Ambient Air Quality and Human Health: Current Concepts—Part 1
There is a fundamental reevaluation of the association between air quality and human health taking place. This reevaluation is motivated by several recent developments: increasing interest in air quality as an environmental issue; interest in the unanswered questions regarding the epidemiology of asthma; and the reduced prevalence of the principal hazard to respiratory health, cigarette smoking, the control of which invites interest in second-order determinants of health. This article attempts to provide a framework for understanding air quality issues that pertain to human health. The objective is to provide the specialist in respiratory medicine with an overview that will assist in educating patients and in responding to their inquiries, and to equip the physician to respond to requests for assistance or interpretation when called upon to comment on public policy issues involving air pollution. The implications of setting air quality standards or objectives to meet arbitrary levels of risk of health effects are examined. The current state of the art does not support risk-based air quality standards. A policy of continuous improvement is most protective of both human health and the environment.