Executive Summary

Air pollution continued to challenge the nation in 2004, 2005, and 2006. Some cities—notably Los Angeles and Houston—managed to steadily cut ozone and particle pollution. Progress stalled in many other cities, slowing or eroding gains recorded earlier in the decade. For the first time, a city outside of California—Pittsburgh—topped one of the lists of the most polluted city—and stands on the verge of topping a second.

The adoption of a new ozone standard on March 12th will require redoubled efforts to reduce the nation’s most common air pollutant. The history of battling ozone shows that aggressive measures can cut emissions, leading to much cleaner air. However, the trends shown in this report warn that progress can stall without putting more measures in place to reduce ozone. Unfortunately, some have proposed changes that would weaken the Clean Air Act and set back the progress toward healthier air.

Looking at the nation as a whole, the American Lung Association State of the Air 2008 finds:

Two of every five people—42 percent—in the U.S. live in counties that have unhealthful levels of either ozone or particle pollution. Almost 125 million Americans live in 216 counties where they are exposed to unhealthful levels of air pollution in the form of either ozone or short-term or year-round levels of particles.
Nearly one-third of the U.S. population—31 percent—live in areas with unhealthful levels of ozone. Counties that were graded F for ozone levels have a combined population of over 92.5 million. One in three Americans live in counties where the monitored air quality places them at risk for decreased lung function, respiratory infection, lung inflammation and aggravation of respiratory illness.
Over one quarter of the people in the United States live in an area with unhealthful short-term levels of particle pollution. Over 81.4 million Americans live in areas where there are too many days of unhealthy spikes in particle pollution. Short-term spikes in particle pollution can last from hours to several days and can increase the risk of heart attacks, strokes and emergency-room visits for asthma and cardiovascular disease, and most importantly, can increase the risk of early death.
One in six people in the United States lives in an area with unhealthful year-round levels of particle pollution. Nearly 50 million Americans suffer from chronic exposure to particle pollution. Even when levels are fairly low, exposure to particles over time can increase risk of hospitalization for asthma, damage to the lungs and, significantly, increase the risk of premature death.
About 30.4 million Americans—roughly one in 10 people—live in 18 counties with unhealthful levels of all three: ozone and short-term and year-round particle pollution.

With the risks from airborne pollution so great, the American Lung Association seeks to inform people who may be in danger. Many people are at greater risk because of their age or because they have asthma or other chronic lung or cardiovascular diseases or diabetes. Here are the numbers of people in each at-risk group.

People with Asthma. Approximately 2.2 million children and over 5.5 million adults with asthma live in parts of the United States with very high levels of ozone. Nearly 5 million adults and over 1.9 million children with asthma live in areas with high levels of short-term particle pollution. Nearly 3 million adults and over 1.2 million children with asthma live in counties with unhealthful levels of year-round particle pollution.
Older and Younger. Over 10.2 million adults age 65 and over and nearly 24 million children age 18 and under live in counties with unhealthful ozone levels. Over 9.4 million seniors and 20.6 million children live in counties with unhealthful short-term levels of particle pollution. Over 5.5 million seniors and 13 million children live in counties with unhealthful levels of year-round particle pollution.
Chronic Bronchitis and Emphysema. Nearly 2.9 million people with chronic bronchitis and over 1.2 million with emphysema live in counties with unhealthful ozone levels. Nearly 2.6 million people with chronic bronchitis and 1.1 million with emphysema live in counties with unhealthful levels of short-term particle pollution. Over 1.5 million people with chronic bronchitis and over 644,000 people with emphysema live in counties with unhealthful year-round levels of particle pollution.
Cardiovascular Diseases. Nearly 20.1 million people with cardiovascular diseases live in areas with unhealthful levels of short-term particle pollution; nearly 12 million people live in counties with unhealthful levels of year-round particle pollution. Cardiovascular disease includes coronary heart disease, heart attacks, strokes, hypertension and angina pectoris.
Diabetes. Over 4.6 million people with diabetes live in areas with unhealthful levels of short-term particle pollution; over 2.7 million people live in counties with unhealthful levels of year-round particle pollution. Research indicates that diabetics face increased risk due to the damage particle pollution can cause to their cardiovascular systems.

