TABLE B.-Local air pollution control agencies in the United States (with annual budget of $5,000 or more, February 1961) 1—Continued

Staff believed to spend considerable time on work other than air pollution. 7 Operated by the State in which located.

Total.

• Median.

The Public Health Service estimates that significant air pollution problems exist in urban areas encompassing 73 million people, with an additional 34 million living in places having minor air pollution problems. At least 60 percent of the total population are thus exposed to undesirable levels of pollution. Many of the local air pollution control programs are very limited, and inadequate to cope with the problems facing them. Few have sufficient information concerning pollution sources, or contaminant levels in the air, and in the few instances where plans for new installations are reviewed, these are usually limited to combustion equipment.

Areas needing further research

Identification and measurement of pollutants.-Although some progress has been made in identifying and measuring general classes of pollutants, there is a need for more intensive research in this field of endeavor. There is also a real need for intensive research into methods for identifying and measuring the individual substances that make up these classes. Simpler and less expensive procedures are needed for this purpose. Our knowledge is far from complete regarding air pollutants: Their identify and quantity, the specific sources from which they derive, factors governing their dispersion and chemical and physical changes in the atmosphere, and their effects, singly and in combination.

Continuing source appraisals.-We are concerned with pollution arising from domestic, municipal, and industrial sources. These pollutants in general are the end products of combustion, the products of incomplete combustion, and the emissions from various types of process industries. Technological development alters and will continue to alter the types of emissions from chemical processing and from manufacturing and other industrial sources, thus emphasizing the need for continuing source appraisals.

The role of motor vehicles.-One ubiquitous source of air pollution is the motor vehicle. In all urban areas, motor-vehicle emissions are already a significant source of pollution. Current trends in their use suggest that motor vehicles may become an even more significant source. The interrelationship between hydrocarbons and oxides of nitrogen, when photochemical air pollution (smog) is produced in the presence of sunlight, needs further elucidation. The role of particulates in the formation of smog, and the mechanism by which smog irritates the eyes and causes damage to vegetation, will require further research. The potentials for reducing motor-vehicle emissions through modifications of engines, as well as other approaches, need active and intensive study.

Photochemical smog.-The formation of ozone and other oxidants characteristic of photochemical smog is known to result from reactions among gases at concentrations of a very low order, at which they originally may be relatively innocuous. Identification and determination of the relative importance of each participating primary pollutant in the photochemical processes is necessary. Changing technology necessitates fundamental studies in photochemistry. Identification of primary reactants associated with secondary toxicants will facilitate the development of more effective and less costly controls. Knowledge of the intermediate and secondary products must also be acquired to determine biologic effects.

Meteorology.—A fundamental scientific problem is that of establishing siutable relationships between meteorological parameters and dispersive capacities. These relationships are necessary to predict the three-dimensional distribution of airborne material, under a wide variety of weather conditions, emitted from sources of known characteristics. Objective determination of reasonable emission rates, and the degree of control required for single sources in a given community, are dependent to a considerable extent on this research.

Economic losses.-Estimates of losses due to air pollution to date have been largely guesses. Studies are required that will provide a sound basis for future estimates of national losses from (1) damage to crops and livestock, horticultural products, and other types of vegetation; (2) corrosion of materials and soiling of surfaces; and (3) interference with ground and air transportation. Economic losses due to the expense of illness and diminished productivity resulting from air pollution are completly unknown, as are the effects of pollution upon the general well-being of healthy individuals.

Studies are also required to identify specific causative agents of economic damage, their mechanisms and rates of action, their effective concentrations, and the costs of control, as a further basis for development of adequate control measures and acceptable levels of pollutants in community air.

Control procedures.-There are control methods available for many of the known sources of pollution. In many cases, however, effective control methods are not yet feasible, either by process design and modification or through the installation of specific equipment. Considerable expansion of research is needed on the fundamental aspects of control, including such concepts as the development of mass transit facilities and regulation of land use, as well as on the development of applicable devices, so that the use of control methods will be more widespread and more acceptable from an economic viewpoint.

