildlife and food products being sold to the consumer. 4. Efforts of all agencies and groups concerned with pesticides usage should be coordinated, and allowance made for all concerned to have a direct voice in making pesticide usage recommendations. A number of programs, agencies and industries are concerned with pesticides manufacture and usage. It is recommended that these coordinate their activities so that there is no duplication of efforts or confusion as to responsibility and authority among health, agriculture, fish and game, and industry groups. An attempt is already being made towards this end in state government through the formation of the interagency pesticides monitoring committee. The Task Force recognizes and encourages this committee in its work. It further recommends that industry and others outside government be involved in this cooperative effort. This body should include representatives of at least the following groups: College or University Entomologists Consumers Custom and Agricultural Applicators Extension Service Representatives Georgia Pest Control Association Georgia Department of Agriculture Georgia Department of Public Health Georgia Fish and Game Department Pesticides Manufacturers and Formulators 5. Industries and the general public should be encouraged to rely less on pesticides for total control of pests, and the public in particular should be educated to be selective about using pesticides at all. Task Force discussion revealed that, in recent years, pesticides have been used more frequently and general sanitation practices, which would decrease the need for pesticides, have been utilized less frequently. In addition, pesticide abuse is encouraged by general availability of pesticides to the consuming public, which is largely unaware of the dangers involved, and a widespread misconception that pesticides are essential for many purposes for which they are not. 90 6. Steps should be taken by the appropriate agencies to insure that pesticides applications are made by persons properly trained to do so, especially in multi-family housing units, and in institutions providing custodial care. The Task Force was informed of the potential health hazard created by the allowance of untrained persons to apply pesticides, particularly in apartment houses, and in institutions such as hospitals and nursing homes. This hazard was recognized, and the Task Force recommends that the appropriate agency, in this case the Structural Pest Control Commission, take action to see that the public health is not endangered through such practices. (Task Force member Dixon Olive commented that simply outlawing pesticides applications by owners of rental or custodial property or their employees, unless they were licensed by the Structural Pest Control Commission, could be dangerous. He said that such action could preclude instruction of an unlicensed person to apply certain pesticides; also, he said, "In many instances the owners would simply use this law to avoid any pest control in their facilities, resulting in occupants being exposed to hazards as a result of no pest control.") 91 BACKGROUND: MILK AND FOOD SANITATION Both milk and food are capable of transmitting pathogenic organisms and toxic material and must, therefore, be closely controlled. Since these consumable products are so widely distributed, milk or food-borne outbreaks could have serious health implications for large segments of Georgia's population. There are approximately 1,400 dairy farms in Georgia producing 375,000 gallons of milk per day for human consumption. This and various quantities of imported milk are processed, pasteurized and packaged by 43 milk processing plants for distribution. In order to produce a safe product, it is first necessary to obtain the milk from a safe herd. Beyond this, proper pasteurization, chemical analysis, sanitary handling, distribution and storage are required to insure the safety and palatability of the milk. Some counties do not have the staff to inspect all phases of milk processing, and in other counties the responsibility of the various regulatory agencies is vague. The problem is now being studied by a special inter-agency task force to further ascertain the needs of milk production and safety in Georgia. Based on current information, there are about 10,500 food service establishments serving more than 2,000,000 meals daily in Georgia. At present about 20 percent of food service establishments, which are the smaller ones, are not inspected and have not been issued permits to operate. The food service industry in Georgia employs approximately 125,000 people, which is a sizable industry, and growing. The rapid increase in the number of food service establishments, and the high turnover rate of employees is a major concern, since human error in the sanitary handling of food is the primary problem at the industry level. Another more recent concern is the increase in food vending machines and catering trucks. Between 1961 and 1968 there were 74 reported food-borne outbreaks in Georgia, involving 7,942 cases; and, due to poor reporting, it is estimated that this represents only 10 percent of the actual number. Statewide regulations designed to prevent food-borne outbreaks were adopted in 1966 to cover those establishments serving or selling prepared foods. These establishments are under the jurisdiction of the Georgia Department of Public Health, but regulations are enforced at the local level. The inspection of wholesale food processing plants, abattoirs, retail groceries and similar establishments is under the jurisdiction of the Department of Agriculture. 93 MILK SANITATION RECOMMENDATIONS 1. Close coordination should be effected between all agencies, including those out of the state, that are involved in the inspection of dairy cows and milk and milk-based products used in the state of Georgia. Milk being brought across state lines into Georgia should meet state inspection requirements. Two kinds of agencies in the state, as well as agencies outside the state, are involved in assuring that Georgia's milk supply is safe. While coordinative efforts between the State Agriculture Department and local health departments are being made, and while milk from both within and outside the State is generally considered safe, it is important to point out the necessity of continuing these efforts in order to assure high milk quality. In the mean time, it is hoped that fragmentation of authority, as indicated in Recommendation 5, will be eliminated. 2 There should be adequate inspection services for all operations handling milk and milk-based products in the state of Georgia. While the state's milk supply is considered safe, constant vigilance through provision of adequate inspection services and personnel is necessary in order to prevent outbreaks of milkborne diseases. 3. Adequate training should be provided for all personnel involved in inspections of milk and milk-based products. As in the case of other inspection programs, there needs to be adequate emphasis on the educative and regulatory aspects of the inspector's jobs. In-service training to enable sanitarians to provide technical assistance to establishments being inspected should be provided. They should also be informed of legal procedures to be followed in the event that voluntary compliance does not occur. 4. The authority of all agencies having responsibility for the safety of milk and milk-based products should be clearly defined to insure animal health and the safety of milk products, and to insure that there is no duplication of responsibilities and that no gaps are left in these responsibilities. The Task Force learned that lines of authority are somewhat confused and duplicated for assuring that Georgia's milk supply is safe. Both the Department of Agriculture and the local health departments have authority, although the concern of the former is for the health of the cow, and the health department is concerned with the quality of the milk supply itself. The situation is made more curious by the fact that health department personnel carry out inspections for agriculture department standards. Authority as well as development of standards and inspection services should be consolidated in one agency that will fulfill all needs. 95 FOOD SANITATION RECOMMENDATIONS 1. Adequate inspection services should be provided for all food service establishments in Georgia. Inspections in the past have primarily consisted of indicating areas of non-compliance to food establishment operators. There is a need for more inspections, as well as an improvement in methods of inspection. Such improvements would involve better communications between state and locallevel personnel so as to encourage unequivocal understanding of rules and regulations, and a proper appreciation of balancing technical assistance and enforcement aspects of food sanitation programs. 2. Results of inspections should be computerized in order to have comprehensive evaluative information about the safety of food service establishments in Georgia. Because of the large number of restaurants and other food service establishments, computerization of results of inspections is essential to evaluating the success of the activity, and to determining potential health hazards. 3. Technical assistance should be provided to operators in chains of food service establishments to encourage self-inspections based on uniform standards of safety. Chain food service establishments constitute a large portion of the state's restaurants, and unsanitary conditions in one establishment reflects on the others. The State Health Department has recently begun a self-inspection program to encourage commercial chain food service establishments and school lunch programs to supervise their own units for health conditions. Impressing such operators with the fact that maintaining high public health standards is good business with give the chain establishments incentive to uphold those standards. 