178 COMMUNITY HEALTH
its sewerage and industrial wastes. Water potability and
safety must meet national standards but water qualities for
drinking, food preparation, and industrial uses may vary
widely. Adequate water supplies are vital to community
health, recreation and cleanliness, but also to industry and
related employment. Carefully controlled use of low mineral
content non-potable water can be used carefully for garden
plots and residential lawns and general use in irrigation tech-
nologies for agriculture.
National dental societies have urged that minimum levels
of fluoride be added to residential water supplies because of
the protective action of this chemical against tooth decay.
However, opposition has arisen in some communities because
high fluoride levels may cause annoying dental discoloration.
Effects of chlorination, also, has been reported to be remotely
associated with malignant conditions in humans but the net
value of better control of intestinal diseases is believed to far
outweigh any possible small toxic effect of chlorinated water.
Water with high mineral content, known as “hard water,”
even though potable, may require water softening equipment
in homes to make it satisfactory for laundry and food prepa-
ration or manufacturing.
Anti-smoking campaigns have emphasized documented
tragic ill effects from tobacco smoke produced by burning
tobacco products, both for the smoker and for persons who are
breathing “second hand smoke,” a mixture of exhaled smokes
and that which rises from the tips of lit cigarettes. Increased
mortality from lung cancer, emphysema, and cardiovascular
disease has been thoroughly documented and other cancers
of the gastrointestinal and genitourinary tracts are believed
to result in part from the swallowing of saliva that contains
nicotine and other constituents of tobacco smoke, and the uri-
nary excretion of tobacco-associated chemicals through those
channels. Bans on indoor use of smoking tobacco have been
promulgated by many local and state governments to protect
non-smokers from immediate or long-term effects of nox-
ious chemicals in tobacco smoke. Existing efforts to restrict
the purchase of tobacco products to adults and prevent sales
to adolescents have been increased. So-called smokeless
tobacco (snuff) has been shown to cause precancerous lesions
of oral structures and ultimately to lead to localized cancer,
even in young adults.
Carbon monoxide (CO) emissions are highly toxic
because the CO radical bonds tightly to hemoglobin in circu-
lating blood cells, markedly reducing their oxygen-carrying
capacity and resulting in serious impairment of cerebral or
cardiovascular function and death. Poisonings have occurred
from CO in motor vehicle exhausts in home garages or
poorly maintained underground parking garages with defi-
cient ventilation, in homes that use fossil fuels for heating
when flues have been obstructed, and when unvented space
heaters are used in small, closed spaces and room oxygen has
been markedly diminished or exhausted. Poorly maintained
mufflers or exhaust systems may leak CO into automobile
or passenger compartments at any time, even when driving
through traffic. Slow and quiet development of this highly
toxic gas can result in unrecognized but fatal levels of CO in
vacation cabins, recreational boating, and private airplanes.Radon is a radioactive gaseous chemical element formed
as a first product in the atomic disintegration of radium.
Rather frequently encountered in homes of what is known
as the “Reading Prong,” a geographic area around the city
in Pennsylvania, radon levels vary from home to home. This
radioactive gas may be an environmental hazard when high
levels exist in confined human habitations that are surrounded
by radioactive soils or rocks. Ambient atmospheric levels can
usually be reduced to safe levels by adequate ventilation.
Additional disease prevention activities of community
health departments include sanitary control of food produc-
tion and distribution, large-scale childhood vaccination pro-
grams, strict quarantine or relative isolation of persons with
infectious diseases, and animal control to minimize animal
bites or rabies and other zoönoses (diseases spread by ani-
mals to humans). In Baltimore, for example, when animal
control was transferred to the health department and the col-
lection of all stray dogs was emphasized, reported animal
bites of humans decreased from over 8000 to under 1500
in a period of four years. Feral animals are dangers to all
humans, to each other, as well as their excreta being a major
source of area insanitation. Increasingly, local laws provide
improved community protection by requiring that animals
be leashed and that owners collect and dispose of animal
feces in a sanitary fashion.NEEDED SERVICESGovernments, large and small, provide health care services in
many bureaus other than the official health department, and
often with little or no coordination. For example, a county may
operate jail medical care, a personnel system for employees,
fire fighters and police, school health programs, health units in
a department of social service, care for indigent elderly, ambu-
lance services, a public general hospital, and more. The total-
ity of community health services operated by a government
is generally poorly comprehended, frequently underestimated
and understated.
Rescue and protection require health departments to
work with police, fire and other rescue agencies where human
health is endangered. When local sickness care units refuse
to care for ill or injured persons, for whatever reasons, health
departments are expected to supply medical care. Because
treatment of homeless or abandoned indigent persons can be
costly for diseases such as tuberculosis or complex condi-
tions such as AIDS (acquired immunodeficiency syndrome),
these tasks may fall to health departments when other health
providers fail to meet their obligations or are overwhelmed
by patient loads of epidemics.
Official health departments in cities and counties operate
personal health clinics for special populations. Although these
services vary with local needs, they have been categorized by
one local health officer as traditionally treating “unwashed
patients with dirty diseases, who live in hard to reach places
and can’t pay.”^13 These groups of patients constitute indigent
or needy citizens with ailments like tuberculosis, leprosy,
sexually transmitted diseases, or AIDS.C003_002_r03.indd 178C003_002_r03.indd 178 11/18/2005 10:17:41 AM11/18/2005 10:17:41 AM