Sulfur oxides.-A major class of pollutants requiring further research in all aspects outlined above are the oxides of sulfur. As a common constituent of liquid and solid fossil fuels, as well as of many commercially important ores, sulfur is oxidized and discharged from many combustion sources and numerous industrial processes. Identification of sulfur compounds in the air, their roles in atmospheric reactions, the limitations of the atmosphere to disperse them satisfactorily, and methods for preventing their large-scale discharge as pollutants are subjects urgently in need of intensified investigation.

The control of air pollution

The consensus arising from the 1962 National Conference on Air Pollution was the need, nationally, for a more effective control of air pollution. There was no agreement as to the timing and method for accomplishing such control. Some favored a continuation, on an accelerated basis, of the present approach in which all control authority rests in State and local agencies. Others felt that this should be supplemented by providing for Federal action in instances where unsatisfactory situations persist. There was general agreement on the gross inadequacy of most State and local programs and of the importance of providing them with greater support. The urgent need for more trained personnel was likewise recognized.

ARCTIC HEALTH RESEARCH CENTER

In 1948-following reports of two American Medical Association teams which visited Alaska in 1946 and 1947, and hearings conducted by the House Appropriations Committee in 1948-an appropriation was made for fiscal year 1949 for technical assistance to Alaska and for health investigations. To conduct the latter, a laboratory was established in Anchorage in July of 1948, under the authority of the Public Health Service Act, as amended. On May 24, 1950, this laboratory was designated the Arctic Health Research Center.

This Center created in response to an obviously great need was located in the Division of General Health Services (later Community Health Services) until the beginning of fiscal year 1962, when it was transferred to the Office of the Chief, Bureau of State Services, as a part of its environmental health program.

Alaska, with a small white population prior to World War II, did not have a full-time health commissioner until 1945. Meanwhile, 150,000 military personnel had been sent to the territory at the height of World War II operations, and a defense buildup following the war brought in many construction workers and their families and an increase in all Federal and territorial activities.

The magnitude of the health problem in the outlying areas, which had been serious for a long time, was by then better documented and more fully understood. A report by the Alaska Department of Health, for example, stated (1950) that 90 percent of the water supply in the territory was surface water, and that only 10 percent of the population and 20 percent of the schools and other institutions had satisfactory waste disposal. The tuberculosis death rate was the highest documented tuberculosis mortality in the world. Periodically, in the 19th century and early decades of the 20th century, epidemics had so ravaged Eskimo and Indian villages that many of them had been abandoned. The Center has now been in operation nearly 15 years. As knowledge of one disease has been acquired and applied-for example, knowledge of the northern life cycle of parasite the presence of another disease has become known and required new attention. The arctic and subarctic lands and waters are still largely unexplored so far as the natural reservoirs of such diseases as brucellosis and tularemia are concerned. Because of the peculiar conditions of the environment, there still is much research to be done in developing practical techniques to control the transmission of disease, the Center seems to have only begun its work.

The principal health problems in Alaska are indicated by the titles of the Center's sections: Animal-borne diseases, epidemiology, biochemistry and nutrition, physiology, environmental sanitation, and entomology. While the specific problems studied have changed through the years, the sections have continued because the need for them still exists.

There have, for example, been successors on the part of the Alaska State Department of Health and Welfare and the Public Health Service in the control of tuberculosis, and partial success in other public health activities, but the environment has changed very little. Permafrost, nutritional insufficiency in some areas, close association with animals (as in hunting and trapping), a frontier life conducive to accidents, and many other factors-socioeconomic and biological as well as physical-continue to promote poor health. In 1960, Alaska still had the unenviable distinction of having the highest mortality of all 50 States among children under 1 year of age and in the 1- to 4-year category. To learn the specific preventable factors involved, the Center's epidemiology section has been studying, for 2 years, maternal and infant morbidity and mortality in 27 Eskimo and Indian villages in west Alaska.

The responsibilities encompassed by the term "Arctic health research" are threefold: (1) expansion of knowledge and the solution of man's health problems associated with a low-temperature environment; (2) contribution to other medical and biological research by utilizing the unique research potential of the arctic and subarctic environments, including especially the indigenous population, with its isolation, unique culture, and long adaptation to the Arctic; and (3) provision of a health research facility in the arctic-subarctic region of the North American Continent as a focal point for (a) the low-temperature aspects of U.S. health research and (b) cooperation with other nations of the world in northern research, particularly Canada.

