Those who live in various towns, some along rivers and others on hilltops, notice clusters of their neighbors fighting cancers and respiratory ailments, while government and epidemiologists are called upon to examine whether environmental factors are the cause.
Black soot falls from the sky, routinely coating cars and backyard furniture, and children who play outdoors have been hit by a "black rain" of emissions from the nearby power plant.
No, this is not China or India. Nor is it a Third World country galloping headlong into industrialization without heed to the consequences of pollution and the need to safeguard public health. This is the region around Pittsburgh, 40 years after the federal Clean Air Act -- a place famed for its post-World War II air and water cleanups and its post-steel transformation to blue skies.
What you don't see or smell, though, can kill you.
That's one message to take from "Mapping Mortality," the landmark, eight-day series that concludes today in the Post-Gazette. Staff writers Don Hopey and David Templeton spent a year investigating air pollution and its impact on a 14-county region. They examined documents, interviewed more than 150 people and mapped the mortality rates for heart and lung disease and lung cancer for the 746 municipalities in those counties. Not only the articles, but also interactive maps showing community disease rates, power plant locations and other information can be accessed on the web at post-gazette.com.
The series found higher disease rates around many of the region's 16 coal-fired power plants and 150 other companies regarded by the U.S. Environmental Protection Agency as major stationary sources of pollution. "Mapping Mortality" also reported that high death rates showed up irregularly in the areas downwind of the power plants and industrial operations.
The Post-Gazette's review and analysis of state health department data showed that 14,636 more people died from heart disease, respiratory disease and lung cancer in the 14 counties in 2000-2008 than national mortality rates would predict. While other factors including smoking, obesity, occupational exposures and genetic predisposition can be at work, scientific studies have documented links between the diseases and air pollution exposure. Among the types of emissions that can play a role are those from coal-burning utilities and plants, vehicles and chemical-based industries.
After the statistics were adjusted for Pennsylvania's higher smoking rates, the number of excess deaths from the three diseases was still 12,883, for a mortality rate that is more than 10 percent higher than expected. The series reported that all 14 counties had heart disease rates that were 8 percent to 25 percent over the national average rate. Twelve counties had respiratory disease rates between 7 percent and 45 percent above the national rate. And three counties, including Allegheny, had higher lung cancer rates than the national average.
These are just some of the findings from the past week's series. Interviews with residents from around the region reminded readers that pollution's ill effects have human consequences. While many southwestern Pennsylvanians feel good about the gains made over decades to improve regional air quality, they have neighbors living not far away with very different stories to tell. And the health damage that shows up statistically can surface in some unlikely places, including Sewickley, Bellevue, Cranberry and Bridgeville.
Like the complexity of the emissions problem, the solution is no simple matter. For starters, greater vigilance is needed from regulatory agencies -- the EPA, the state Department of Environmental Protection and the Allegheny County Health Department. Tougher monitoring would teach us more about the scope and sources of the hazards. More careful scientific review of the factors that contribute to such diseases would better explain the possible cause-and-effect.
It is also time to factor in the measurable toll on public health to the overall cost of burning coal and permitting other potentially harmful industrial emissions. While no one would drive through the Pittsburgh region today and call it "hell with the lid off," parts of the metro area may still be enduring some hellacious impacts from air pollution.
"Mapping Mortality" must be the beginning of the conversation, not the end.