Noise as a Public Health Hazard

Abstract
Noise is unwanted and/or harmful sound, first recognized as a public health hazard in 1968. The Noise Control Act of 1972 declared that “it is the policy of the United States to promote an environment for all Americans free from noise that jeopardizes their health or welfare.” The promise of that legislation remains unfulfilled 50 years later. Human exposure to harmful noise levels is widespread. Major sources include transportation, military aircraft and combat operations, noisy recreational vehicles, industrial machinery, recreational and leisure activities, outdoor power equipment, consumer products, and, possibly, wind turbines. Loud noise causes hearing loss and tinnitus and can contribute to non-auditory health problems. Chronic noise, even at low levels, can cause annoyance, sleep disruption, and stress that contribute to cardiovascular disease, cerebrovascular disease, metabolic disturbances, exacerbation of psychological disorders, and premature mortality. Noise interferes with cognition and learning, contributes to behavior problems, and reduces achievement and productivity. The health of more than 100 million Americans is at risk, with children among the most vulnerable. Noise-related costs range in the hundreds of billions of dollars per year. Yet, the United States has no federal standards for non-occupational noise exposure. Federal standards for occupational noise exposure from the 1970s address only hearing loss as an adverse health effect and do not apply to all workers (e.g., those in agriculture and construction). Calls for action have gone largely unheeded. This policy calls for national noise standards, enforcement, education, outreach, and action on noise as a public health hazard. They are long overdue.

Relationship to Existing APHA Policy Statements
Apart from Policy Statement 20135 (Environmental Noise Pollution Control) and the original noise policy statement (1968), no existing policy statement relates to noise as a public health problem. This update incorporates all noise exposures, including environmental noise pollution. The APHA policy statements below relate to this update by advocating for the following: reducing environmental stressors and their harmful effects on public health, rectifying the disproportionate burden of environmental hazards borne by disadvantaged populations, and encouraging actions to mitigate adverse effects. Including noise as a stressor in future APHA policy statements and updates is recommended.

• APHA Policy Statement 20197: Addressing Environmental Justice to Achieve Health Equity 
• APHA Policy Statement 20183: The Public Health Impact of Energy Policy in the United States
• APHA Policy Statement 20189: Achieving Health Equity in the United States 
• APHA Policy Statement 201713: Establishing Environmental Public Health Systems for Children at Risk or with Environmental Exposures in Schools
• APHA Policy Statement 201711: Public Health Opportunities to Address the Health Effects of Air Pollution
• APHA Policy Statement 201710: Protecting Children's Environmental Health: A Comprehensive Framework 
• APHA Policy Statement 20157: Public Health Opportunities to Address the Health Effects of Climate Change 
• APHA Policy Statement 20137: Improving Health and Wellness through Access to Nature 
• APHA Policy Statement 201210: Promoting Health Impact Assessment to Achieve Health in All Policies
• APHA Policy Statement 20078: Addressing the Urgent Threat of Global Climate Change to Public Health and the Environment 
• APHA Policy Statement 200412: Support for Community Based Participatory Research in Public Health 
• APHA Policy Statement 20005: Effective Interventions for Reducing Racial and Ethnic Disparities in Health
• APHA Policy Statement 200011: The Precautionary Principle and Children’s Health

Problem Statement
Noise is unwanted and/or harmful sound. It was first recognized as a public health hazard in 1968.[1] In 1972, the Noise Control Act of 1972 was signed into law, declaring that “it is the policy of the United States to promote an environment for all Americans free from noise that jeopardizes their health or welfare.” An amendment to that legislation, the Quiet Communities Act, was enacted in 1978. The United States Environmental Protection Agency (EPA) was given responsibility for coordinating “the programs of all federal agencies relating to noise research and noise control.” The promise of that legislation remains unfulfilled 50 years later.

