Public Health through the EPA Looking Glass

The Random House Dictionary defines “public health,” as “health services to improve community health, esp. sanitation, immunization, and preventive medicine.” Sanitation — particularly water purification and sewage treatment — and immunization are largely responsible for the near doubling of life expectancy in this country since 1900.

In 1977 immunization eliminated smallpox from the planet. Polio will be next, perhaps by December 1999. Rotary International has raised $400 million in private contributions and organized millions of volunteers for vaccination programs, and governments around the world have immunized millions on National Immunization Days.

Compare those public health accomplishments — the doubling of life expectancy and the eradication of smallpox — and its expectations — the eradication of polio (and other diseases to follow) — with what Browner says. She doesn’t speak of lives saved or diseases averted. She can’t.

She can’t trace a path from the billions of dollars spent controlling chemicals in water to reductions in disease. And it’s a good bet that she won’t say that EPA “science” contributed to a deadly epidemic. Ninety‐​eight percent of U.S. water systems use chlorine as a disinfectant, but the EPA warns that chlorine reacts with chemicals in water to produce cancer‐​causing compounds. Heeding that advice, Peruvian officials reduced chlorine in drinking water. Cancer cases didn’t fall. Cholera skyrocketed. The epidemic that originated in 1991, when under‐​chlorinated water failed to kill cholera bacteria, swept across South America, killing almost 12,000 people by 1997.

Last year EPA assistant administrator Dr. Lynn Goldman said air pollution was suspected as a cause of childhood asthma. That’s another example of EPA science. The EPA’s own data show that air pollution has gone down at the same time asthma cases have increased. Shouldn’t something else be the suspected cause?

“One American in four lives within four miles of a toxic waste dump,” said Browner. She couldn’t say that that one person was any more likely to be sick than the three who lived farther away.

The EPA takes credit for reducing lead levels in children’s blood by 70 percent. The EPA says that the old high lead levels caused poor academic performance. Are test scores up? Is delinquency down?

Unperturbed by the lack of any measured health benefits, the EPA churns out estimates of the number of years of life its regulations save. Based on the EPA’s numbers, researchers at the Harvard School of Public Health estimate that EPA regulations require the expenditure of $8 million to save one person one year of life. We are constantly told that health care costs too much — but, on average, $19,000 spent on medical intervention saves one year of life. That’s 400 times less than what it costs the EPA.

The EPA’s costs are outrageous compared with public health expenditures. Dr. D. A. Henderson of Johns Hopkins University, who led the program that eradicated smallpox, calculates that it cost $8 million in 1977 dollars. The eradication of polio, with the prevention of at least 70,000 cases annually, is expected to cost $800 million. EPA regulations that cost that much may add a year to the lives of 100 people, and they may not.

Immediate savings follow from public health successes. The United States still spends $230 million annually on polio immunization because of fear that some contagious person will arrive on an airplane. That cost will become a thing of the past.

EPA costs never decline, and the EPA keeps pushing for larger budgets to impose and enforce tighter and more expensive regulations. A favorite measure of “success” is fines levied. 1997 was a banner year. The EPA sent more than 700 cases to the Justice Department, which generated about $260 million in fines — no mention of lives saved.

Nowhere is the EPA’s emphasis clearer than in its 1999 budget request. On March 11, Chairman Ken Calvert of the House Subcommittee on Energy and Environment drew attention to the EPA’s decision to request a 9.5 percent decrease in the agency’s research and development budget while increasing its requests for regulatory programs.

Lewis Carroll’s Humpty Dumpty would like Carol Browner’s use of “public health.” He told Alice, “When I use a word, it means just what I choose it to mean — neither more nor less.”

Alice said, “The question is whether you can make words mean so many different things.”

But Ms. Browner knows — as Humpty did — that words aren’t the issue. She knows, along with Humpty, that “the question is which is to be master — that’s all.”