4. Public information efforts should be directed at encouraging the public to avoid unsatisfactory food service establishments and motivating them to patronize those whose operations conform to uniform standards of safety. Members of the public should be made aware that, while illnesses due to consumption of unhealthy foods are not often reported, the chances are greater that they will contact such diseases if they are not discriminating in the places where they eat. Valid indicators of food contamination should be publicized in an innovative way in order to encourage such discernment. 5. Food vending operations should be studied for possible problem areas, and appropriate actions taken to ensure that the public health is not endangered by dispensing operations. 97 While food kept in enclosed vending machines has not, so far as is known, been a health problem, there is concern about perishable food such as sandwiches being sold on counters outside restaurants. Consideration should be given to adopting vending machine food rules and regulations in order to prevent contamination before it is reported. In the case of food outside of vending machines, but not in restaurants, existing food service rules and regulations would apply and should be utilized. 6. Enforcement procedures should be streamlined and legal counsel made accessible in order to reduce the number of businesses operating with unhealthful conditions, rather than allow them to continue business while in non-compliance with health standards. Enforcement of food service standards is often frustrated by a local sanitarian's lack of knowledge or access to advice about legal alternatives for enforcement of the standards. It should be acknowledged that effective food sanitation hinges on both an educative and regulatory effort, and that adequate assistance should be provided for both. Alternatives for providing legal assistance include the state's requiring that local health boards allot appropriations for legal fees. Should this not be possible, local cases should be turned over to the State Board of Health for prosecution, and sufficient legal assistance should be provided to the State Board through the State Attorney General's Office. 7. Permits that certify compliance with State Health Department rules and regulations should be subject to periodic review and made easily revocable for non-compliance with the standards. A permit, once granted, is in effect for an indefinite period of time. While it may be revoked after considerable time and effort, it is not subject to renewal. A renewable permit system would promote continuation of healthful conditions in establishments that are granted permits. 8. A rating system should be established that would grade food service establishments as to relative safety. The rating should be displayed prominently in the establishment. Many other states in the U. S. have used a rating system of relative food establishment safety, thus encouraging their operators to comply with health standards. Implementation of such a program would require adequate public education in order to be effective, as the educated consumer is the one who would choose one restaurant rated over another. 98 o.z... i= ~ ou~ u BACKGROUND: OCCUPATIONAL HEALTH More than 1.25 million persons make up the work force in Georgia, and many are exposed to potentially hazardous conditions due to their work or working environment. Approximately half a million of these individuals are employed in the 7,000 to 8,000 industries scattered throughout the state and are frequently exposed to health hazards such as sharp instruments, moving parts, poor lighting, high temperatures, high noise levels, toxic dusts, gases, fumes, solvents, acids and alkalies. The disabilities suffered by workers at their place of employment are difficult to assess either state-wide or nationally, due to inadequate reporting of occupational morbidity and mortality data. However, the information obtained from the Workmen's Compensations Board and Vital Records Service indicates that occupational hazards are significant. Damage claims totaling thousands of dollars are made each year due to dermatitis, which is the most prevalent occupational disease. In fiscal year 1968 there were four deaths due to silicosis, five due to silico-tuberculosis as contributory cause, one from byssinosis and chronic bronchitis, two from asbestosis and three from asphyxiation with argon gas. The major causes of most occupational health problems are inadequate safety and occupational health programs. Few employers, especially the small ones, can afford these services. However, if these needless injuries and deaths are to be prevented, some method must be found to educate the workers, eliminate or minimize working hazards and conduct medical examinations to insure that workers do not have potential health problems that are incompatible with the intended work or working environment. 99 OCCUPATIONAL HEALTH RECOMMENDATIONS 1. Preventive health services, including screening for chronic diseases and to determine the compatibility of a person's medical problems with his job requirements, should be promoted for all persons employed in establishments now lacking such services. The screening procedure provides for early detection when there are no symptoms, permits application of other preventive measures, and indicates the compatibility of individual medical problems with the requirements of particular jobs, with or without work restrictions. Employees, ~surance companies, the health authorities and employers have a mutual interest in such preventive techniques, and should cooperate in an effort to place such services in industries allover the state. 2. Legislative action should be sought to make the workmen's compensation occupational disease schedule more inclusive, and to broaden the coverage of workmen's compensation to include agricultural workers and other employed groups not now protected against work-related illnesses. Workmen's compensation does not allow for many illnesses, including workrelated hearing loss, that are subtle but real results of the work environment. A comprehensive review should be carried out for ways to expand the workmen's compensation coverage, and appropriate remedies made through legislation. 3. Georgia's occupational illness reporting service should be improved so that job-related health hazards throughout the state can be adequately analyzed and reduced by appropriate follow-up measures. Evaluation of the State's occupational health hazards is contingent upon effective reporting to the State Health Department's Occupational Health Service by the State Workmen's Compensation Board. Relationships between the two state agencies should be strengthened, and the causes of diseases sufficiently pin-pointed to make effective evaluation possible~ 4. The feasibility of an employee's health service, including screening, counseling and referral, and easily accessible to all state and local government personnel, should be explored and, if feasible, the service should be activated. Presently, the Occupational Health Service offers multi-phasic screening, counseling and referral services to all state employees in Atlanta. However, such services are not available outside the city. District and local health departments would appear to be the most appropriate sites for such services, were they found feasible, for government employees allover the state. 101 5. To help employees gain a better understanding of the health problems of their working environment, educational materials dealing with the health hazards of particular industries or occupations should be made available to them from voluntary health agencies and other sources. Industrial physicians, voluntary health agencies, insurers, the Occupational Health Service, and employee representatives should cooperate in development of materials that will relate health hazards in particular working environments to employees. For instance, farm workers should know about dangers in applying certain pesticides, and chemical manufacturing employees should be fully cognizant of potential hazards in their work. 6. Consideration should be given to expanding the occupational health program to include inspections and enforcement procedures to assure that working environments in Georgia do not contribute to employee injuries or illnesses. Resources presently allocated to the Occupational Health Service do not make routine inspections of working environments possible, nor are there sufficient uniform standards by which to judge working places. As Georgia's industries grow in number, size and complexity, consideration should be given to the need for uniform health and safety standards for industries. 102 o...I ~ t- oZu o~ t- Uw > BACKGROUND: VECTOR CONTROL Insects and rodents have always posed a serious threat to life and health. Georgia has experienced outbreaks of most vector-borne diseases. After years of little concern, the State Health Department, with the help of municipal agencies such as those in Atlanta, and with the stimulus of the U.S. Public Health Service, proved that many of these diseases could be eradicated. However, a constant threat of reintroduction exists. Malaria, Typhus, yellow fever, and dengue are examples. Since 1953, nearly 800 cases of malaria were reported in the state, primarily from returning Southeast Asia veterans. Other vector-borne diseases, such as Rocky Mountain spotted fever, tularemia, typhoid fever and encephalitis are endemic within Georgia. Only environmental measures can keep them under control. Vector control measures impinge on many other environmental problems. For example, surveys show that in larger cities (over 5,000 population) threefourths of the land disposal sites for solid waste have insect and rodent problems, and in smaller cities this figure rises to nearly 100 per cent. Concern over use of certain pesticides for controlling vectors, which have been most effective in that mission, will require searching for some new methods of control. The benefit-risk ratio must be ascertained. In addition to disease transmission, insects and rodents affect the wellbeing of Georgia's citizens by causing irritation from bites, discomfort, by adversely affecting property values and tourist trade. Further efforts should be aimed at nuisance insects in addition to proven disease vectors. At present, vector control activities at the state level include cooperating with local health agencies in the training of personnel and the implementation of local programs. Only some of the larger metropolitan areas have well-organized programs. 