Noise is defined in this policy statement as “unwanted and/or harmful sound.”[2] This definition amends an earlier definition (“unwanted sound”) that did not reflect the serious health impacts of noise and placed the onus on those who complained rather than on the noise source. Environmental noise is “unwanted and/or harmful outdoor sound created by human activities, including noise from road traffic, railway traffic, airports and industrial sites,” to which the public is exposed involuntarily.[3] Occupational noise is distinct from environmental noise in that it is, by definition, associated with the workplace. Measures to reduce or eliminate noise are the responsibility of employers.[4] Non-occupational noise exposures include noise from consumer products (e.g., personal audio systems, children’s toys, household appliances, power tools, lawn and garden equipment) and leisure and entertainment venues (e.g., restaurants, bars, clubs, concerts, movies, sporting events).

The problem of noise has increased since it was first recognized as a public health hazard. Noise exposure in everyday life is sufficient to cause auditory[5,6] and non-auditory health problems.[7,8] Common sources of harmful noise include but are not limited to the following: transportation; military aircraft and combat operations; noisy recreational vehicles (e.g., motorcycles, snowmobiles); industrial machinery; recreational and leisure activities; social, sports, and entertainment venues; sirens and alarms; outdoor power equipment (e.g., construction, land care); power tools; consumer products (e.g., personal audio systems, children’s toys, household appliances); and, possibly, wind turbines. The risk of adverse health effects starts at low decibel (dB) levels and differs by noise source. For example, the World Health Organization (WHO) environmental noise guidelines for road traffic are no more than 53 dB average levels and 45 dB from aircraft over the course of a day to prevent adverse health effects; average nighttime levels are even lower.[9] Noise levels from many of those sources exceed safe thresholds. For example, a jackhammer is 130 A-weighted decibels (dBA), a jet plane takeoff is 120 dBA, a siren is 110 to 129 dBA, power tools are 90 to 110 dBA, subway noise is 80 to 106 dBA, a hair dryer is 94 dBA, traffic noise is 80 to 85 dBA, restaurants and bars average 81 to 87 dBA, and personal audio system outputs can be as high as 125 dBA.[10,11] Because the decibel scale is logarithmic, recommended exposure times are reduced by half with each 3 dB increase in volume. Therefore, an average exposure of 70 dB for 24 hours is equivalent to 75 dB for eight hours or 85 dB for one hour.[10] In the case of extremely loud noise (e.g., plane takeoffs, jackhammers, fireworks), no exposure duration is safe.[11]

Decades of scientific evidence show that noise causes or contributes to hearing loss (noise-induced hearing loss [NIHL]), annoyance, sleep disruption, cardiovascular disease, metabolic disturbances, and exacerbation of anxiety and depression.[3,7–9,12] It also has adverse impacts on communication, activities, learning, productivity, and quality of life.[3,8,13] The health of more than 100 million Americans is estimated to be at risk.[14]

Hearing loss is the third most common chronic physical condition in the United States, with a prevalence twice that of diabetes or cancer.[15] Approximately 5.2 million children (6–19 years of age) and 26 million adults (20–69 years of age) have hearing damage from excessive noise exposure (i.e., NIHL).[16] In addition to the physical and mental health effects, the costs of hearing loss are considerable. Untreated hearing loss has been shown to increase health care costs by 46%, the incidence of inpatient stays by 47%, and the likelihood of 30-day hospital readmission by 44% over a 10-year period.[17] These findings may be related to consequences that include higher risks of falls,[18] depression, cognitive decline, and dementia.[17] Work productivity losses due to hearing loss are estimated in the hundreds of billions of dollars per year.[19]

Approximately 145 million Americans are at risk of noise-related hypertension, thus increasing the risk of noise-related ischemic heart disease, stroke, and related mortality. Noise-related effects on non-auditory health add considerably to the health and economic burden of noise.[3,20] In Europe, the loss of disability-adjusted life-years attributable to environmental noise is 61,000 from ischemic heart disease, 45,000 from children’s cognitive impairment, 903,000 from sleep disturbance, 22,000 from tinnitus, and 587,000 from annoyance.[3]