The motivation of U.S. effort to extend the knowledge of low-temperature environments as they affect health rests upon the need to develop the full potential of Alaska and upon the opportunity, by keeping pace with other nations active in northern research, to take advantage of work done elsewhere. Motivation is also provided by the location of Alaska between the Old and New Worlds. It is a hub for so-called over-the-pole and the trans-North Pacific air traffic linking northwestern Europe, North America, and eastern Asia. It holds potential for undersea transport. It lies in one of the fallout paths of the Northern Hemisphere. A terra incognita cannot be permitted in so vital a location.

Until World War II, white and nonwhite populations were nearly equal in number in Alaska. By 1950, in contrast, the former was over 21⁄2 times the

size of the latter. By 1960, 77.2 percent (174,546) was white and 22.8 percent (51,621) nonwhite. In total population increases, 1950-60, Alaska ranked third among the States (after Florida, and Nevada), with an increase of 75.8 percent; 57,000 by natural increase and 41,000 by immigration. While the total population in 1960 (226,167 of which 34,167 were military) was not large it is the rate of increase that intensifies the health problems. Moreover, the native population (Aleut, Eskimo, Indian) is growing faster that the nonnative. (See table A.) In summary, the rate of natural increase for Alaska is nearly twice

that for the United States.

In a general way, Alaska's two types of society-village and city-correspond to its two principal types of population: the native who constitutes 83.5 percent of the nonwhite; and the white consisting largely of newcomers to Alaska. The differences between the two chief elements of population are demonstrated in table B. This shows that the nonwhite population (especially the Eskimo, Aleut, and Indian) is younger than the Alaska white population, is not nearly so well educated in formal schooling, has larger households (usually in much smaller space) and more dependents per head of household, holds chiefly jobs requiring little education, and has, accordingly, lower income.

The State as a whole is going through a crucial and economically precarious period of urbanization. The native peoples increasingly are moving to large villages and towns, and are trying more and more to live an urban-type life, while fewer outsiders are settling in the bush to trap and mine gold. See table C, regarding increase of urban population.

The cities already have a high standard of living and the villages are struggling to raise their standard, yet in the health field, for example, the State has no medical school or Veterans' Administration hospital and had no mental hospital before 1962. (Mental patients were hospitalized in Oregon.) The Alaska Department of Health and Welfare is still in the initial 5 years of statehood, and is struggling to effect an organization equal to its new responsibilities. State institutions cannot be expected to mature in so short a period. As a result, the Department of Health, Education, and Welfare and the Department of Defense have carried nearly all the weight of health research required for this northern frontier population.

The rural nonfarm population in Alaska consists of many isolated villages as well as the suburban developments and new country settlements. Eighty percent of the nonwhite adult population, but only 56 percent of the white, is rural nonfarm. Since the former is characterized by large families and crowded homes, periodic work with low annual income, nearly everywhere lacking private medical care, which cannot be supported in such circumstances, and since this village population is, because of its racial composition, the responsibility of the Federal Government, it is to be expected that it requires the type of care that can be provided only by Government field hospitals. It should be expected also that such a population cannot support for example, experimentation on village water systems and food protection, even if it had the necessary skills. Occupational hazards and radiation hazards from fallout on the food sources are examples of the complex problems that are far beyond the competence of communities that are not yet even organized in the utility districts and boroughs (the latter in lieu of counties) that the State will ultimately have. Although the State agencies will assume more and more responsibility as time goes on, they do not plan to have in the near future the research facilities required by the kinds of environmental health problems-especially the new problemscharacteristic of the Arctic.

The technological revolution has had the most basic impact on frontier Alaska, as on many other formerly isolated areas, through new rapid communication and transportation. Since this is not an industrial State, and the health problem areas of Federal concern are even less industrialized than the relatively healthy cities, mechanization of industry has not changed their life so much. But lacking roads in the North's great areas of small population density, they have gone from dog-team mail and freight direct to airplane and radiophone. Increased and more rapid mobility spreads communicable diseases faster, but, on the other hand, medical research and service can be brought to all parts of this farthest northern State more quickly and more often.