103 VECTOR CONTROL RECOMMENDATIONS 1. Continuous, comprehensive surveys should be made of the public health dangers due to presence of certain vectors in Georgia, and standards and activities revised in order to deal most effectively with the most important problems. This field of environmental control is very complex, due to the changing problems within it. Vectors may be of greater or less pUblic health significance, depending on their concentrations and the conditions in which they exist. In order to determine which vectors should be controlled, information on the situation should be constantly updated, and standards and activities tailored to the most pressing needs. Coordination should be effected between all agencies, organizations, and industries involved to avoid duplication of efforts, and adequate resources should be applied to the entire effort. 2. Vector control activities should be a part of the health and welfare program in every area of the state. The information gathered from the activity described above should be transmitted quickly and clearly to health department and other agencies concerned with control on the local level, in order to promote effective response to public health and other hazards created by vectors. Additional training should be given to local personnel in order to foster appreciation of the relative economic as well as health importance of control programs, and of the need for applying appropriate control techniques. Welfare caseworkers should be trained to look for rodent and insect problems during home visits and to refer them to local health departments. 3. The public and sanitation officiam should be educated on steps that can be taken to prevent disease-bearing vectors from causing a public health hazard. Problems with rats and insects are concentrated in certain identifiable areas, particularly in inner city areas where there is poor housing and general lack of sanitation. While the inner city resident may not be able to satisfy the greater need for adequate housing, short-range solutions can be found through education in preventive techniques, such as proper handling of food wastes, placement of garbage cans and storage of refuse out of reach of rats. Sanitation officials dealing with collection and disposal of wastes should be fully aware of preventive measures that need to be taken in order to control vectors. 105 .z.... oz 0i= i= =!:: !::z - zen ''e.1n- BACKGROUND: INSTITUTIONAL SANITATION There are about 3,500 institutional environments in Georgia which affect the lives of over a million and a half persons. Insuring that these institutions maintain clean, safe and healthy environments is within the realm of institutional sanitation. The types of institutions included in this category are schools, hospitals, work camps, prisons, nursing homes, and development and care centers. In each institution any factors which may influence the health or safety of the individual must be considered. Therefore, it is necessary to insure adequate water supplies, liquid and solid waste disposal systems, food service, maintenance, safety measures, space allocation, heating, lighting, ventilation and general sanitation. Based on program plans submitted by local health departments, it is estimated that nearly 200,000 people are housed in or are attending approximately 800 institutions which do not meet acceptable health standards. This indicates that one out of every seven institutionalized persons is exposed to potentially hazardous conditions. The problems in institutional sanitation involve inadequate funding and personnel to carry out inspections. In addition, regulations and standards are not as comprehensive as desired for all institutions. Inadequate funding and inadequately trained personnel are normally a problem for the institutions and regulatory agency. The Georgia Department of Public Health has only three full time employees in the Institutional Sanitation Section to review school plans, to make site inspections or to supervise inspections by local health officials for the numerous institutions involved. 107 INSTITUTIONAL SANITATION RECOMMENDATIONS 1. Adequate administrative and inspection staff should be provided to insure that institutional sanitation standards are enforced. These should be properly distributed in order to effectively enforce standards for privately-owned facilities and for publicly-owned facilities. In view of the large part of Georgia's population--nearly a third--that spends a good deal of time in institutions such as schools, hospitals and prisons, adequate manpower and services on all levels--state and local--should be provided. Inspections should be made regularly and regardless of whether, as is the case with schools, the institution's plan for construction has been approved and the constructed facility has been approved. Cross-training of inspectors to enforce all applicable standards, such as hospital licensure, food sanitation, fire and safety regulations would increase the number of inspectors, and make more comprehensive inspections possible. 2. The various educational, professional and regulatory agencies of the state should be more effectively used in special educational programs for persons charged with institutional sanitation responsibilities. More in-service training is needed for inspectors. Such training should be designed to increase the competence and confidence of inspection personnel in acting as consultants to institutions, as well as enforcers of applicable rules and regulations. Cross-training of personnel, as suggested in Recommendation 1, would increase manpower, and it would also increase the competence of inspectors. An important part of training for institutional sanitation is adequate explanation of legal procedures involved in enforcing standards. 3. Standards covering water supply, liquid and solid waste disposal, food service, maintenance, safety, space, heating, lighting, ventilation and general sanitation should be improved, or developed where they are lacking, in order to assure healthful surroundings for persons in Georgia's institutions. While rules and regulations have been developed for some aspects of the institutional environment, standards regarding maintenance, safety, space, heating, lighting and ventilation have not been developed. There is a need for these in order that both inspector and administrator will have a clear definition of institutional health. Standards relating to water supply, liquid and solid waste disposal and food service have often been designed for establishments other than institutions and should continue to be reviewed for their applicability. 109 oz ~ o..~ ........ D. w o&I) z BACKGROUND: NOISE POLLUTION Noise has often been described as unwanted sound, sound without value or vibrational energy out of control. Regardless of the definition used, noise in the envrionment has reached a level of national concern and is an increasing problem. Generally, this noise is grouped into three types, depending upon its source. These groupings are related to noise resulting from transportation, occupational or industrial and communities. Since any noise is capable of producing both physical and psychological damage, all sources must be controlled. Aircraft noises usually come to mind when discussing transportation noises. However, noise from surface vehicles such as trains, boats, trucks, automobiles and motorcycles are more widespread and therefore are more significant. The noise levels emitted by various sources are given in Figure 10 A Federal law (PL 90-411) requires the certification of all commercial aircraft, and FAA standards issued in 1969 will result in lower noise levels for all new aircraft of the turbofan variety. Laws to limit other forms of transportation noise are lacking or they are not enforced. Most occupational noise results from metal to metal contact or high-speed equipment such as blowers. Occupational noise is therefore a serious problem in such industries as steel, paper, textile and petrochemical. However, occupations other than the heavy production industries are also affected. Printing is an expample. The physical damages which result are normally a loss of hearing, and the magnitude of the impairment depends upon the time-intensity exposure. Unfortunately, long exposure usually results in permanent hearing loss in varying degrees. The Walsh-Healey Health and Safety Regulations specify a maximum exposure of 90 dBA for a continuous exposure of eight hours. But this law applies only to industries holding federal government contracts in excess of $10,000, and thus provides only minimum protection for the citizens of Georgia. (See Page 114). Even in the coufines of their own homes, Georgians are bombarded with noise. The number and type of convenience items such as radios, record players, dishwashers, lawnmowers, disposals and ice crushers are increasing to such an extent that the noise level in the home is approaching that in mechanized industry. The noise problem in Georgia may be reduced in three ways. The