A full accounting of noise-related health costs in the United States does not exist, but studies suggest that those costs are considerable. Medical costs for treatment of hearing loss are estimated at $3.3 billion to $12.8 billion annually.[21] Cost estimates of lost productivity due to hearing loss vary widely, from $1.8 billion to $194 billion annually. An analysis by Neitzel and colleagues suggests that those costs may be higher; the authors found that preventing NIHL in just 20% of those potentially affected would save $123 billion in productivity losses.[19] When noise-related hypertension is considered, lowering environmental noise just 5 dB is estimated to reduce the prevalence of hypertension by 1.4% and the prevalence of coronary heart disease by 1.8%, resulting in medical cost savings of $3.9 billion annually.[20] The inclusion of other noise-related health effects, such as ischemic heart disease and mental health disturbances, would increase those cost estimates considerably.

In the United States and internationally, low-income and minority communities are more likely to be exposed to environmental health hazards, placing them at high risk of poor health and performance outcomes.[22,23] As is the case for air-polluting industries and hazardous waste landfills, sources of noise pollution tend to be located in or close to poorer communities. In the United States, nationwide studies show that exposure to road and air traffic noise is highest in minority and low-income neighborhoods[22] and in public schools serving lower-income and minority students.[24] Poorer preexisting health status of residents in these communities may increase their vulnerability to noise exposure and risk of adverse health outcomes. The disparate exposure of these communities is likely to stem from post–World War II decisions to site federal highway and aviation infrastructure near minority neighborhoods.[22,24,25] Other factors may include zoning and land use decisions on roads, industrial sites, and other sources of noise and pollution that favor the wealthy and take advantage of differences in political power defined by race and socioeconomic class.[26,27]

Children and those with autism spectrum disorders, sensory processing disorders, and other conditions may be especially affected.[28,29] Noise has been shown to elevate blood pressure in children,[30] disrupt learning,[31] and contribute to behavioral problems.[32] Children and adults with hearing damage, attention-deficit hyperactivity disorder, autism spectrum disorders, sensory processing disorders, posttraumatic stress disorder, and noise-induced developmental disorders are known to have heightened sensitivity to certain types of noise that can result in problems with mental and physical function.[28]

Despite the breadth and seriousness of its health impacts, noise has not been prioritized as a public health problem for decades. The Office of Noise Abatement and Control (ONAC) was established within the EPA in 1970 and given responsibility under the Noise Control Act of 1972 to fund research, education, product labeling, regulation, and community support. However, funding for the ONAC was terminated in 1981. Since that time, there has been little federal action on noise.[33] No new federal noise regulations or standards have been promulgated by the EPA since 1986. Guidelines are more than 45 years old and need updating. There are still no federal recommendations, guidelines, or standards for non-occupational noise exposures. Uniform definitions, criteria (e.g., validity, enforceability), methods, and metrics for addressing noise are lacking. Noise-related activities are poorly coordinated. Each federal agency may have a different approach. Major efforts around noise, for example the NextGen program of the Federal Aviation Agency (FAA) and the National Academy of Engineering’s publication Technology for a Quieter America, have not been informed by federal health agencies. The Federal Interagency Committee on Aviation Noise — tasked with identifying research and development needs around aviation noise — does not include representatives from federal health agencies.

In the absence of federal infrastructure, state and local governments responsible for regulating noise in areas not preempted by federal law have been slow to act. Many states do not have noise legislation, and, among those that do, some do not enforce the legislation. According to the Noise Pollution Clearinghouse, there is little consistency across states and municipalities with regard to the descriptors, criteria, and methods incorporated in noise legislation.[34,35]

Tools such as health impact assessments, environmental screens, and measures of community health can be useful in evaluating and mitigating the impact of noise on low-income communities and vulnerable populations. However, they do not consistently include noise as an indicator, precluding consideration of noise mitigation.[36] Neither the EPA’s EJScreen, an environmental justice mapping and screening tool,[37] nor California’s CalEnviroScreen[38] includes noise as an environmental indicator. Even when included, consideration of the health impacts of noise may be limited (e.g., to sleep disturbance).[36]

