Feature

Making waves over pollution

The long, hot summer has propelled the issue of environmental pollution rapidly up the political agenda. Simon Bullock calls for concerted action to make sustainable development a central aim of government policy

People in Britain often think that environmental problems do not affect them too greatly, or that their impacts are far removed from their everyday lives. Global warming will be bad for the islanders in Mauritius; ozone depletion means that Australians have to wear more sun-cream; a few toads lose their homes when a much needed bypass get built: the environment is seen as a luxury concern, and action to protect it as a good thing, but only if there weren’t more important things to do.

Yet in reality environmental pollution is causing misery for millions, and death for thousands of people in Britain every year: traffic-induced air pollution aggravates the symptoms of the country’s 3 million asthmatics; lead in drinking water is affecting children’s development (the government’s limit is 60 per cent higher than the level known to impair children’s IQ); and smoke particles from diesel engines and industry kill 10,000 people a year.

And there is no escape: Britain’s bathers risk diarrhoea and skin infections from a dip in the sea, visitors to our national parks get lungs full of ozone, and dioxins and pesticides are ubiquitous in our food. So why is so little being done?

Health policy and funding are geared towards curative rather than preventive actions. Even though the government accepts that preventive action will be increasingly necessary in years to come, there is little sense of urgency. Even less is being done to prevent environmental health problems: the Health of the Nation strategy barely touches on environmental health issues.

Preventive action on health problems is urgently needed, yet when it comes to action, prevention seems to mean no more than exhortations about lifestyle changes. These are rife in government health documents: urging people to smoke less, drink less and exercise more, essentially blaming them for their own ill-health. It’s easy to see why the government pursues health policies which revolve around persuading individuals to change their lifestyles: they are cheap; they fit Conservative ideology and if they don’t work there is a simple scapegoat-the victims themselves. Usually these exhortations are wrapped up in rhetoric about choice. But government policies are such that many people cannot make healthy choices.

For example, out-of-town superstores are built round a car culture, and their cheaper prices make it harder for poorer households to have a healthy diet, because they reduce the range and quality of food available in uncompetitive local shopping areas. Poor people, those with disabilities and those without access to a car (a third of the population) are affected here. There is also not much choice when urban air is full of particulates, nitrogen and sulphur dioxides, and rural air is polluted with ozone.

Five million people have lead in their drinking water higher than WHO guidelines. Levels of dioxins in the environment are at levels, for all of us, which are expected to cause adverse health effects. How can people exercise choice in these circumstances?

This point is made by George Forwell, Glasgow’s director of public health medicine: ‘Most people have little choice about the way they live: tobacco advertising, the food which is most readily available and affordable, vehicle exhaust fumes and the frustrations of daily living all predispose to ill-health and premature mortality.’¹

It has always been very difficult to establish direct links between environmental pollution and ill-health (think how long it took to prove that tobacco causes cancer), because we are all exposed to a vast array of different substances, which all have different effects of different magnitude on different parts of the body. Nobody knows the cumulative and synergistic effects. Previously the argument has been that as the exact nature of the problem is unknown, no action should be taken until we have more information. But there are already far too many pesticides, carcinogens, hormones and man-made chemicals in the air, soil and water. The full health implications of these are only just beginning to be realised, and each new research finding strengthens the links between environment and ill-health.

It is time now to radically change the way environmental health problems are dealt with. Instead of tinkering at the edges, and burdening an increasingly beleaguered NHS with the costs of curing sick people, public health should be given a much stronger role by government to deal with environmental health problems from a preventive approach. Waiting for full scientific evidence is not an adequate response.

It is time the government got its priorities straight-ts definition of the ‘precautionary principle’ has it that precautionary action should be taken ‘if the balance of costs and benefits justifies it’.² Because the benefits to the public’s health are hard to evaluate (what would be the financial gain in terms of children’s health if a school were not down wind of an incinerator?), and the effects on the short-term profits of the industries involved are easy to evaluate, it is all too easy for the status quo to prevail. Commerce and industry have much more influence than the general public (for example, the McDonalds versus London Greenpeace law suit) making it very hard to change any policy where a financially strong body has a vested interest.

This is part of an equity argument which runs strongly through calls to act on environmental health problems. Current decisions not to act further concentrate power on those who already have it, and the costs of inaction are paid by the public with their health. The irony is that when public concern does mean that an environmental problem is acted upon, it is usually the public who pay: there are fewer pesticides in drinking water now than two years ago-water companies remove them from the water supply and pass the costs onto consumers, rather than the government banning farmers from putting pesticides onto the land in the first place.

It is a highly inefficient way to run the country (like stopping an overflowing bath by scooping out water rather than turning off the tap), and this from a government which prizes efficiency above almost any other virtue (apart from integrity and honesty). The current systems are inefficient as a whole but, broken down, the rich benefit and the public lose out. That the government can justify overall inefficiency because it benefits the rich minority at the expense of the poorer majority is a strong indictment of the way it pursues its environment and health policies.

The government should act on its paper commitments to sustainable development, and integrate all its policies to make sustainable development a central driving aim.

It is scarcely credible that environmental health problems can have affected people for so long with so little action having been taken. But the worsening problems mean that the public demand for action will soon reach such a pitch that it will be difficult for the government to avoid change. We must hope that the powerful medical community throws its weight behind the environmental groups, to ensure that action is taken, and the public’s health and environment are protected.