first is to reduce noise at the source through the design of better machinery, quieter engines, highway tires and home appliances. The second is to institute operational procedures for machinery operation or aircraft landings and takeoff. The third is personnel protection through the wearing of such devices as ear plugs. All of these noise reduction methods cost money and require the education of the general public. If steps are not taken to reduce noise, we will continue to pay for our inaction through hearing loss and numerous lesser impairments. For example, it is estimated that $4 million is lost in the U.S. each day through decreased work efficiency due to noise. In 1971 the Federal Government is expected to spend only $34 million in noise abatement and this is primarily for aircraft noise. Very little effort is now being exerted by the State of Georgia to abate noise pollution. III Figure 10 - WEIGHTED SOUND LEVELS AND HUMAN RESPONSE SOUND SOURCE dB (A)-k 150 RESPONSE CRITERIA Carrier Deck Jet Operation 140 Painfully Loud 130 Limit Amplified Speech Jet Takeoff (200 feet) 120 Discotheque Auto Horn (3 feet) Riveting Machine 110 Jet Takeoff (2000 feet) Shout (0.5 feet) 100 N. Y. Subway Station Heavy Truck (50 feet) 90 Pneumatic Drill (50 feet) 80 Freight Train (50 feet) Freeway Traffic (50 feet) 70 Air Conditioning Unit (20 feet) 60 Light Auto Traffic (50 feet) 50 Living room Bedroom 40 Library Soft Whisper (15 feet) 30 Broadcasting Studio 20 Maximum Vocal Effort Very Annoying Hearing Damage (8 hours) Annoying Telephone Use Difficult Intrusive Quiet Very Quiet 10 Just Audible o Threshold of Hearing * Typical A--Weighted sound levels taken with a sound-level meter and ex- pressed as decibels on the scale. The "A" scale approximates the frequency response of the human ear. Source: Department of Transportation 112 NOISE CONTROL RECOMMENDATIONS 1. State and local government agencies having responsibilities for control of hazardous noise levels should develop mechanisms for dealing with the problems on a regional basis, in order to handle problems that originate in different political jurisdictions. As with most environmental problems, the hazard affects more than one local government unit. Regional agreements should be developed to deal effectively with sources of noise pollution, such as airports, which affect more than a single political jurisdiction. The state's antinoise program which is presently being developed in the State Health Department should consider creating mechanisms in the program that would make interstate agreements possible. 2. A statewide effort should be made to conserve the hearing of Georgia's citizens through coordinated activities that would make individuals and manufacturing and transport industries aware of and responsive to the need for preventive measures to protect hearing. Civic organizations in Georgia, which have been enthusiastic sources of many needed community services, should be encouraged to develop programs for hearing conservation as hearing loss, with some exceptions, is permanent loss and cannot be repaired. An important part of a conservation program is to make the average citizen aware of how he unwittingly endangers his hearing, for instance, through misuse of stereo equipment. The Lions Clubs of Georgia have provided corrective services for the visually handicapped through their "Lighthouse for the Blind" program. Civic groups could prove to be a valuable aid in the hearing conservation effort as well. Agencies such as health authorities should provide the technical assistance necessary. State and local health departmen~ should work with manufacturing and transportation industries to make them aware of the need for engineering and operational measures to conserve the hearing of persons that may be affected by noise from factory and transportation sources. Both types of efforts--by civic club or by official agency--will require accurate, accessible information on noise hazards. The official agency should be responsible for gathering this information and making it available to groups carrying out hearing conservation programs. 3. A special public education campaign should be undertaken in order to educate Georgia youths about the hazards of high intensity rock music in live or recorded form. The Task Force learned that such music is a particular hazard to youth, and that the problem merits special attention, due to the fact that irreparable damage can be cause, and the fact that the source of the hazard is so popular. Techniques of education should be developed that would appeal particularly to the youthful population. 113 4. Standards for noise levels and exposure limits should be developed for transportation, industrial and community noise sources. The Task Force was informed that sufficient research has been done to enable at least preliminary standards to be set to control the three sources of noise and to prevent hearing loss. Standards based on present knowledge should be developed and revised as more information about causes of hearing loss is uncpvered. Standards for noise exposures contained in the federal Walsh-Healy Act are recognized as acceptable for all environments. However, the Act covers only industries supplying more than $10,000 in materials to the federal government. The standards are as follows: PERMISSIBLE NOISE EXPOSURES Duration per day hours Sound level dBA 8 90 6 92 4 95 3 97 2 100 11~----------------------------110502 ~ 110 t or less 115 Exposure to impulsive or impact noise should not exceed 140 dBA peak sound pressure level. 5. Research should be conducted in order to determine the long-term physical, social, and psychological effects of noise above the tolerance level; to assess the sources of the most damaging noise; and to determine more exact criteria for limitation of personnel noise exposures in all environments. More research is needed to provide further information about the effects of noise so that preliminary standards, once developed, can be perfected. 6. Effective legislation should be developed and enforced to the most practicable degree at the most feasible level of government in order to prevent hearing loss and annoyance due to transportation, industrial or community noise. Local ordinances should be devised and/or State legislation drafted which would, when effectively applied, safeguard the physical and mental health of the State's citizens. Along with this legislation, legal procedures should be outlined and communicated to those charged with implementation so that enforcement will be vigorous and comprehensive. 114 .... Z. cl dl el COMBINED ACHIEVEMENT OF SUB OBJECTIVES ACHIEvEM~,~r OF PRIME OBJECTIVES Figure 1 Example of Work Sheet WORK SHEET NO.2 EFFECTIVITY MATRIX FORM 11 to e "1 ~ t-J m X OJ 3 iJ ~ -m .(~.). -5. '< ~ PRIME OBJECTIVES NORMALIZED WEIGHTS WORD RATINGS 1. 2. 3. OPTIMIZE QUALITY MAXIMIZE PATIENT OF CARE COVERAGE ACCEPT. Wl = .23 W2 = .20 W3 = .14 GRADE EXCEEDS GOALS 110 FULL Y MEETS STATED OBJECTIVES 100 ALMOST TOTALL Y ACCEPTABLE 90 SOMEWHAT SHORT OF MEETING OBJECTIVES 75 X X CONSI DE RABL Y SHORT OF MEETING OBJECTIVES GENERALLY UNACCEPTABLE __ 50 ... _ - - - - - _. .- 25 - X -- - _. OBJECTIVE GRADE (WEIGHTED} GRADE MULTIPLIED BY WEIGHT P!! 4. 5. 6. 7. s. g. TRAINING \PROF.I TRAINING MEDICAL (NONPROF.I RESEARCH RESEARCH IN HEALTH DELIVERY W4 = .07 W5 = .Og W6 = .16 W7= .11 Ws= Wg= I ,, I I I IX X I I X - - - -I X I --_. I , ! , I ! 10. WlO= I :OJ; THESE SPACES RESERVED FOR x FUTURE RE EVALUATION EFFECTIVITY RATING -- SUMMATION OF ALL OBJECTIVE GRADES NUMERICAL PRODUCTIVITY -- NO. OF PATIENT VISITS PER Sloo COSTS INITIAL 77.3 5.2 _ - R-E---E-V-A_L.U-.A. TION I-' -I" \0 t'tl ~ QQ (I) ..... 0\ tr1 .tt1.'t.l.=..<:.l. ~0t1 t1 t1 0 .... ::s rtS ~'< (I) =:l t:::rt t'""(1)~ rt .... ID t:::t1t-'} ID S ~ ::s ........ o ,C.ll: =:l ~ rt~ .... 0 o t1 =:l to NOTE Permission to reprint this article, which appeared in the August, 1970 issue of Appalachia, has been granted by the editors. GEORGIA PIONEERS IN SOLID WASTE DISPOSAL In a double-barreled effort to improve the environment, the Northwest Georgia Regional Health Advisory Council, Inc., has undertaken a solid waste disposal program which abates pollution while simultaneously reclaiming useless land. Under this program, solid waste is deposited in sanitary landfills, which can then be covered and used for reforestation or recreation. The program is financed jointly by the council (one of the ten demonstration health areas funded by the Appalachian Regional Commission) and by the twelve counties and two cities participating in the program. (The counties are Bartow, Chattooga, Cherokee, Fannin, Floyd, Gilmer, Gordon, Murray, Paulding, Pickens, Polk and Whitfield; the cities are Rome in Floyd County and Dalton in Whitfield County.) THE PROBLEM The solid waste disposal problem is particularly severe in northwest Georgia, and has been increasing rapidly in both scope and complexity. In 1966, it was estimated that 750,000 cubic yards of refuse were produced annually in the 12-county area. By mid-1970, the volume had more than tripled; during the first four months of the year alone, 850,000 cubic yards were deposited in the 17 sanitary landfills operated under the new program. One important reason for the growth of the waste disposal problem in the area is the expansion of the tufted carpet industry, which now has plants in nine of the twelve counties and which it is predicted may double its production within the next four years. The wastes produced by these plants-liquid latex and fibers-are practically indestructible; they will not satisfactorily burn, compact, crush or deteriorate. Prior to the operation of the new program, these wastesplus the normal solid wastes which accumulate in an area with a population of approximately 300,000 people -were hauled to unsightly, smelly and unsanitary dumps. It became daily more apparent