Metrics and methods for evaluating the health effects of environmental noise are also underdeveloped.[31,39] Use of sound pressure levels (in decibels) as the sole measure of health impacts from noise is insufficient. Data on factors such as noise pattern and duration, frequency band distribution, frequency of exposure, and time of exposure that bear on human response are needed. Furthermore, reliance on A-weighted decibels to reflect the impacts of sound involving strong low-frequency components (e.g., aircraft, outdoor power equipment) is widely criticized as inadequate, because A-weighting underrepresents those components and their potential harms.[40–42] The importance of meaningful metrics is well understood by the European Commission, which convened a working group to study and recommend indicators to describe noise from all outdoor sources for the purposes of assessment, mapping, planning, control, and implementation.[43] Metrics other than A-weighted decibels that account for characteristics such as frequency, tonality, and intermittency would allow decision makers to more accurately assess the harmful effects that noise may have on communities.

International guidelines recognize the incontrovertible scientific evidence that noise causes auditory and non-auditory health problems.[7–9,31] In Europe, environmental noise is widely recognized as a public health hazard, and information is made widely available to the public.[3] In the United States, the issue has received far less attention. Information is fragmented and is not readily available. The United States has no federal standards for noise exposure of the public.[44] Standards applicable to workplaces are based on data from the 1970s, are focused on hearing conservation rather than hearing loss prevention, and do not apply to all workers. Many hazardous noise exposures experienced by the public emanate from sources where people are working and where exposures are highest.[45] In the absence of federal standards, safe noise exposure levels published by the EPA in 1974[46] and WHO community guidelines[9] are sources of guidance. Regardless, these levels are routinely ignored, and more than half of all Americans[20] continue to be exposed to harmful levels of noise.[10,14,20,31,47]

Previous calls by the APHA and the American Academy of Nursing to protect the public from the adverse effects of noise have gone largely unheeded.[48] The magnitude and seriousness of noise as a public health hazard warrant action.[40,48] A more assertive and coordinated approach is needed.

Evidence on noise exposure and auditory health: NIHL is caused by irreversible damage to cochlear hair cells and primary auditory neurons.[49] Hearing loss in later life is largely NIHL.[50] While hearing damage can occur from a single exposure to loud noise, it more commonly results from a lifetime of exposure to high-decibel sources such as leaf blowers, car horns, and traffic.[10] Reducing noise exposure is the only means of preventing NIHL.[10] NIHL is the only form of hearing loss that is entirely preventable.

Hearing loss is associated with higher risks of social isolation, depression, and possibly Alzheimer’s, Parkinson’s, and other neurodegenerative diseases, thus amplifying hearing loss–related morbidity and economic burdens.[51,52] A survey of 5,227 older adults in the Chicago area showed that each 10 dBA increase in neighborhood noise was associated with a 36% increase in the risk of mild cognitive impairment and a 29% increase in the risk of Alzheimer’s disease.[51]

The risks of occupational noise exposure have long been known. The National Institute for Occupational Safety and Health (NIOSH) recommended a permissible exposure limit in 1972,[53] but in 1981 the Occupational Safety and Health Administration (OSHA) adopted a less protective standard that has not been updated.[54] The OSHA permissible exposure limit of 90 dBA averaged over an eight-hour shift does not protect workers from hearing loss, let alone the other adverse health effects associated with exposures at much lower levels. Standards applicable to workplaces are based on data from the 1970s; are designed only to conserve hearing, not prevent hearing loss; and do not apply to all workers, including those in agriculture and construction. Moreover, immigrants and people of color are overrepresented in jobs involving a higher risk of injury.[45]

Among occupational exposures, members of all branches of the military are exposed to high noise levels, especially with respect to impulse noise from weapons but also including vehicle, aircraft, and shipboard noise. It is difficult to balance the need for situational awareness in combat situations with the need for hearing protection.[55]

