RECREATION Increase in leisure time and in social and economic gains of our population is reflected directly in the need for increased recreational opportunities, particularly outdoor recreational pastimes, sports, or related activities. The length of the average workweek will drop in the future and much of the new free time available will go to outdoor recreation activities. Qualified authorities have estimated that by the year 2000 current available recreational facilities should be doubled. The mobility of urban populations across the Nation has generated a demand for recreation in outlying areas. This complicates greatly the planning for and provision of facilities. The development of existing and new recreational areas require meaningful planning to assure that adequate environmental health considerations are applied to such factors as space requirements, water supply, sewage disposal, refuse disposal, vector control, food protection, and other problems. Particularly difficult are those involving water contact, camping, trailer, and boat living. SOLID WASTES Although ridding the comunity of refuse and other solid wastes in a satisfactory and healthful manner is clearly a concern of health agencies, few State or local health departments have devoted more than token efforts to solving solid waste problems or planning corrective measures. With more people, and increased industrial and agricultural activity, more wastes are being produced. Solid waste disposal is generally unsatisfactory across the Nation and in many metropolitan areas the problem is acute. Continued urbanization, scarcity of land, more restrictive air pollution control requirements, and less isolation, are combining to aggravate the problem. Air and water pollution control, agricultural, and public works agencies continue to enact regulations from a categorical interest standpoint which restrict disposal practices, but health agencies need to meet the broad responsibilities for standards, regulations, and planning for adequate solid waste disposal facilities to insure that public health interests are fully covered. Refuse disposal facilities are inadequate in 90 percent of the 9,000 communities with populations over 1,000. Sanitary landfill sites are consuming land areas at a rate of 5,000 acres per year. In many areas, the problem of locating disposal sites, without posing a threat to water quality, is a vital concern. A total of $2.8 billion is spent annually for the collection and disposal of solid wastes $1.5 billion by municipalities and other local governmental units and $1.3 billion by contractors and private collectors-there is ample justification for the increasing interest in this problem. TRAVELING POPULATIONS About 35.5 million of the 177.4 million persons 1 year old and over who were living in the United States in March 1961 had moved at least once since March 1960. Of this total, 5.8 million had moved interstate. A growing number of Americans live in mobile homes. In fact, more than 3 million persons now live in 1 million mobile homes in the 15,000 trailer parks in the United States. Those public agencies responsible for the operation and maintenance of recreation areas also face problems of providing modern sanitation facilities with adequate water, electric power, and sewer connections to serve tourist population groups. The gross number of persons traveling, as well as the speed and complexity of modern travel, lead to unique sanitation problems with regard to drinking water and food service and waste disposal on public conveyances. Aircraft are spending less time in stopovers and are creating problems in servicing the planes with water, removing wastes, and serving food. Interstate vessels and buses equipped with water, food handling, and toilet facilities are creating new sanitation problems. Health officials in particular are increasingly preoccupied with present difficulties. Population growth and increased leisure can only increase them. Two-thirds of the entire U.S. population now live in 212 metropolitan areas. In the last decade, 84 percent of the population growth was adjacent to, but outside the core cities. This tremendous growth in urban population, resulting from inmigration and natural population increases, has had a direct and immediate effect on maintaining health facilities in these areas. Physical facilities which were not originally designed to carry present loads are facing problems of expansion or obsolescence. Many housing developments served by septic tanks and private water systems constitute positive evidence of the fact that the problem of extending water and sewer lines to serve the expanding fringe areas has been beyond the resources of many communities. Similar situations exist with regard to air pollution, solid waste disposal systems, recreational areas and open space. The 1960 census revealed that more than 11 million homes were dilapidated or lacking in one or more basic plumbing facilities. An additional 5 million residences are facing serious deterioration. The hygiene of housing is a neglected area. Unless positive action is taken with purposeful planning and capital investment in needed facilities, increasing amounts of waste products, concentrated in areas with growing populations will result in the creation of serious health hazards. As stated in the Gross report, "these threats are of an insidious nature, a form of creeping paralysis which, if not recognized and corrected, can lead to urban stagnation and death as surely as the most violent epidemic." 