that there was a need for an efficient, attractive and inexpensive disposal system, and that the only practical way to handle these unusual industrial wastes was to bury them in a sanitary landfill. THE PROGRAM The new program, which was fund- ed in]une 1968, began operation in November of the same year and is under the direction of Joseph Hunt, an environmental sanitarian who has worked in 40 of the 50 states of the United States during his career with the U.S. Public Health Service. Under this program, each of the twelve counties plus the two cities signed a contract with the Northwest Georgia Regional Health Advisory Council and agreed to operate at least one landfill according to specifications, which included furnishing an appropriate site for each landfill, obtaining the necessary personnel, maintaining the equipment used in the program and taking any legal actions required to close the old dumps as the new landfills became available for use. The council agreed to provide 80 percent of the purchase cost of the necessary equipment and to pay the costs of preparing the landfill site, closing old dumps and building a grease pit and an equipment and personnel shelter. The program staff of the council also provided the counties and cities with technical assistance as required. The council agreed to pay 100 percent of operating costs during the first and second years of operation. The funds are provided under Section 202 of the Appalachian Regional Development Act. During the third. fourth and fifth years, the council and the counties (or cities) will pay operating costs on a 50-50 basis. A total of 21 tractors have been purchased for the program, the type of equipment ordered for each landfill depending on the type of terrain where it is to be used. Of the 21 tractors, nine are bulldozers (which are equipped with a blade that pushes waste and dirt into place) and twelve are front-end loaders (which are able not only to push the dirt and refuse but also to pick it up and deposit it in a new location). There are always special equipment maintenance problems involved in sanitary landfill work. In this case the problems are complicated by the troublesome nature of the tufted carpet wastes, which are damaging to the cooling system of earth-moving equipment. As a result, the tractors used in the program had to be equipped with what is now called a "sanitary landfill packet," a series of special equipment items including a complete hood engine enclosure, a screened and mounted air intake, heavy duty filters, a counterweight to balance the landfill blades, a dry chemical fire extinguisher and a seim-enclosed cab for the driver. The multicounty nature of the effort and the economies of mass bidding and purchase resulted in substantial financial savings in the purchase of this equipment; the council saved more than $165,000 on the list price of the tractors used in the program. The cost of the disposal program to date has averaged 24 cents per cubic yard of waste. Since this cost includes 151 heavy initial expenditures for equipment, the average is expected to decline as the program continues. If the minimum expected equipment life of five years is achieved, the average cost will decline to only five cents per cubic yard. DISPOSAL SITES Obtaining the landfill sites posed some initial problems for the counties. "The first site is always hard to get," according to Mr. Hunt. "After the first one has been filled up and covered over, and people see how nice it looks, it's a different story. Then they come to us and ask that we use their land for our program." The initial landfill sites have included two abandoned strip mines in Bartow County near Cartersville and several plots of marginal eroded land, frequently on hillsides where timber has been harvested. When strip mines are used, the open pits are filled with compacted wastes, which are covered with a final layer of soil approximately two feet deep. These areas can then be used as playgrounds or parks. Planting of row crops is not recommended because plowing might disturb the underlying solid waste if the layers of waste are not perfectly even or if the plow penetrates to varying depths. Completion of landfills at the two Bartow County strip mine sites was handled so efficiently and made such a significant improvement in the appearance of the area that the mining company offered a third and much larger mine site (four miles long and 100 feet deep), and the new site is already in use. When deforested land is used as a disposal site, deep trenches are dug in the hillsides, filled with compacted solid wastes and then brought to the original level with a three-foot cover of soil. Since these areas can then be reforested, and since the landfill program eliminates promiscuous dumping which causes fires, several timber companies in the area have given the counties inexpensive leases on cutover land for use as landfill sites. PERFORMANCE When all 17 of the landfill sites are fully operational, they will serve approximately three-fourths of the population of the twelve-county area. To date the program has been very successful in terms of both efficiency 152 ~ Tllfted carpet wastes, which are practically indestructible, are bun'ed in a sanitary lalldfill ill Ilorthwest Georgia. and convenience to users. Of the present 17 sites, 16 have been rated Class A and one Class B on the basis of efficiency rating procedures prepared by the U.S. Public Health Service. User convenience has been augmented by the fact that, because of the multicounty nature of the program, all 17 landfill sites are open for use by any resident, r'egardless of where he lives or which county is operating a given landfill. Directions to the disposal sites are clearly marked on the area's roads and highways, and people drive their cars or trucks directly to the par_tion of the site currently being filled, as indicated by a series of large arrows. During the first six months of 1970,124,001 vehicles visited the landfills to dump more than 1,250,000 cubic yards of refuse. All twelve county health boards have passed, or are in the process of passing, regulations which will close all the old open dumps and require the disposal of solid waste in the new network of sanitary landfills. To date, approximately 300 roadside dumps have been closed, and more are in the process of being cleaned out by county road crews. SERVICE IN RURAL AREAS The program has also tackled the problem of furnishing disposal sites to serve the small incorporated communities (400 to 1,000 population) and the strictly rural areas which are located too far away from the central Lalldfills have already been completed at two strip mine sites, and a third is now in use. landfills to be used by residents on a regular basis. In a three-county area, a pilot project is being developed to construct six conveniently located mobile disposal sites. The key to this program is the imaginative use of very large multivehicle trailers which haul automobiles across country. These trailers, which are retired as new automobile models are put on the market, can be purchased at low cost ($200-$500, depending primarily on the condition of the tires). Under this program, steel plates will be installed on the bottom and sides of the trailers, transforming them into large receptacles or bins, each of which can hold from 60 to 70 cubic yards of refuse. At selected sites, trenches will be dug and lined with reinforced concrete. The trailers, which will be pulled to the site by tow truck, will be inserted into the trenches through cleared areas prepared at both ends. Since the area on one side of each trench will be blacktopped for all-weather use as a parking ramp, and since the side of the trailer will extend only one foot above the ground, residents can easily drive their cars or trucks directly to the trailer and dump their trash into it. At regular intervals, the tow truck will pull an empty trailer to each site, pull out the trailer full of refuse, substitute the empty trailer and then pull the full trailer (which has been carefully covered to prevent blowing or spilling) to the nearest central landfill site, where it will be emptied and readied for its next tour of duty. With the purchase of a used tow truck and seven trailers (one for each of the six sites plus one extra for use as the "empty"), this pilot program will service the six locations on a twice-aweek basis. RECORDS Extensive records are maintained by each county and the two cities to show the amount and type of solid wastes being handled for each site, the sour~es of the wastes and the cost and effectiveness of the program. These records enable the staff to recognize the deficiencies of a given site, schedule the manpower required at the site at various times of day, maintain equipment, make adjustments in the estimated life of the site, determine the magnitude of the waste disposal problem in the county or city and develop cost data for future sites. FUTURE PLANS In addition to expanding the mobile dumping station network described earlier in this article, future plans call for various types of research and action designed to improve the physical environment of the area. A study of the potential recycling or reclaiming of waste products, particularly manufacturing waste, has been proposed. Studies of the refuse collection systems in Rome and Dalton are currently under way, and similar studies are planned for all major communities and selected rural areas in the twelve county area. Overall surveys of the exterior environment in the major communities will also be conducted in order to inform officials and the public about the quality of the environment and how it can be improved. Any recommended improvement programs-general cleanup, enforcement of a large animal ordinance, improved refuse storage containers, removal of junk and/or abandoned cars-will be handled on an areawide basis and will disregard geographic boundaries. Mobile dumping stations furnish waste disposal service to small towns and rural areas. 