Non-occupational noise exposure causing hearing loss was recognized as an issue in 1966, but the Centers for Disease Control and Prevention (CDC) did not begin work on this problem until 2016.[44] Everyday noise exposure is now known to cause NIHL.[10] As a result, approximately 25% of American adults 20 to 69 years of age have NIHL (defined by audiometric notches), most without significant occupational noise exposure, and 17% to 23% of Americans 12 to 19 years old have hearing loss greater than 15 dB.[44,56] Personal audio systems pose a particular risk for young people due to ubiquitous use at high sound levels several hours a day for several days a week.[10] Hearing loss may have a substantial impact on young people because good hearing is vital for communication, socialization, education, and future vocational success. Of particular concern for communities are the F-35 and F-16 fighter jets that produce noise levels of 115 dB and 94 dB at an altitude of 1,000 feet.[57]

Evidence on noise exposure and non-auditory health: Sleep disruption, annoyance, and stress caused by environmental noise play central roles in the development of clinical disease. These responses set off a cascade of physiological responses involving increases in stress hormone levels, blood pressure, heart rate, and other risk factors that, in turn, raise the risks of stroke, hypertension, ischemic heart disease, myocardial infarction, metabolic disturbances, and related mortality.[7,8,58] Pathophysiological changes associated with noise can result from either daytime or nighttime noise but may be more pronounced with nighttime noise for reasons that are as yet unclear.[59]

Exposure-response studies show that increasing levels of transportation noise raise the risks of myocardial infarction, premature death, stroke, and hypertension.[58] For example, a meta-analysis of road traffic noise studies revealed that each 10 dB increase above 50 dBA increased the relative risk of ischemic heart disease by 8%[12]; other meta-analyses have shown similar results.[58]

Pathophysiological and epidemiological studies suggest that environmental noise is also implicated in metabolic diseases such as diabetes and obesity.[58] Furthermore, research shows that noise exposure substantially increases the risk of anxiety and depression. For example, a German study of 15,010 individuals revealed a direct interrelationship among noise, annoyance, and the prevalence of anxiety and depression, with the highest levels of noise associated with a twofold increase in the prevalence of anxiety and depression.[58]

Evidence on noise, learning, and productivity: Environmental noise can diminish productivity and learning, with annoyance and sleep disruption playing important roles.[31] High ambient noise levels affect speech perception, listening comprehension, short-term memory, reading, and writing.[13] Many studies have shown negative effects of chronic noise on children’s cognitive development, including poorer reading comprehension, memory, and listening skills.[13,31] In a large 10-year cross-sectional study of 6,000 U.S. schools located near the nation’s 46 leading airports (average day/night noise levels of 55 dBA or above), aircraft noise was found to be associated with lower standardized test scores. Installation of sound insulation in 119 of those schools reversed that effect.[60] Many other studies have shown that transportation noise adversely affects both children’s and adults’ learning and performance of complex tasks.[13,31,60] Current understanding of the causal pathway from noise exposure to cognitive, learning, and productivity impacts involves annoyance and sleep disruption.

Evidence-Based Strategies to Address the Problem
As a topic that has essentially lain dormant for 40 years, it is a formidable challenge to bring noise as a public health hazard into public awareness and effectively address its myriad aspects and sources. It will require a strong commitment at the national, state, and local levels, as well as engagement with nonprofit organizations, professional associations, and the public.

A well-funded federal noise control program — led by the EPA or another agency — is necessary to initiate, coordinate, administer, and oversee federal, state, and private sector policies, programs, and projects that can lead to reductions in the burden of noise.[33] Existing legislation needs to be implemented and enforced. The accomplishments of the EPA’s ONAC during the 1970s are grounds for optimism. Examples of what was accomplished during its brief, 10-year tenure include the following: (1) publication of evidence-based guidance on safe levels of noise to protect the health of the public[46] (although published in 1974, this guidance remains useful as a basis for noise control actions in the United States along with the WHO guidelines and NIOSH standards); (2) noise emission regulations on trucks, motorcycles, motorcycle mufflers, and construction equipment, allowing citizen suits against violators and enforcement by the courts; (3) dissemination of information and educational materials on noise and health effects, including even a children’s book; (4) a model community ordinance; (5) the convening of a federal interagency committee on noise; and (6) the Urban Noise Initiative, a multiagency effort that provided for soundproofing schools and hospitals, promoted quiet design features in transportation projects, encouraged noise-sensitive housing development, supported neighborhood efforts to address local noise problems, and provided help to federal, state, and local agencies to buy quiet equipment.