The American Lung Association also calls for these key steps needed to improve the air we all breathe.

Ensure every county is protected from ozone. The U.S. Environmental Protection Agency (EPA) has just adopted a new, tighter national standard for ozone, an important step that drives the measures to clean up the sources of ozone pollution all across the nation. Now the EPA must determine which counties to protect and which counties to leave out of the clean up requirements. The American Lung Association urges the EPA to include every county in planning and protection in every metropolitan area that has monitored unhealthy levels of ozone. The Lung Association opposes leaving counties left out of the planning for protection from this dangerous pollutant.
Protect the Clean Air Act. Since 1970, the Clean Air Act has proven to be one of the nation’s leading public health laws. Thanks to clean-up measures put in place under the Act, emissions from all pollutants have dropped in half since 1980. However, in March the EPA proposed substantial changes to the Act, changes that would weaken decades-old protections to the public. The American Lung Association will oppose any changes that weaken the Clean Air Act.
Clean up dirty power plants. Old, coal-fired power plants are among the biggest industrial contributors to unhealthful air, especially particle pollution in the eastern United States. The toll of death, disease and environmental destruction caused by coal-fired power plant pollution continues to mount. The EPA issued rules in 2005 that give states the tools to clean up these plants. However, the EPA has issued other rules that give the electric power plants huge loopholes in complying with the Clean Air Act. The American Lung Association and our partners will continue to take steps to ensure that loopholes are removed. Several Northeastern states are considering adopting even more stringent requirements for their power plants. The American Lung Association repeatedly urged the EPA to use this opportunity to clean up even more pollution, faster. The American Lung Association supports efforts in Congress to strengthen the Clean Air Act to further clean up these heavy polluters.
Clean up existing diesel equipment. New diesel buses, trucks, and heavy equipment are cleaner than ever, thanks to clean up requirements EPA has put in place in the last decade. Diesel fuels are also much cleaner. However, old diesel engines last a long time. Diesel engines in school buses, highway trucks, and other equipment continue to operate for hundreds of thousands of miles, threatening the health of millions—especially those on or near highways—with dangerous exposure to diesel exhaust. Each community should move rapidly to retrofit and replace old diesel school buses and other equipment in the public diesel fleet. Communities should require contractors to clean up trucks and construction equipment. These and other steps can reduce the burden of pollution from old, dirty, diesel equipment and vehicles.
Require all ships calling on U.S. ports to use cleaner marine fuels and engines. Although international shipping is essential to the global economy, it also produces large amounts of air pollution. Emissions from these engines seriously worsen national ozone, carbon monoxide, sulfur oxide, and particle pollution levels, especially in communities near commercial ports such as Seattle, Oakland, Chicago, Los Angeles, New Orleans, and New York. Both foreign-flagged as well as U S ships must be required to use much cleaner fuels and engines.

Individual citizens can do a great deal to help reduce air pollution outdoors as well. Simple, but effective ways include:

Drive less. Combine trips, walk, bike, carpool or vanpool, and use buses, subways or other alternatives to driving. Vehicle emissions are a major source of air pollution. Support community plans that provide ways to get around that don’t require a car, such as more sidewalks, bike trails and transit systems.
Don’t burn wood or trash. Burning firewood and trash are among the largest sources of particles in many parts of the country. If you must use a fireplace or stove for heat, convert your woodstoves to natural gas, which has far fewer polluting emissions. Compost and recycle as much as possible and dispose of other waste properly; don’t burn it. Support efforts in your community to ban outdoor burning of construction and yard wastes. Avoid the use of outdoor hydronic heaters, also called outdoor wood boilers, which are often much more polluting than woodstoves.
Get involved. Participate in your community’s review of its air pollution plans and support state and local efforts to clean up air pollution.
Use less electricity. Turn out the lights and use energy-efficient appliances. Generating electricity is one of the biggest sources of pollution, particularly in the eastern United States.
Send a message to decision makers. Send an email or fax to urge Congress to oppose measures that weaken the Clean Air Act. Log on at www.lungusa.org to see how easy that can be.