153 "The optimum population for a highly-developed, industrialized nation with a high per capita G.N.P. (gross national product) is very much lower than the population that can be supported at a subsistence level in an undeveloped nation, because the per capita consumption of resources and the production of wastes are so much greater in the developed countries." Optimum Population and Environment: A Georgian Microcosm By EUGENE P. GnUM Director, Institute of Ecology, University of Georgia THE WORLD SEEMS to be getting smaller and more limited in its ca- pacity to support human beings be- cause the per capita use of resources in developed countries, and the per capita expectations in undeveloped countries, keep going up. Thoughtful persons everywhere are agreeing, perhaps reluctantly in many cases, that if a high quality human existence is to be achieved man must now "manage" his own population as well as the natural re- sources on which he depends.* To the ecologist, this means first and fore- most that the population growth rate must be drastically reduced so that an equilibrium can be reached in the very near future if we are to avoid the very high risk of excessive population, reduction in the per capita availability of resources and a loss in the individual's freedom of action. If this is indeed the case, then the question of what constitutes an optimum population density for man becomes * This article is based on the sixth and final pre- sentation in a public lecture series: "Ecology 1970 -Principles for Action," sponsored by the Institute of Ecology, University of Georgia, Winter Quarter, 1970. Copyright held by the author. 1 See, for example, historian Lynn White's essay entitled "The Historical Roots of Our Ecological Crisis," originally published in SCIENCE, 115: 1203, 1967, and widely reprinted in paperback. 2 See Natural Resources: Quality and Quantity (Berkeley: University of California Press, 1967), pp. 7-18. a key issue. An ecological approach to this problem involves considering the total demands that an individual makes on his environment, and how these demands can be met without degrading or destroying his living space or lebensraum. Since the environment is both a "supply depot" and a "house" for man, the concept of the integrated system, the "ecosystem," is the basis for the relevant ecology of today. In the conduct of human affairs in the past, these two functions of the environment have been considered as separate and unrelated problems, as many writers are now pointing out.1 The dramatic change in peoples' attitude towards their environment and the rise of a sort of "populist" ecology in the 1970's stem from a general recognition that the quality of the lebensraum is so intimately interrelated with the rate of production and consumption of resources that the total "manin-nature" ecosystem must now be the basis for intelligent management. Lewis Mumford places this concept in more general terms when he says that "Ideological misconceptions have impelled us to promote the expansion of knowledge, power, productivity, without inventing any adequate systems of controls," and that therefore "the problem of our age" is how to use quality to control quantity.2 In actual fact, it will be much 355 155 356 CURRENT HISTORY, JUNE, 1970 TABLE 1. WORLD DISTRIBUTION OF PER CAPITA G.N.P. Per capita G.N.P. ($) Number of countries % world population 40-149 31 56.5 150-299 25 8.8 300-599 15 4.7 600-2400 16 30.0 Source: Revelle in Prospects of the W orld Food Supply (Washington, D.C.: National Academy of Science, 1966) Table 1, p. 24. easier to "invent" controls than to agree on a "set point," or optimum level, for the "population-stat." THE GEORGIAN MICROCOSM In the fall of 1969, my class in advanced ecology at the University of Georgia elected to tackle the question of "the optimum population for Georgia" on the assumption that this state was large enough and typical enough to be a sort of "microcosm" for the nation and the world. The basic question asked was: How many people can Georgia support at a reasonably high standard of living on a continuing, self-contained equilibrium basis, in the sense that imports and exports of food and resources would be balanced. As it turned out, Georgia is a good microcosm for the United States because its present density and growth rate, and the distribution of its human and domestic animal population are close to the mean for the whole nation. Likewise, food production and land use patterns in Georgia are average. Furthermore, since pollution, overcrowding and loss of non-renewable resources have not yet reached very serious proportions, the state, like most of the nation, has the opportunity to plan ahead for a new kind of "progress," based on the right of the indIvidual to have a quality environment and to share in the economic benefits of wise use and recycling of resources. It is self-evident that such planning must start at the local and state level. The ecological and population situation is so varied in the nation as a whole that it is not likely that a nationwide plan for optimum population and environment can be initiated until states and regions take their inventories and set tentative standards. For example, the impetus to redesign the internal combustion engine to reduce air pollution started in California where the problem was locally acute. And once California sets rigorous control standards the nation must quickly follow, because manufacturers have to meet maximum, not minimum, standards, since they cannot (for long, at least) build one kind of car for California and another for other states. As background for the Georgia inventory, two general principles were adopted. The first principle can be stated as follows: "The optimum is almost always less than the maximum." In terms of human population density, the number of people in a given area that would be optimum from the standpoint of the quality of the individual's life and his environment is considerably fewer than the maximum number of people that might be supported, that is, merely fed, housed and clothed as dehumanized robots or "domestic animals." The same principle can be applied to automobiles; certainly the greatest number of cars that can be accommodated bumperto-bumper on a freeway is not optimum for the forward progress of the individual automobile. Perhaps, then, the idea of the "greatest good for the greatest number" is not really a tenable principle. Maybe Dr. George Wald's slogan, "a better world for fewer babies" is more relevant to our times. A second principle is that afRuence actually reduces the number of people who can be supported by a given resource base. Thus, the optimum population for a highly developed, industrialized nation with a high per capita G.N.P. (gross national product) is very much lower than the population that can be supported at a subsistence level in an undeveloped nation, because the per capita consumption of resources and the production of wastes are so much greater in the developed countries. Thus, if one person in the United States exerts 50 times more demand on his environment than does an Asian, then it is obvious that no environment can support as 156 Optimum Population and Environment 357 many Americans as Asians without disastrous deterioration in the quality of that environment. Table 1 illustrates how sharply our world is divided into "developed" and "undeveloped" nations. The distribution of G.N.P. is strongly bimodal, with very few people living in intermediate (so called "developing") nations. Shocking as it may seem, the United States is now in as much danger of overpopulation at its level of per capita living as is India at her present standard of living. Population control must be an overriding issue in both the developed and undeveloped worlds, but the levels that are critical, the limiting factors and the strategy of control are quite different. MINIMUM AMERICAN PER CAPITA ACREAGE REQUIREMENTS Table 2 is the consensus estimate made by the students of the minimum acreage necessary to support one person at a standard of living now enjoyed by Americans, including a pollution-free living space, room for outdoor recreation and adequate biological capacity to recycle air, water and other vital resources. The per capita area required for food was obtained by taking the diet recommended by the President's Council on Physical Fitness and determining how much crop and grazing land is required to supply the annual requirement for each item. If Americans would be satisfied with merely getting enough calories and greatly reducing their consumption of meat, as little as a third of an acre per person would be adequate, but the kind of diet Americans now enjoy including orange juice, bacon and eggs for breakfast and steaks for dinner-all of which require a great deal of land space to produce -takes at least 1.5 acres per capita. Thus, the American "demands" from his agricultural environment 10 times the space that is required to produce the rice diet of the Oriental (assuming equally efficient crop production in both cases). The one-acre requirement for "fibers" is based on present per capita use of paper, wood, cotton and so forth, that equals the average annual production of one acre of forest and other fiber- TABLE 2. MINIMUM PER CAPITA ACREAGE REQUIREMENTS FOR A QUALITY ENVIRONMENT Food-producing land Fiber-producing land Natural use areas (watershed, airshed, greenbelt, recreation, waste disposal, etc.) Artificial systems (urban, industrial, highways, waste treatment facilities, etc.) TOTAL 1.5 acres 1 acre 2 acres 0.5 acres '5.0 acres producing land. The two acres for "natural area use" are based on the minimum space needs for watersheds, airsheds, green belt zones in urban areas, recreation