No abstract

An area of major concern in considering increased coal production and utilization is the health and safety of increased numbers of workers who mine, process, or utilize coal. Hazards related to mining activities in the past have been especially serious, resulting in many mine related accidental deaths, disabling injuries, and disability and death from chronic lung disease. Underground coal mines are clearly less safe than surface mines. Over one-third of currently employed underground miners experience chronic lung disease. Other stresses include noise and extremes of heat and cold. Newly emphasized technologies of the use of diesel powered mining equipment and the use of longwall mining techniques may be associated with serious health effects. Workers at coal-fired power plants are also potentially at risk of occupational diseases. Occupational safety and health aspects of coal mining are understood well enough today to justify implementing necessary and technically feasible and available control measures to minimize potential problems associated with increased coal production and use in the future. Increased emphasis on safety and health training for inexperienced coal miners expected to enter the work force is clearly needed. The recently enacted Federal Mine Safety and Health Act of 1977 will provide impetus for increased control over hazards in coal mining.

Objective: This article describes the personal experience and perspective of the authors, who had primary responsibility for drafting the initial health-based regulation limiting lead content of gasoline during the early 1970s while employed by the U.S. Environmental Protection Agency (EPA). Data sOurce: Information used by the U.S. EPA in developing the initial health-based regulation limiting lead content of gasoline in December 1973 and studies documenting the impact of that and subsequent actions. Data extractiOn: Among the lessons learned from this experience is the importance of having input from independent scientists to the regulatory decision-making process. This also demonstrates the critical role of independent peer-reviewed research, such as that supported by the National Institutes of Health, as well as research conducted by scientists from the Centers for Disease Control and Prevention, in delineating the consequences of lead exposure in the population. Data synthesis: Removal of lead from gasoline in the United States has been described as one of the great public health achievements of the 20th century, but it almost did not happen. The experience of the authors in developing this regulation may be helpful to others involved in developing health-based regulatory policy in the future. cOnclusiOn: The initial U.S. EPA health-based regulation to remove lead from gasoline is clearly an example where science successfully affected public policy. The leadership of the U.S. EPA at that time deserves much credit for establishing an atmosphere in which this was possible.

Summary The Fogarty International Center (FIC) of the U.S. National Institutes of Health has supported long-term (>6 months) basic, clinical and applied research training and research for over 3,600 future leaders in science and public health from low- and middle-income countries (LMICs); tens of thousands more persons have received short-term training. FIC started these programs in 1988 with the flagship HIV/AIDS International Training and Research Program (AITRP) in response to the global pandemic. More than 23 extramural training and research programs plus an intramural program are now operating – all in collaboration with other Institutes and Centers at NIH, U.S. government agencies, foundations, and partner institutions in LMICs and the U.S. While infectious diseases still reign mightily in Sub-Saharan African and South East Asian countries, non-communicable diseases are emerging globally, including in LMICs. Newer FIC training programs are addressing chronic, non-communicable diseases and strengthening the quality of medical schools and health care provider training, in addition to expanding expertise in infectious diseases. The model for successful training is based on long-term commitments, institutional strengthening, “twinning” of research centers, focus on local problems, and active mentoring. Trainees from Africa, Asia, and Latin America have made notable scientific contributions to global health, attained leadership positions, and received special recognition nationally and internationally. As the FIC programs are institutional-strengthening partnerships and candidates are carefully selected and mentored, close to 90% of FIC trainees return to their countries of origin. After returning home the FIC-trained leaders have continued to mentor and train thousands of individuals in their home countries.