The US is responsible for 23% of all greenhouse-gas emissions, mainly a result of burning fossil fuels. The editorial comments: '[George W] Bush's Clear Skies Act 2003 aims to reduce power-plant emissions of sulphur dioxide, nitrogen oxides, and mercury, but ignores the role of carbon dioxide, concentrations of which have dramatically increased over the past century. The new chief of the US Environmental Protection Agency, Mike Leavitt, faces a tough time ahead if the energy bill is enacted, even with the help of the Clear Skies Act.'

'To protect the environment, Leavitt needs to persuade US citizens to use fewer fossil fuels.

The Kyoto Protocol, which the USA rejected in 2001, would at least offer a peg around which to enforce reduction of greenhouse gases. Air pollution as a whole also warrants Leavitt's attention, especially now that the link with ill health is clear. Excess deaths and cardiorespiratory illness have been associated with extreme air-pollution episodes where stagnant air conditions led to greatly increased concentrations of soot, sulphur dioxide, and other pollutants from coal fires or factory emissions. Two studies published in this journal last year (Lancet 2002; 360: 1184, 1203, 1210) confirmed that combustion-related particulate air pollution is an important environmental risk factor for cardiopulmonary mortality. One of these studies by Hoek and colleagues showed that living within 100 m of a highway or within 50 m of a major road was associated with a relative risk for cardiopulmonary mortality of 195 (95 CI 109-351).'

The editorial concludes: 'Changing behaviour will need changes in law (and tax incentives) to persuade not just Americans to reduce their fuel consumption, switch
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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
21-Aug-2003