areas (state golf courses) as estimated by recent land use surveys. Again, we could do with less by designing more artificial waste recycling systems and doing away with outdoor recreation, but at a high cost to society as a whole. In considering the five-acre per capita estimate, two points must he emphasized: (1) If the per capita use goes up in the future, either more land is needed or greater production per acre must be forced by increased use of chemical controls that, in turn, tend to pollute the total environment, creating a cost in taxes that would reduce the individual's "take home" pay. (2) The five-acre estimate is relevant only to an area such as Georgia that has a favorable climate (adequate rainfall and moderate temperature). The per capita area requirement would be much greater in regions with large areas of deserts, steep mountains or other extreme ecosystems. The inventory of Georgia is summarized in Tables 3-6. The per capita density (Table 3) of 1 in 8 acres compares with the national average of 1 in 10 acres. The urban-rural distribution is comparable to the national average. A domestic animal population 5 times that of people is also close to the national average, as is the 10 per cent of land devoted to agriculture (see Table 4). In considering the impact of man on his environment, the importance of the domestic animal is too often overlooked; yet such animals are actually consuming more "primary production" (i.e., photosynthetic con- 157 358 CURRENT HISTORY, JUNE, 1970 TABLE 3. GEORGIA: AREA AND DENSITY, PEOPLE AND DOMESTIC ANIMALS Total area 37.7 million acres Total people 4.8 million Per capita density 1 in 8 acres Population density- (31 % Atlanta met. area.: 60% urban, 56% under 30 yrs. of age.) Domestic Animals Population equivalent* 21 million Total Man-Animal 26 million Population equivalent* 1 in 1.5 acres * Population equivalent is a unit of animal weight equivalent in metabolism to one adult person. version of sun energy to organic matter) than man, and they require huge amounts of land. Also, in this country, pets such as dogs and cats are estimated to consume enough food to support five million people. We could do away with all domestic animals, of course, and substitute people, but to the ecologist that would mean not only giving up meat in the diet, but also dehumanizing man to the level of a domestic animal. It is interesting that Georgia now produces enough food to feed 12 million people, provided that people actually consumed the crops directly. A diet of corn, other grains, soy beans, peanuts and vegetables could supply adequate calories and protein. In actual practice, of course, very little of Georgia's crop production is consumed directly; most of it is fed to animals or shipped out of state in exchange for food from elsewhere. If we consider for the moment that one person in five acres is a reasonable per capita density, then Georgia is rapidly approaching that level. As shown in Table 6, the net growth rate is two per cent which, if continued, would mean a doubling of the population (leaving only four acres per capita) in 35 years. Almost before we realize it Georgia is moving from what was considered essentially a sparsely populated state to one that is beginning to feel the adverse effects of population pressure. As emphasized, this 4 Several such models were prepared for the University of Georgia lecture series. See footnote* above, p. 355. pressure is due not so much to the number of people, but to the great increase in the per capita demands on space and resources. It comes as a shock to everyone that Georgia and the nation could be badly overpopulated by the year 2000. NATURAL REGULATORS It is possible to prepare graphic models for population growth and stabilization to show how animal populations in nature normally regulate their density well below the limit that would be imposed by the food supply.4 In this event the quality of both the individual and the environment is insured, since the individual is neither likely to run out of food (or other resources) nor to "overgraze" or otherwise permanently damage his habitat in his efforts to obtain the necessities of life. In some populations, death controlled by predators, disease or parasites is the regulator; in other populations, birth control is the mechanism. In some of the best regulated species of the most highly evolved animals, namely the birds and the mammals, the essential control is behavior that restricts the use of space. This sort of "territorial control" would seem to be relevant to the human population problem. Best of all, planned and controlled land use mutually agreed upon through the democratic process can be accomplished at the local and state level right now, while we continue the discussions about birth control and abortion in an effort to reach some kind TABLE 4. GEORGIA-LAND USE IN 1968 Crops food fiber idle (rotated) Pasture Forest private public Recreation (public) Coastal wetlands Urban, etc. (per cent) 7.5 .8 3.7 7.4 66.3 4.5* 1.8* 1.3* 4.5 * Total of these 3 categories or 7.6% is all land now set aside for "natural use" only (i.e., protected from exploitation). 158 Optimum Population and Environment 359 TABLE 5. FOOD PRODUCTION IN GEORGIA -1969 KcaI/year x 1012* Corn Grain Sweet Potatoes Soy Beans Peanuts Vegetables Total 8.5 0.6 0.03 1.8 1.4 0.05 12 x 1012 * 106 Kcal will support one person one year. of national and international consensus that can make these approaches effective nationwide and worldwide. Consequently, it certainly will be worthwhile to consider what we might accomplish along the lines of territorial control through land use planning. LAND USE PLANNING In actual fact, Georgia is extremely vulnerable to overpopulation for two reasons: (1) the immigration rate is high and can be expected to increase as people flee from the crowded, polluted and deteriorated part of our country and (2) land is open to immediate exploitation on a huge scale because there are so few protective laws and so little land in public ownership. Many of these factors apply to other areas of the nation. Even if the birth rate drops in Georgia and other less crowded states, population growth rate would remain high because of immigration that will come as people discover the relatively cheap and quickly available "open spaces." As already indicated, a growth rate of two per cent per year means that Georgians would be down to one man in 4 acres in 35 years. A land speculation spiral that is economically ruinous to all but a few speculators could well result unless plans are made now, and control legislation is enacted. Georgia has a lot of open land now but very little has been set aside to remain so. Only about seven per cent of Georgia (see Table 4) is reserved in national, state or city parks, refuges, greenbelts or other protected categories; even our best farmland is vulnerable to real estate exploitation. As citizens, what can Georgians do? First, they can instigate and support drives, both at the local and state levels, to get more land into public ownership (parks, state and national forests, greenbelts) and can work to have an "open space" bill passed that will enable private owners to establish scenic easements and other restrictions on the use of land that is valuable in its natural state. Second, they can work towards the establishment of metro-commissions and state-wide environmental commissions with strong zoning powers. The passage by the Georgia legislature of the marshlands protection bill early in 1970 was a step in this direction because almost half a million acres were put into a protective category with an agency empowered to insure the best and highest use of a natural resource that otherwise is very vulnerable to destructive types of exploitation. TABLE 6. 1970 ESTIMATES OF POPULATION GROWTH-RATE IN GEORGIA Birth rate Immigration Death rate Net growth rate (per year) 2.4% 0.4% 0.8% 2.0% If about one-third of the area of Georgia were in a protected category, then we would be well protected against overpopulation, and we would have a big buffer that would make the technical problems of pollution control much easier. It is important to note that Western states are fortunate in that 40-50 per cent of their land is already in public ownership. The battle there will be to mobilize public opinion to prevent overdevelopment and degradation of these lands. The third function that citizens can perform is to be more selective about the type (Continued on page 365) Eugene P. Odum is the Alumni Foundation Professor of Zoology and director of the Institute of Ecology at the University of Georgia in Athens. He is the author of numerous articles in scientific journals and of Ecology (New York: Holt, Rinehart and Winston, 1963) and Fundamentals of Ecology (Philadelphia: Saunders, 1959). 