Real noise from the urban environment: how ambient community noise affects health and what can be done about it.

The increasing interest in the potential effects of the community environment on individual health has so far excluded those of the acoustic environment. Yet it has long been recognized that continued exposure to elevated sound levels leads to noise-induced hearing loss. Noise is defined as unwanted sound that disturbs communication and speech intelligibility and interferes with sleep and mental tasks. Evidence points to numerous psychophysiologic outcomes of sustained exposure, including annoyance, reduced performance, aggressive behavior, and increased risk of myocardial infarction. Populated areas have experienced a steady rise in outdoor ambient noise resulting from increases in vehicular traffic and the ubiquitous use of machinery. In 2000, the WHO produced guidelines on occupational and community noise. The European Union mandated noise surveillance and abatement programs in cities. In the U.S., a few cities have revised their noise ordinances, but proactive noise reduction initiatives remain confined to new transportation infrastructure projects, thus leaving a large portion of the population at risk. Adding community noise to the public health agenda seems timely. Research needs to measure population-wide health effects of involuntary long-term exposure to ambient noise. Further study of the range and severity of co-morbidities will help refine the thresholds used to protect health. Policies and interventions, including health impact assessments, will require detailed data on actual ambient noise levels. Reducing noise at the source will likely require new road standards and lower allowable engine noise levels. Finally, noise abatement programs have an environmental justice dimension and need to target the at-risk population.