However, it will take more than funding for the United States to build out a 21st-century federal noise control program. While the concepts underlying the Noise Control Act of 1972 and the Quiet Communities Act of 1978 are still relevant today, the science has advanced 40 years and international progress has raised the standard for modern-day programs. The United States would be well advised to consult and seek guidance from international governments (e.g., the European Union) and agencies (e.g., WHO) on revamping a federal noise control program.

The European Union’s approach to environmental noise could serve as a model for the United States. The problems are the same in Europe and the United States (e.g., transportation as a major source of environmental noise, concerns over disparate impacts of noise on vulnerable and disadvantaged groups, and lack of needed standards). The federal-state systems in the European Union and United States are comparable. Environmental Noise Directive 2002/49/EC created a federal framework that aimed to “define a common approach intended to avoid, prevent or reduce on a prioritized basis the harmful effects, including annoyance, due to the exposure to environmental noise.”[61] Its main focus is on transportation (roads, railways, airports) and industrial noise responsible for the vast majority of adverse health effects, but it also covers mandatory and voluntary noise labeling for outdoor equipment and household products, respectively. Consideration is given to quiet spaces in public parks and other areas that may help mitigate effects in noise-sensitive areas. The directive requires member states to monitor and assess the number of people affected by noise throughout Europe; inform and consult with members of the public on noise exposure, its effects, and measures to address it; and address local noise issues through evidence-based action plans to reduce harmful noise and preserve good environmental noise. It does not require member states to legislate noise limits. Member states are required to produce noise maps and evidence-based action plans every five years using the European Union’s uniform set of noise indicators to evaluate exposures around major population areas, roadways, railways, and airports.[62] The European Union and its member states have relied on input from WHO for evidence-based guidelines (community noise, nighttime noise, environmental noise) and analyses (e.g., the Burden of Disease from Environmental Noise report) to inform existing policies and future legislation.[3,9]

This strategic approach has resulted in significant developments including a common method for noise mapping to allow comparison across countries, legislation mandating retrofitting of rail freight fleets with quiet brake blocks, legislation to ensure that airports take measures to mitigate noise, and an increase in the use of quieter electric vehicles.[62] However, much still needs to be done. Overall noise reduction goals set by the European Union and WHO for 2020 have not been met, in part because of the failure of some member states to develop action plans, poor quality of plans, lag time to implement plans, and absence of mandatory thresholds or the means to enforce them. The European Union is contemplating revisions to improve the effectiveness of its strategy, one of which is to align noise and air pollution reduction strategies, where possible, to achieve greater cost-benefit ratios.

Disparate impacts of noise on low-income and minority communities can be addressed in part by focusing noise reduction activities in densely populated urban areas most affected by transportation and industrial noise sources through means such as traffic sound barriers and quiet pavements, as well as improving railways and incentivizing the use of quieter electric vehicles. Federal, state, and local governments and academic institutions should ensure that noise is consistently included as an indicator in health impact assessments, environmental screens, and community health measures to help identify and mitigate adverse effects on disadvantaged and vulnerable communities. Inclusion of noise and air quality indicators in health impact assessments has resulted in modifications of housing and transportation development projects in lower-income areas of Oakland and San Francisco, California, to mitigate harmful effects on low-income communities.[36]

Opposing Arguments/Evidence
In the evidence-based strategies section, a strong federal noise control program was proposed to supply infrastructure and provide state and local governments with technical assistance, as articulated in existing legislation. One argument is that noise is a local problem and states are better suited than the federal government to address it. For example, states and localities are allowed to limit noise emissions on products not regulated by federal law and can regulate the use of products whose noise emissions are regulated by federal law. However, very few states have actually taken such steps. Furthermore, state and local governments do not have the resources to conduct the noise surveillance and research essential to guide development of effective programs at the state and local levels.