159 OPTIMUM POPULATION AND ENVIRONMENT (Continued from page 359) and location of new industry. Citizens will be doing industry and society a favor by establishing tough pollution ~tandards and requiring advance waste treatment because it is much cheaper to engineer and internalize the costs of complete waste treatment, water and air recycling at the beginning than to take action later and also pay for repairing a damaged environment. There is no longer a need nor excuse for "dirty" industries that pollute and pay low wages. Any state can now attract industries that have the resources to pay good wages and the public conscience to do what is necessary in waste management. In summary, our microcosm study makes a case for basing the optimum population on total space requirement and not on food as such. The world can feed more "warm bodies" than it can support high quality human beings. NOTE Permission to reprint this article, which appeared in the June, 1970 issue of Current History, has been granted by Current History, Inc. 160 V. BIBLIOGRAPHY OF MATERIALS SENT TO MEMBERS OF THE TASK FORCE* ARTICLES: Alexander, Tom. "Where Will We Put All That Garbage?" reprint from Fortune Magazine, October, 1967, by the U.S. Department of Health, Education, and Welfare. Cassell, Eric J., M.D. "Reviewing the Right to a Clean Environment," The American Health Foundation Newsletter, I, 4 (July, 1969), 1-4. Committee on Environment of the American Public Health Association. "Environmental Factors in Health Planning." American Journal of Public Health, LVIII, 2 (February, 1968), 358-361. "GMA to Study State Laws on Local Government," Urban Georgia, XIX, 9 (September, 1969), 6. Hatcher, Robert A., M.D. "Sterilization of Males Easy," Atlanta Constitution, April 17, 1970, 1. Lieberman, E. James, M.D. "Reserving a Womb: Case for the Small Family," American Journal of Public Health, LX,l (January, 1970), 87-92. Metts, Albert, M.P.H. "Relationship Between Comprehensive and Environmental Health Planning," Public Health Reports, LXXXIV, 7 (July, 1969~ 647-654. "New Water and Sewer Regulations Benefit Homeowners," Georgia's Health, XLIX, 11 (November, 1969), 2. "The Pollution of Georgia's Environment," Georgia's Health, L, 2 (February, 1970). Pridle, Richard A., M.D. "The Population Crisis," Archives of Environmental Health, XIX (October, 1969), 564-569. Waxler, Alan. "New Techniques in Housing Construction Needed," Urban Georgia, XIX, 9 (September, 1969), 10-12. BOOK: National Tuberculosis and Respiratory Disease Association. Air pollution Primer. New York: NTRDA, 1969. * Excludes the numerous sources used by consultants and resource persons in preparing information for presentation to the Task Force, as well as sources available to Task Force members individually. 161 GOVERNMENT REPORTS: Georgia Department of Public Health. Residential Environment Profile: Hall County, Georgia, 1968. Atlanta: GDPH, 1969. Georgia Department of Public Health. Unwanted Births in Georgia: 1968. Atlanta: GDPH Maternal Health Service, 1970. Hickman, H. Lanier, and Sorg, Thomas J. Sanitary Landfill Facts. U.S. Public Health Service Publication No. 1792. Washington: U.S. Government Printing Office, 1969. The Task Force on Environmental Health and Related Problems. A Strategy for a Livable Environment. U.S. Government Printing Office, 1967. U.S. Department of Health, Education and Welfare. Abortion Surveillance Report: Annual Summary, 1969. Atlanta: National Communicable Disease Center, 1970. U.S. Department of Health, Education, and Welfare. Clean and Green. Public Health Service Bureau of Solid Waste Management Project Number l-D01-UI-00178. U.S. Department of Health, Education, and Welfare. Environmental Health Planning Guide. Public Health Service Publication No. 823. Washington: U.S. Government Printing Office, 1967. U.S. Department of Health, Education and Welfare. Estimate of Accidental Deaths Involving Various Environmental Factors. Cincinnati: Environmental Control Administration, Environmental Epidemiology Branch, 1970. U.S. Department of Health, Education and Welfare. How Accidents Affect the Nation's Health. Cincinnati: Environmental Control Administration, Environmental Epidemiology Branch, 1970. U.S. Department of Health, Education and Welfare. Medical Services Required for Injuries. Cincinnati: Environmental Control Ad- ministration, Environmental Epidemiology Branch, 1970. 162 GOVERN:MENT REPORTS - PAMPHLET: U.S. Department of Housing and Urban Development. This is Operation Breakthrough. Washington: Government Printing Office, 1969. NEWS RELEASES: "Caution Urged in Setting Goals to Correct Georgia's Environment," Georgia Department of Public Health, Atlanta, January 22, 1970. "Environmental Health Task Force Set in Motion," Georgia Department of Public Health, Atlanta, January 13, 1970. "Health Board Sets Rules for Private Sewage Systems in State," Georgia State Board of Health, Atlanta, Georgia, September 30, 1969. "Health Department Tells Macon to 'Tear Up' Burning Dump," Georgia Department of Public Health, Atlanta, February 27, 1970. "Nader's Savannah Statement Draws Howard's Fire," Georgia Water Quality Control Board, Atlanta, March 12, 1970. "New Water Supply Rules Beef Up Health Checks--Also Aid Home Buyers," Georgia State Board of Health, Atlanta, Georgia, October 28, 1969. REPORTS: Bonitatibus, Ronald W. Solid Waste--Its Relationship to Environmental Health. Augusta, Georgia: Central Savannah River Area Planning and Development Commission, 1969. Caterpillar Tractor Company. Recommended Standards for Sanitary Landfill Operations. Community Health, Incorporated. What of Environmental Health Planning? New York: CHI, 1970. SPEECHES: Anderson, Thomas J., M.D. "Comprehensive Health Planning," Delivered before the Environmental Health Task Force on January 22, 1970. 163 SPEECHES: Gillespie, Eugene J., M.D. "Speech Before Task Force on Environmental Health," January 22, 1970. "Excerpts from Speech of Howard W. Chapman, Regional Assistant Administrator, Environmental Health Service, Public Health Service, Region IV, to the Task Force on Environmental Health," January 22, 1970. Hanlon, John J., M. D. "Compreventive Health, A New Proposal?" Thirteenth Annual Lectureship, American College of Preventive Medicine. Philadelphia, November 12, 1969. Hanlon, John J., M.D. "Conservation of the Environment Through Epidemiology and Comprehensive Health Planning." Presented at the University of Chicago Center for Health Administration Studies, Institute for Areawide Health Planning Agency Executives. Chicago, December 5, 1968. Kindsvater, Carl E. "Environmental Health: Water Resources," Delivered at a meeting of the Environmental Health Task Force, January 22, 1970. Venable, John H., M.D."Quality in Environment--A Must for Quality in Life," Delivered Before the Governor's Conference on Environmental Quality, July 10, 1970. Venable, John H., M.D. "Remarks Before the Task Force on Environmental Health," January 22, 1970. UNPUBLISHED MATERIALS: "Highlights of 'Solid Waste Practices in Tennessee' by James C. Ault in The Tennessee Planner, Spring, 1969." Georgia Department of Pub 1 ic Heal th. "Program Plan for Fiscal 1970." Excerpts. Northwest Georgia Regional Health Advisory Council, Inc. "Location and Evaluation of Sanitary Landfills in the Area," December 3, 1969. UNPUBLISHED MATERIALS - LETTERS AND MEMORANDA* Letter from Jerry O. Bange, Executive Director, Altamaha Area Planning and Development Commission, Baxley, Georgia, January 6, 1970. *These letters and memoranda are replies to a query to key persons about the seriousness of environmental problems throughout the state. 164 UNPUBLISHED MATERIALS: Letter from Glenn E. Bennett, Executive Director, Atlanta Regional Metropolitan Planning Commission, Atlanta, Georgia, December 18, 1969. Letter from Ronald W. Bonitatibus, Solid Waste Consultant, Central Savannah River Area Planning and Development Commission, Augusta, Georgia, January 5, 1970. Letter from G. B. Creagh, M.D., District Director, Department of Public Health, Athens, Georgia, January 2, 1970. Letter from M. K. Cureton, M.D., District Director, Department of Public Health, LaFayette, Georgia, December 29, 1969. Letter from Gilbert Chancey, Public Health Sanitarian, Catoosa County Department of Public Health, Fort Oglethorpe, Georgia, December 19, 1969. Letter from Ralph C. Davis, District Director of EnVironmental Sanitation, Department of Public Health, Griffin, Georgia, December 19, 1969. Letter from C. M. Graham, Jr., District Director of Environmental Sanitation, Department of Public Health, Jesup, Georgia, December 23, 1969. Letter from James D. Harless, Public Health Sanitarian, Walker County Health Department, LaFayette, Georgia, December 17, 1969. Letter from Thomas Fox, Public Health Sanitarian, Chattooga County Health Center, Summerville, Georgia, December 17, 1969. Letter from Max W. Harral, Director Slash Pine Area Planning and Development Commission, Waycross, Georgia, December 15, 1969. Letter from Lewis W. de Jarnette, District Director of Environmental Sanitation, Department of Public Health, Decatur, Georgia, December 17, 1970. Letter from George W. Lee, Jr., District Director of Environmental Sanitation, Department of Public Health, Lawrenceville, Georgia, December 29, 1969. 165 UNPUBLISHED MATERIALS: Letter from Jesse F. Piland, District Director of Environmental Sanitation, Moultrie, Georgia, January 12, 1970. Letter from F. D. Richardson, Public Health Sanitarian, Walker County Health Department, LaFayette, Georgia, December 18, 1969. Letter from Frank M. Tidwell, Public Health Sanitarian, Walker County Department of Public Health, Rossville, Georgia, December 18, 1969. Letter from Jack D. Whelchel District Director, of Environmental Sanitation, Department of Public Health, Statesboro, Georgia, December 29, 1969. Letter from James M. Womack, Public Health Engineer, Cobb County Health Department, Marietta, Georgia, December 17, 1969. Memorandum from Lyndon Beall, Director, Emergency Health Service, Georgia Department of Public Health, Atlanta, Georgia, December 9, 1969. Memorandum from Robert H. Byers, Director, Water Supply Service, Georgia Department of Public Health, November 25, 1969. Memorandum from Richard H. Fetz, Director, Radiological Health Service, Georgia Department of Public Health, Atlanta, Georgia, November 26, 1969. Memorandum from James P. Gibbs, Director, Housing Hygiene and Accident Prevention Service, Georgia Department of Public Health, Atlanta, Georgia, December 5, 1969. Memorandum from William A. Hansell, Director, Air Quality Control Branch, Georgia Department of Public Health, Atlanta, Georgia, December 8, 1969. Memorandum from Hugh L. Parker, Director, Industrial Hygiene Service, Georgia Department of Public Health, Atlanta, Georgia, November 25, 1969. 166 UNPUBLISHED MATERIALS: Memorandum from W. Scott Sprinkle, Director, Environmental Sanitation Service, Georgia Department of Public Health, Atlanta, Georgia, December 9, 1969. 167