Like the technological revolution, the socioeconomic revolution in Alaskaactually a basic cultural change-has both positive and negative health aspects. People congregated in large villages of 350 to 1,500 can be reached better by such public services as schools and clinics. On the other hand, they create difficulties or increase those characteristic of the region, such as contamination of soil, water, and some of the local food sources. The northern community that

is too large to be protected adequately by household sanitation alone, yet is not large enough to support a city system of water supply or waste disposal, becomes a special problem in public health research. Similarly, a hotel or residence school located in the open country, especially if located on permafrost, has problems unlike those of either the individual settler family or the town.

Even while some Alaska residents are building the most modern hotels and restaurants, others are hunting caribou or seal, trapping muskrat and netting fish in primitive conditions that facilitate transmission of disease from animal hosts to man. The Center has tried to meet the needs of the two groups that these people represent: for example, by perfecting a means of constantly circulating water to prevent freezing in household pipes and city mains for the urban dwellers; and by trying to improve fish storage for the village dwellers.

Despite unexpected demands, most sections of AHRC have managed to progress on long-term plans: for example. methodically searching for the sources of enteric disease organisms or identifying the extent and causes of nutritional deficiencies. Similarly, a search for arthropodborne viruses is being initiated. In a region to which the health sciences are new, such comprehensive surveys are essential. For example, it was necessary to identify the biting insects of Alaska. Now the entomology and virology can be combined.

Commercial use of a nonrenewable resource such as petroleum has both direct and indirect significance for health agencies. It provides income for the State government through the sale of mineral leases; by providing a local source of gas and fuel oil, it helps to lower prices, important since the general high price level in this non-self-supporting region is an obstacle to development; it induces quick temporary growth of local populations, with temporary community health needs for which no institutions are prepared; and without good controls, it may cause local pollution of water.

Somewhat different opportunities and problems are presented by a renewable resource industry that is growing rapidly in southwest Alaska: shellfish preservation by freezing or canning. Although the Center and other agencies have done some work on shellfish poisoning, the extent and nature of this health threat are not well known.

The economy of Alaska needs processing industries, and various ones have been proposed. Technological advances in the prevention of water pollution and air pollution in the next few years-which presumably would be incorporated in new factories, here as elsewhere-cannot be counted on to eliminate all dangers. No technological advances will get rid of permafrost (permanently frozen subsoil) that is many hundreds of feet thick or make the winter days lighter or less cold or rid the vast area of Alaska of mosquitoes and biting flies. Although the social environment is more amenable to change than the physical environment, we must accept the probability that the educational and economic lag of the nonwhite population is so great that it will not soon be overcome. Most of the broad types of research that have been conducted by the Center in the past 15 years, therefore, can be expected to be necessary in the next 15 years. The work already accomplished is the best indication of the kind and value of work that will be done, provided that staff of the same competence can be maintained. Construction of a new facility, presently requested, is important in this regard.

The small staff of AHRC has made numerous significant contributions, both in solving known problems and in extending the limits of knowledge essential to the identification and eventual solution of less obvious problems. Some specific accomplishments are:

(1) Identification of (a) several species of parasitic worms that infest man in the Arctic and subarctic, (b) their other animal hosts and life cycle, and (c) their distribution, although the last is not yet completely known. Hosts, not formerly suspected, of Trichinella, Diphyllobothrium, Echinococcus, and other parasites have been found. Association of parasitism with chronic anemia has been tested in the area most seriously affected and found to be not so important as diet, answering a longstanding question.

(2) Because of the problems of sanitation in frontier communities built on permafrost, dimensions of the reported enteric disease problems had to be found: epidemiology, causative organisms, and influential factors such as viability of bacteria and helminths at low temperatures in soil, water, and animal host. These objectives have been largely accomplished by the cooperative effort of the Armed Forces Epidemiological Board and the Arctic Health Research Center.

(3) One of the most spectacular accomplishments has been the control of tuberculosis in Alaska by concentrated effort of AHRC and the Tubercu