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Why does air make people sick? Torbjdrn Malmfdrs The fact that air is absolutely essential to all life has never been questioned. The ancient Greeks, who included air as one of the four basic elements, knew this. Today, we know that it is the oxygen in the air'that sustains life and that the carbon dioxide we exhale is necessary for plants. Nevertheless, it has been known for quite some time that air can be the source of everything from discomfort and inconvenience to illness and death. Prior to our knowledge of the existance of bacteria, viruses and a number of other substances, there were all sorts of opinions and theories about magical or supernatural powers that made air a health hazard. On the other hand, it was also believed that air could be healthy and beneficial. The expression "out in the fresh air," for example, is used daily to imply that outdoor air is healthier than indoor air. But is this true? How much do we really know about the effects of air on life and death? Is there a difference between the air at different places, outside as well as inside? This brings us to the objective of this paper: How can we find out and explain how air affects health? Air in general, i.e. in the absence of an indisputable, identified factor in the air in an industrial working environment that can cause illness, for example, affects our health in several ways. A large number of epidemiological and other investigations have revealed a difference in the disease pattern displayed by individuals who have spent time in places with a confirmed variation in indoor and outdoor air quality. The health effects examined comprise everything from certain vague sensations dealing with air and irritating reactions to such highly dangerous diseases as lung cancer. Why does air affect our health? Even though there seems to be some doubt in this issue at present, something other than the particles found in air causes these health hazards.

Air contains - in addition to nitrogen, oxygen, carbon dioxide and several other substances that are always present - a number of chemical substances that can be grouped under the collective name of contaminants as well as other pollutants in the form of solid particles and drops of liquid. The solid particles and, to some extent, the drops of liquid often have a complicated composition. These particles can be either organic - microorganisms (viruses, bacteria, fungi or fungi spores), pollen, fibers, etc.) or inorganic in nature. Modern photographic techniques have been used to present a dramatic and frightening picture of the degree of pollution in the air we breathe. Added to this is the fact that modern analysis techniques can detect hundreds and perhaps thousands of pollutants in the air, many of which have been proved to have the ability to present serious health hazards when found in sufficiently large quantities. Nevertheless, in the majority of cases we still do not know what it is in the air that affects the health of the individual. This also means that the knowledge of how these health effects come about is limited. The mere presence of a substance is not sufficient to label it as the cause of the observed health effects. This requires a certain concentration under a particular period, levels and quantities that are practically always unknown. Consequently, it is difficult to determine whether a particular substance or a few substances are the cause of the health effect observed, or whether a large number of the pollutants or perhaps all of the pollutants in combination are the cause of the effects. According to the basic principles of toxicology ( the study of poisons and their effects), a chemical substance must react specifically with organisms in order to cause an effect. Different chemical substances react in different ways, in different areas in the organism and thus cause different effects. Even if various chemical substances do work together, present knowledge concerning the conditions for this cooperation seems to indicate that the health effects from air can be traced to a single or a few substances rather than to the majority of substances present in air. How then can we find out which substance causes which health effect?

Man does not have a sense organ that reacts to hazardous chemcial substances. Our sense of smell, however, functions as a warning system for both known and unknown dangers in the air. Unfortunately, our sense of smell is unreliable in many respects, but as it is extremely sensitive to certain air pollutants it functions continuously as a conscious and unconscious human instrument for analyzing air pollutants. This means that our sense of smell is often placed on an equality with measurements and that odors can trigger reactions that lead to health effects which are not a result of the air pollutant in question. In addition to the unreliability of our sense of small, there are other reasons why we should be critical of using smell as a means of subjectively determining how hazardous air is to our health. It is far better to utilize scientific knowledge (toxicology) of the health effects resulting from air pollutants. The primary contribution of this knowledge to the discussion of the effect of air on health is an objective assessment of the causal relationship between air pollutants and different health effects. It would carry us too far to describe this process as well as the existing possibilities and difficulties here, but it is important to emphasize that this is the only method of accurately determining whether an observed health effect is dependent upon a particular air pollutant or not. It is entirely possible that observed health effects - especially those of a more subjective character for example fatigue, headaches and irritation - can be caused by factors other than air pollutants, for example, physical, psychological and social factors. So, even if is becoming more popular today to single out the quality of air - both indoor and outdoor - as a major hazard to our health and our lives, there is amble reason to stop and reflect on this. Obviously, we must continue to strive to achieve completely clean air, no matter how we choose to define this. But we must also realise that this is an unattainable utopia. We must learn to accept a certain degree of air pollution in order to make life bearable. This does not mean, however, that we should stop trying to eliminate or reduce the air pollutants - exhaust fumes, mold, tobacco smoke and I