32-692-649 WATER POLLUTION The national water pollution problem is directly related to population and economic growth, new technological developments, growth of urban complexes and changing land practices. The Since 1900, the percentage of the population served by sewers has risen from 32.2 to 57.4 percent and the population equivalent of municipal wastes discharged to streams, treated and untreated, has increased threefold to 75 million. concentration of population and industry in urban centers is resulting in the discharge of large volumes of complex wastes into often limited water resources. Although much progress has been made since 1956, there are still more than 5,000 municipal sewage treatment facilities to be constructed, and more than this number of industrial waste treatment facilities needed. A major need is to develop entirely new waste treatment methods which will provide for maximum reuse of water. The rapid growth of industrial production (800 percent since 1900) has resulted in an even greater increase in organic waste production (1,000 percent). In 1960, the "population equivalent" of organic wastes (of animal or vegetable origin such as meatpacking, food canning, paper, textiles) was estimated at 150 million. In addition to organic wastes, industry produces large amounts of inorganic wastes (principally of mineral and chemical origin) resulting from the mining, processing, and manufacture of a wide variety of mineral, metal, and chemical products. Inorganic wastes have different adverse effects on water quality from organic wastes, causing tastes, odors, color, hardness, corrosiveness, and some are toxic. Each year additional millions of acres of land are withdrawn from agricultural use for streets, highways, airports, shopping centers, housing, and other buildings. The runoff from these hard-surfaced areas carries with it all of the accumlated deposits-oils, organic matter, trash, soil and industrial dusts, other air pollutants, fertilizers, and pesticides. Probably the most important emerging land drainage problem involves the tremendous increase in the use of agricultural pesticides and fertilizers. Pesticide use is now well over 500 million pounds annually and fertilizer production over 50 million pounds. A substantial and increasing amount of these are finding their way into the Nation's streams. THE WORKPLACE Although varying greatly in degree, from dermatitis to systemic poisoning, health hazards are associated with practically every occupation. In recent years, society's acceptance of the need for a healthful workplace has extended beyond the traditionally dangerous mining and manufacturing industries. Increasingly, all aspects of occupational activity are coming under scrutiny. The definition of what constitutes a healthful working place is also changing. Concern now extends beyond averting acute and disastrous illness to reducing less dramatic but nonetheless costly sickness, absenteeism, and decreased efficiency. Thus, more attention is being directed to delayed effects of low-level exposures over a long period of time and to their possible relation to chronic disease. Occupational areas claiming more attention include agriculture, with its increasing dependence upon a great variety of synthetic chemicals. Even office work has experienced an increase in potential hazards from technologic innovations. The old problems of extremes of pressure and temperature are being examined anew in relation to manned spaceflight, undersea exploration, and increasing urbanization with the need for extensive underground tunneling. Problems of noise and vibration are also being intensified. In addition to continuing accelerated research on occupational health problems, more vigorous efforts are required to promote the application of knowledge already available. It is estimated that basic industrial hygiene control measures are lacking in over half the industrial plants in this country, and shortages of trained occupational health personnel compound this problem. THE BASIC APPROACH Technological innovation and growth are expanding so rapidly in this country that it is becoming increasingly difficult to develop specific control methods for environmental pollutions resulting from this expansion. Other methods must be sought-methods sufficiently fundamental to permit generalizations to be made. To meet this challenge, it will be necessary to supplement our present efforts, directing a portion of our overall program toward acquiring this basic understanding, while proceeding with categorical approaches directed at primary areas of established need. This was the essence of the request of the House Appropriations Subcommittee in 1959 that the Public Health Service make a thorough study of environmental health problems, and of the most efficient organization of its facilities to meet these needs. The subsequent organizational study ("Final Report of the Study Group on Mission and Organization of the Public Health Service") identified, as an important new program, one which would strengthen the basic resources and knowledge upon which the operating divisions depend. This, too, was the sense of the Gross committee conclusion "that the current categorical approaches represented by the Public Health Service's divisional programs are incapable of either (a) the necessary cognizance of combined multiple effects of environmental impacts, or (b) the depth of effort required by the individual divisional programs.” Recognizing that a clear area of need existed, the Service has taken steps to provide for this. Patterns of disease The great overall increase in life expectancy over the past hundred or more years has been frequently and properly referred to as objective evidence of improvement in our general state of health. This increase has been due in large measure to a decrease in infant mortality. In achieving this, the contribution of epidemiology has been great. Improvement in the health status of the adult, particularly those past 45, has been less dramatic. Even though giant strides in preventive and curative medicine have taken place during the past 25 years, we recognize a remaining health problem of substantial proportions. Classical epidemiological investigations have contributed greatly to our knowledge of infectious diseases, the prime targets of many of our health programs. These techniques have been less effective in clarifying our concepts of the diseases which result from stresses, in the internal or external environment, which exceed either individual or community reserve or capability. The reason is partly that time factors and the determinants for disease are greatly different. Many of the more glaring hazards of the modern environment do, of course, have a clear cause-effect relationship; it is not necessary to study vital statistics to perceive this. However, the bulk of the problem relates to insidious onsets of |