Since the defunding of the ONAC in 1981, states and municipalities have had ample time to develop noise abatement and control programs, but there is little evidence to suggest that there have been widespread efforts to regulate noise and fund such programs. As noted in the problem statement, many states and municipalities do not regulate noise, leaving their citizens without legal recourse to stop harmful noise exposures. The defunding of the federal program was a critical factor. Testimony from several state officials describes how, in the absence of a federal program, noise would be deprioritized and state programs defunded, as summarized by the following statement from a staff member of Oregon’s Department of Environmental Quality: “Without a federal program…it became politically expedient to classify noise pollution as a ‘nuisance’ and cancel out programs under the pretext that it was a cost savings measure. Paradoxically, the costs borne by those exposed [to] the airports, highway, railway, and other egregious noise producers, if calculated…are by no means insignificant.”[33] The lack of federal infrastructure made local noise control programs unaffordable for many jurisdictions, and the problem of noise has increased over the years.[40]

Another argument relates to the perception that noise is simply a nuisance and is too expensive to regulate.[33] The problem statement noted that noise was identified as a public health problem more than 50 years ago[1] and summarized the extensive evidence showing its serious impacts on auditory and non-auditory health. Arguing that noise is too expensive to regulate neglects the substantial external costs associated with noise exposures. It is difficult to imagine that the cost of abatement and control programs would be anywhere near the hundreds of billions of dollars incurred each year for noise-related health care and lost productivity.

Action Steps
Noise is ubiquitous and must be recognized as a major public health hazard, one that is largely controllable. A significant body of research, primarily conducted in Europe, has consistently documented the myriad deleterious effects of noise on health. Noise is an environmental justice issue, disproportionately affecting low-income and minority populations (who also experience health inequities). In order to mitigate the public health impact of noise on the American public, it is critical to reestablish a strong federal noise control program that is evidence based and builds on lessons learned in the European Union.

APHA urges

1. The U.S. Congress to:

• Reinstitute EPA funding for the ONAC and/or its mandated activities, as required by the Noise Control Act of 1972 and the Quiet Communities Act of 1978, statutes that are still on the books.
• Stipulate in the 2023 Federal Aviation Administration Re-Authorization Act that exposure to aviation noise must be addressed by the FAA in collaboration with the EPA and health agencies including the CDC.
• Assume leadership in reducing harmful noise and promoting health by providing support to federal agency programs.

2. The federal administration to:

• Ensure that reduction of noise exposures is part of all environmental and health platforms.
• Recognize the disparate noise levels in communities where low-income and minority populations reside as an environmental justice issue.