substances discharged from building materials - which we can objectively prove are hazardous to our health. Accomplishing this requires knowledge, communication of knowledge and competent use of this knowledge - all based on the latest scientifi,c findings, experience, broad-mindedness and common sense - not on nearsighted environmental political propoganda, opportunistic scientific ambition or misdirected mass-media information. a

The radon daughter content present in Swedish buildings is thought to cause between 100 and 3,000 deaths each year from lung cancer, of which 1,000 is the most probable number. This is how the threat posed by radon is described in a recent publication from the Swedish National Board of Health and Welfare, the Swedish National Board of Physical Planning and Building and the Swedish National Institute of Radiation Protection. Is this possible? Is the radon problem as frightening as this? "I believe in the threat that's been pictured and that something's got to be done about it," says -Dr. Ingemar Samuelson, the National Board of Physical Planning and Building and one of Sweden's leading experts on radon in buildings. The radon debate became more intense after the alarming reports released in 1979. This was when the Swedish government appointed a committee to investigate the health risks associated with radon emission. This was also the same year that the cancer committee was appointed to determine methods for preventing cancer. Why not more cancer? There are those, however, who maintain that radon is not is not as dangerous as generally claimed. Their argument is based on the premise that the population living in areas where the ground contains large quantities of radon must have been exposed to large doses of radiation throughout time. The province of Skaraborg is such an area. The conclusion: If radon is extremely dangerous, the population of Skaraborg ought to display a high frequency of lung cancer. But they do not! "There could be other reasons as to why this relationship doesn't exist," maintains Ingemar Samuelson. Quite a long period of time, 10-40 years, is required from the first exposure to radiation to the time that cancer appears. Today's illnesses are a result of exposure to radiation as far back as in the 1940s. "People lived differently before. That could also have an effect on whether radon resulted in lung cancer or not. People didn't live as long in those days, either. Lung cancer may not have had a chance to develop. The causal relationships haven't been established. "We insulate our buildings to a greater degree today. And this has probably led to a two or threefold increase in the radon content of buildings. The effects of this won't manifest themselves until well into the next century. "ThatBs when I believe we'll begin to note an increase in the frequency of lung cancer." N U1 0 ~ .¢ ~ N w Gtt

Radioactive Radon is a rare gas formed by the decay of the radioactive material radium. Radium is present in the ground, building materials and subsoil water. Decay is a continuous process. Radon, in turn, results in radon daughters. It is the radiation from these particles that can occur in high concentrations in homes. When air containing radon daughters is inhaled, some of these particles remain in the lungs. The radiation from these residual radon daughters can result in lung cancer.

