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The EPA's emissions rollbacks will be devastating for Americans' health

The EPA's emissions rollbacks will be devastating for Americans' health
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The COVID-19 pandemic has taught us two key lessons. First, that things we cannot see can hurt us. And second, that preparedness and medical science are essential to protecting us against invisible threats to health.

Mercury is one such invisible threat. Mercury is a potent neurotoxin that targets the developing brains of fetuses in the womb. It causes IQ loss, shortens attention span and disrupts behavior. It increases risk for ADHD and learning disabilities. Early-life exposure of even small doses can cause lifelong brain injury. Each year an estimated 300,000 to 600,000 American children are exposed to mercury before they are born. 

For the past decade, a highly effective federal program – the Mercury and Air Toxics Standard, MATS – has protected unborn children against mercury poisoning. Now under cover of the COVID-19 pandemic, the Trump administration has issued rulings to weaken MATS. As physicians and public health advocates, we consider this deeply scientifically unsound. As citizens we consider it cruel and immoral.  

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Coal is the main source of mercury. When coal is burned in power plants, mercury vaporizes, goes up the stack and enters the atmosphere. It reaches rivers, lakes and the oceans, enters the marine food chain and concentrates to high levels in fish at the top of the chain — species such as tuna and swordfish. When a pregnant woman eats contaminated fish, mercury enters her body and silently passes into her unborn child. 

Mercury in fish is invisible. It has no taste or smell. There is no medical treatment for prenatal mercury exposure. Prevention is the only solution. To prevent mercury poisoning in children, the Environmental Protection Agency (EPA) issued the MATS standard in 2011. MATS limits mercury emissions from coal-burning power plants. It has been highly effective. Since MATS was issued, mercury emissions in the United States have decreased by over 80 percent — a remarkable victory for public health. 

MATS has had a further benefit. In addition to limiting mercury emissions, MATS has reduced emissions of other harmful pollutants, most notably emissions of small airborne particles less than 2.5 microns in diameter - PM2.5 pollution. PM2.5 is highly toxic because fine airborne particles can enter deep into the lungs and in some instances enter the blood stream, from where they can reach every organ in the body and damage distant tissues.

PM2.5 pollution has been shown through multiple clinical and epidemiological studies to cause disease, disability and death across the lifespan. Chronic exposure increases risk of heart attack, stroke, type 2 diabetes and hypertension. It increases risk of death from pneumonia. In children, it increases risk of preterm birth and asthma. A recent Harvard study reports that even small increases in PM2.5 exposure are associated with increased mortality from COVID-19.   

According to EPA’s own estimates, MATS prevents as many as 11,000 premature deaths, 130,000 asthma attacks, 4,700 heart attacks, 5,700 hospital and emergency room visits and 3.2 million restricted-activity days each year. Notably PM2.5 emissions are not equally distributed — black Americans face a disproportionate burden of exposure. And as a result, any weakening of emissions regulations would further racial health disparities. 

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The EPA’s previous analysis found that MATS is also highly cost-effective. That analysis considered the economic benefits of preserving children’s IQ, preventing heart attacks and strokes, and averting premature death. It estimated that MATS produced between $3 and $9 in health benefits for every $1 invested in pollution prevention. MATS is clearly one of the most effective public health protections ever put in place by the EPA. 

Now, to justify rolling back MATS, the administration has released a new cost-benefit analysis. This new calculation disregards the totality of benefits, including protecting adults against heart disease and stroke. It ignores the health benefits derived from reductions in fine particulate matter. The new straw man analysis questions the regulation’s economic and legal justification. It makes MATS vulnerable to future legal challenges, and paves the way for unnecessary disease, disability and death.

As physicians, we counsel pregnant women to avoid eating fish that contains high levels of mercury. We warn our adult patients against vigorous exercise on bad air days. But even as we offer this advice, we know that physician guidance and individual behavior change are not enough.  

If Americans are truly to be protected against mercury, PM2.5 and other invisible threats to health, the EPA must fulfill its statutory responsibility. It must safeguard Americans’ health by protecting America’s environment. It is unconscionable that during this pandemic the Trump administration is continuing to roll back nearly 100 environmental regulations. This administration is ignoring medical science, undermining preparedness and politicizing the methodology that underpins public policy. These issues are of profound importance. They go far beyond public health and portend a crisis of truth that threatens the very core of our democracy.   

Now more than ever, the health of our nation is at stake. What is freedom if not the ability to breathe clean air?    

Dr. Akash Goel is an assistant professor of medicine at Weill Cornell / New York Presbyterian Hospital. Dr. Philip Landrigan is the director of the Program for Global Public Health and the Common Good at Boston College.