3. The following actions be taken by relevant federal agencies:

• The EPA (or another agency) should take charge of and reestablish all of the functions mandated in the Noise Control Act and the Quiet Communities Act via the ONAC or other internal mechanisms; create a modern strategic plan for a federal noise control program; coordinate with the National Environmental Justice Advisory Council to address environmental justice issues; update its program to reflect the current status of scientific evidence on the adverse effects of noise; develop and incorporate source-specific, evidence-based guidelines in the development of standards; create uniform metrics and methods to measure and monitor noise; seek the means to encourage states and local governments to implement actions to reduce noise; and coordinate efforts with other federal and international agencies.
• The Department of Labor should work with federal health agencies to adopt more protective standards to address work-related noise exposures, including a lower permissible exposure limit, that apply to workers in all industries.
• The Department of Transportation should increase surveillance and monitoring of noise from existing air and road traffic and work with federal health agencies to ensure best practices for assessments and mitigation; provide funding for noise mitigation in existing areas; develop and implement regulations regarding noise for all new proposed airports and highways, ensuring inclusion of noise in health impact assessments; and engage with local communities on health impact assessments.
• The FAA should reconsider allowable flight concentrations, paths, and hours for all airborne equipment and accelerate adoption of quieter, more fuel-efficient engines.
• The Department of Defense should modify flight paths and hours of operation to mitigate some of the worst impacts on civilians, strengthen the military’s existing hearing conservation programs for service members, make military equipment quieter without sacrificing performance to protect the hearing of service members and the public, and reduce noise exposures experienced by civilians at domestic and foreign bases and in combat operations.
• The Department of Health and Human Services should develop educational materials for health professionals and the public on the deleterious effects of noise on health, promote assessments of noise exposures in guidelines for individual health care, incorporate goals regarding noise exposures in Healthy People, ensure that noise exposures are considered in all efforts to reduce health inequities and environmental injustices and promote noise mitigation efforts, and develop and promulgate recommendations, guidelines, or standards for non-occupational noise exposures.
• The Department of Education should develop and provide educational materials to educators to inform them about noise effects on learning and cognition, provide guidance to state and local governments to aid in mitigating noise in schools, and ensure that standards regarding the location of new schools are utilized, including those involving noise.
• The National Institutes of Health should increase research support for surveillance of environmental noise and its effects on healthy lives lost and disability-adjusted life-years lost in the United States due to noise exposures, develop research-based standards for acceptable levels of environmental noise, and ensure incorporation of noise as a factor in research on health inequities.
• The Department of Housing and Urban Development should develop and promulgate standards for noise exposures in proposed low-income housing, promote noise mitigation actions for existing low-income housing in high-noise areas, evaluate supplementary metrics to A-weighted decibels to better assess and evaluate the health impacts of noise, and engage with local communities on health impact assessments.
• The Consumer Product Safety Commission should work with the EPA to ensure that household appliances and consumer products are assessed in terms of decibel levels and develop standards to promote low levels for products sold in the United States; the agency should also require noise labels for noise-emitting consumer products.
• The National Institute of Standards and Technology should include health impact assessments in its development of standards in order to fulfill its mission of promoting quality of life

4. Actions by state governments to:

• Use federal resources to promote healthy environments (e.g., parks, green spaces), free from deleterious noise, for their citizens.
• Ensure that public health and primary care providers educate the public on the risks of occupational and non-occupational noise exposure and prevention strategies. 
• Ensure that states monitor and implement noise control standards for occupational and environmental noise.
• Implement noise standards for location of schools, ensure that environmental noise is considered prior to building new schools, and ensure that funding is provided for remediation as needed in older schools.
• Use zoning guidelines and noise standards developed by federal agencies to protect disadvantaged populations from excessive noise. 
• Provide guidance to local governments to reduce noise exposures (e.g., model noise ordinances).
• Regulate use and operation of high-noise equipment.

5. Actions by local governments to:

• Promulgate and enforce noise ordinances to control road traffic noise, including noise from vehicle operation and illegally modified exhaust systems.
• Promulgate and enforce ordinances to control neighborhood noise from equipment and households.

6. Actions by nongovernmental agencies and professional societies to:

• Educate health professionals on the risks of noise exposure, the need for assessment of exposures, and prevention strategies.
• Promote education of the public on the health risks of noise exposures and the need for action to reduce noise.
• Influence governmental action at all levels (national, state, and local) to reduce noise exposures as a means of promoting health.

Furthermore, it is recommended that APHA take the leadership in coordinating a campaign with health professionals and health-related organizations to reduce noise exposures and, thereby, the negative effect of noise on health and health inequities. Reductions in noise exposures will also help reduce the nation’s health care costs.

References
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4. Concha-Barrientos M, Campbell-Lendrum DH, Steenland K. Occupational noise: assessing the burden of disease from work-related hearing impairment at national and local levels. Geneva: World Health Organization; 2004.
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6. Neitzel RL, Gershon RRM, McAlexander TP, Magda LA, Pearson JM. Exposures to transit and other sources of noise among New York City residents. Environ Sci Technol. 2012;46(1):500–508. 
7. Münzel T, Schmidt FP, Steven S, Herzog J, Daiber A, Sørensen M. Environmental noise and the cardiovascular system. J Am Coll Cardiol. 2018;71(6):688–697. 
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