The data clearly indicates the need for this workshop. Let me begin by putting this into some context. We are defining indoor environments as built, non-industrial structures. This includes workplaces, schools, offices, houses and apartment buildings, and vehicles. And according to a recent study, we Americans spend between 85 and 95 percent of our time indoors. (1.) So while we need to be cognizant and concerned about our outdoor environment, including pollution and smog, we must put at least equal emphasis on the long-overlooked issue of indoor environments.

In just the past 25 years, the percentage of health evaluations that the National Institute for Occupational Safety and Health at the CDC has conducted related to indoor-air quality has increased from 0.5 percent of all evaluations in 1978, to 52 percent of all evaluations since 1990. (2.) This means that in those years, the evaluations related to air quality concerns have increased from one of every 200 evaluations to one of every two.

The problem is also adversely affecting our children's health: One in five schools in America has indoor air quality problems. (3.) This can trigger various allergies and asthma. Asthma alone accounts for 14 million missed school days each year. The rate of asthma in young children has risen by 160 percent in the past 15 years, and today one out of every 13 school-age children has asthma. (4.)

Yesterday I announced that the Office of the Surgeon General will focus on healthy children this year. I believe that we can and will improve the health of our next generation by focusing on healthy indoor environments.

Acknowledgments

This workshop follows on the work of thousands of dedicated scientists, clinicians, advocates, and public health professionals.

I particularly want to thank the developers of this workshop, beginning with:

• My Chief of Staff, RADM Bob Williams, Public Health Service Chief Engineer. Bob has tirelessly championed the idea of this Surgeon General's Workshop that was first introduced by the U.S. Public Health Service Building Design and Construction Subcommittee, Engineer Professional Advisory Committee.

Also the Workshop Planning and Coordination Group:

• Workshop coordinator Captain Sven Rodenbeck, from the Agency for Toxic Substances and Disease Registry
• Captain Allan Noonan from the Office of the Surgeon General
• Captain Susan Conrath of the Environmental Protection Agency
• Captain Stephen Redd of the National Center for Environmental Health at CDC
• Also from the National Center for Environmental Health, Dr. Clive Brown
• Dr. Jean Cox-Ganser from the National Institute for Occupational Safety and Health at CDC
• Also from the National Institute for Occupational Safety and Health, CDR Margaret M. Kitt, who is currently in Afghanistan.
• Dr. Allen Dearry of the National Institute of Environmental Health Sciences at NIH

• Jim Rifenburg, National Center for Environmental Health at CDC

• Brian Kong of the Office of Research Services, NIH
• Retired Captain Bill Brodt, now with NASA, who was one of the Public Health Service engineers who originally proposed the concept of this workshop.

I would also like to thank their respective agencies for permitting them time to help develop this workshop and for providing the necessary support for convening this workshop.

Please join me in thanking these dedicated public servants.

Framework and Goals

Our goals over the next two days are ambitious. Fortunately, we are well organized and we have strong precedent for success - the many Surgeon General Workshops that have come before ours.

We will all have to work hard during the next two days, and I hope that we'll find reasons to build upon what we learn and what we decide together at this workshop.

My three goals for this workshop are to:

• First, identify the relevant scientific data related to indoor environments.
• Second, summarize the evidence and potential research needs. and
• Perhaps most importantly - build collaborations around the common goal of improving our indoor environments.

As you know, secondhand smoke, lead, radon, and asbestos are threats to the indoor environment.

The research that uncovered these threats, extensive public health education campaigns, and the development of partnerships across government and the private sector, have saved and improved the lives of millions of Americans by reducing and eliminating exposure to these health risks.

But the reality is that our work is just begun.

Part of what a Surgeon General's Workshop can do is illuminate the larger scientific and public health aspects of an issue. We are here to gather as much information as possible about the contributing factors and potential solutions to health concerns and health questions related to the indoor environment.

As we look at health and the indoor environment, we must ask:

• What are all the issues? We must be comprehensive.
• How do the issues interrelate?
• How, if at all, do they impact health and well-being? and
• What should be done to prevent any negative impact on health and well-being?

Your efforts during this workshop will begin to define next steps to ensuring healthier indoor environments for all Americans.

With that, I want to again thank you for being here, and offer my personal gratitude for all that you're about to do. I suggest that we proceed to the first scientific discussion.

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References:
1. Jones 1998, Rauh et al. 2002, Stolwijk 1990, Wakefield 2002
2. Oliver 1998, NIOSH 1997
3. GAO 1995, 1996, and 1999
4. EPA, 2004