"Many buildings have abnormally high levels of radon. The ground represents the major problem." So says Dr. Ingemar Samuelson of the Swedish National Testing Institute. The ground in Sweden has been surveyed thoroughly. We know in which areas radium is present. But that does not fully explain how radon enters buildings. "The province of Bohus contains a great deal of radioactive granite. But little radon is transmitted from the ground. The density of granite prevents this. "The problem becomes much larger when granite is crushed. The greatest radon problems are found in ridges of gravel." Radon is everywhere Surveying the radon problem is therefore extremely difficult. In principle, every Swedish building would need to be tested in order to ascertain the extent of the problem. "Radon could be present in every building," stresses Ingemar Samuelson. "It's absent in the majority, but we don't know which buildings contain it. The only buildings which we can say with a reasonable degree of certainty are radon free are those located on rock or moist clay. But should the clay dry out, then radon can pass through it. " If the content'of radon daughters exceeds 400 Bq/m3 of air in an existing residence, then a sanitary problem is said to exist. Municipal and health-care authorities can then, backed up by the health care act, force the owner of the building to lower the radon daughter content. The radon daughter content in newly constructed buildings may not exceed 70 Bq/m3 of air or 200 Bq/m3 of air after remodeling, according to the Swedish National Board of Physical Planning and Building. Very high content "Buildings where ground radon is present can have a very high content. The highest we've measured reached 30,000 Bq/m3! "Values of several thousands of Bq/m3 are recorded quite often," says Ingemar Samuelson. "And that's unacceptable!" Abundance of radium in Sweden The radon problem is special for Sweden. There is an abundance of radium in Swedish bedrock. In addition, the bedrock has been worn down by the numerous glaciers that passed through this area. Radium is also present in many building materials, particularly in alum shale-based blue-gray concrete, so-called "blue concrete" manufactured between 1929 and 1975. Few building materials contain so much radium that they release large quantities of radon.

"If the radon comes from the building material, then the measures required are simple," says Ingemar Samuelson. "It's simply a question of increasing the degree of ventilation. "But if the radon comes from the ground, greater ventilation can increase the low pressure in a building. And then more radon is sucked in. It's important to determine the source of the problem before deciding what's to be done about it. "The measures themselves can cost everything from a few dollars to the sums required to remodel an entire building!"

Swedish construction know-how is being exported to England. Anders Nisses AB is launching a major project in the very heart of London. "We're going to restore a large building in Edwardian style," says C-G Petterson. director of building at Anders Nisses AB, a company of developers listed on the Stockholm Stock Exchange. The building in question, which is situated on the Thames adjacent to the Houses of Parliament, was built during WWI as headquarters for the Crown Agency, an authority charged with the task of holding the British Commonwealth together. "Originally constructed in an old-fashioned and beautiful style, the building has since been disfigured and destroyed through extensive reconstruction. The interior of the building is in total ruins today." The exterior of Millbank 4/5, on the other hand, calls up memories of British Empire's heyday. These dreams still live on in the minds of Englishmen. They would like for these grand old buildings to regain the stately charm once displayed during the Edwardian and Victorian eras. Stucco finish "Extensive stucco finish and beautifully formed ceilins are characteristic of this particular style," explains C- G Petterson. This is where Anders Nisses AB comes into the picture. English construction companies prefer to tear down and rebuild in modern styles. If they are forced to retain an old style for cultural and historical reasons, they tear down everything except the facade. Anders Nisses has documented experience in restoring old buildings and converting them into offices that correspond to modern requirements, while at the same time preserving the original style and feeling. "Beautiful ceilings disappear during conventional installations, which is what happened in the case of the building in question." Ventilation ductwork and false ceilings were installed in this venerable old building. From the time of the building's completion in 1916 up to 1980, numerous changes in the organization of the Crown Agency required extensive modifications. Three or four well-preserved rooms are all that remains today. "We're going to restore the building to it's original condition, but give it a modern climate and installations," says C-G Petterson. Well-tried technology Anders Nisses will employ the same technology that has yielded good results at Alviks Strand in Stockholm. All ventilation, electric cables, telecommunication lines, etc. are placed under the floor. This leaves the ceiling free, and the original stucco finish can be restored. The

surrounding garden will be retained in order to allow sunlight to enter the premises, which is normal practice in Sweden but considered quite unusual in England. "Our English consultants just shake their heads. The English practice is to build on every millimeter of ground area. They don't think it's necessary to have windows for viewing the outdoors," says C-G Petterson. When finished, it will be impossible to distinguish the new from the old at Millbanks 4/5. The old venerable environment will remain, but with all the criteria of a modern office building. Anders Nisses expects to spend in the neighborhood of SEK 650 million to put the 20,000 square meters of office space back in top condition.