COMMUNITY HEALTH 177
residents, or the general public about unsafe workplace envi-
ronments. Officials inspect sites where alleged infractions
of regulations have occurred, interview complainants and
workers, and take samples or measurements of gases, dusts,
or other possible toxic agents. Corrections may be made on
the scene, or the respective departments will initiate official
regulatory actions or seek legal sanctions. Airborne particles
of asbestos, silica, metallic dusts, chemical gases or fumes,
and organic fibers can pose dangers to workers or the general
public and must be promptly abated.
Once widely used in fireproofing, building construc-
tion, and insulation, asbestos, if inhaled, results in fibrosis or
chronic scarring of lungs with moderate to severe respiratory
disability. Late effects include cancer (mesothelioma) of the
lining membranes of the pleura (chest) or the peritoneum
(abdominal wall) and is uniformly fatal. Abatement of exist-
ing asbestos-containing material from limited building areas
that do not involve major razing must be sealed off to prevent
dusts from spreading to unaffected areas; workers engaged
in asbestos removal must be carefully garbed in protective
clothing and equipped with approved protective respiratory
equipment. All asbestos demolition activities, and the debris
containing asbestos must be handled with strict attention to
federal and local laws and regulations.
Inhaled coal dusts result in coal miner pneumoconiosis or
black lung disease, a disabling condition more often seen in
mines producing anthracite or hard coal. Unprotected inhala-
tions of dusts from the floors of factories that produce pot-
tery or electrical insulators has resulted in silicosis, a severe
pulmonary fibrosis that may be associated with recurrences
of old pulmonary tuberculosis.
Control of known toxic volatile inhalants is also spread
among several agencies at all governmental levels, occa-
sionally with no clear delineation of regulatory boundaries
or with control and enforcement distributed among several
departments. Urged by insurance companies and pressured
by legal actions to improve worker and community safety,
industries strive to provide healthy workplace environments
and still achieve satisfactory manufacturing profits.
Federal funding remains for lead paint poisoning preven-
tion, rodent control in cities, water fluoridation, air pollution
control, protection against hazardous materials, and staff
education or training. The blood lead level that is consid-
ered to be toxic in children and adults continues to decrease,
but the problems of plumbism (lead poisoning) associated
with chipped and worn lead paint in homes persist. Although
paints containing lead were banned in Baltimore city by an
ordinance more than half a century ago, walls and wood-
work of old homes retain lead paints under successive covers
of new lead-free paint. Nevertheless, children continue to
suffer from plumbism, albeit lower levels, because they
inhale lead dusts in homes or eat lead paint chips that fall
from old painted surfaces. Adults who are unaware of the
toxic effects of lead paint dust may suffer from a more acute
form of plumbism when they fail to wear protective masks
of industrial-quality in de-leading homes.
To correct environmental hazards, officials benefit from
epidemiologic data to locate where toxic wastes have beendumped and to measure the effects of toxic substances on
community health. After chemically damaged land has been
identified, reclamation or redevelopment as prime com-
mercial and residential sites is often difficult without costly
decontamination. States have established official registries
of toxic substances that include listings of associated cancer
cases. Toxic substance registries are valuable in the long run
but high initial costs, operational difficulties, and challenges
from local industries have hampered their development.
Air pollutants may merely annoy residents in a neighbor-
hood because of unpleasant odors but, when residents sus-
pect that pollution can be hazardous, high levels of general
community anxiety can result. Persons who work or dwell in
a polluted area cannot avoid breathing the air that may cause
acute or chronic respiratory difficulties. When pollutants
are known to have serious short-term or long-term effects,
citizens or workers demand that regulatory action be taken
to reduce or eliminate the offending pollutants. However, if
threats of job losses occur should the cost of controls cause
major industries to move away, low level pollution may
be tolerated. Detection, accurate measurement and clearly
defined pathologic effects of fumes and dusts on human and
animal health have been recorded, as well as toxic damage to
fabrics or delicate machinery and other personal or industrial
equipment.
Air pollution from industrial processes or solvents used
in manufacturing is closely monitored by most industries but
small, non-union or inexperienced producers may be unaware
that hazards exist in a workplace. In some cases, managers
will ignore or defy governmental regulatory control. Health
department inspection staffs may be too small to carry out
regular inspections of the thousands of small industries in
their jurisdictions and complaints from citizens or workers
may be needed to give the earliest warnings of serious small-
factory air pollutions. Health inspectors may be called upon
to test and measure for toxicity of fumes in workplaces from
chemical processes, spills or misuse of dangerous mixtures,
or emanations from treated fabrics, compressed wood prod-
ucts, and other finished products. Local health departments,
however, are no longer responsible for water supply, sewage
treatment, and trash and garbage disposal.
The emphases of governmental air pollution control
efforts range from entire geographic areas, such as area-wide
ambient levels of industrial stack pollutants and motor vehi-
cle emissions, to residences that may be contaminated with
radon emissions from soils or rocks. Although state or fed-
eral governments are responsible for monitoring large area
contaminations, toxic emissions control in local industries is
often a community task.
Water pollution results when surface contaminants from
industry spills or runoffs from soil fertilizers and pest control
agents enter streams and reservoirs or filter into an area’s
aquifer and wells. Water filtration plants carefully monitor
bacterial and chemical contaminants of inflows and outflows
to assure that pleasantly tasting potable water and low min-
eral content is delivered to a community. This is a major task
when a downstream community depends on river water to
supply its needs while upstream another community dumpsC003_002_r03.indd 177C003_002_r03.indd 177 11/18/2005 10:17:41 AM11/18/2005 10:17:41 AM