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Health Issues
HEALTH ISSUES AT SUPERFUND SITES Several studies of industrial dumps and contaminated water supplies during the last decade have reported adverse health effects among exposed human populations’. The principal health findings include:
To summarize: Epidemiological studies cannot prove a cause and effect relationship. Nevertheless, available information indicates that hazardous waste dumps can harm and have harmed, humans living nearby. Likewise, contaminated water supplies have harmed people. The problem of waste dumps is continuing to grow. As the National Research Council of the National Academy of Sciences said in 1991, "A limited number of epidemiological studies indicate that increased rates of birth defects, spontaneous abortion, neurologic impairment,, and cancer have occurred in some residential populations exposed to hazardous wastes. We are concerned that other populations at risk might not have been adequately identified." And the Council said, "Millions of tons of hazardous materials are slowly migrating into groundwater in areas where they could pose problems in the future, even though current risks could be negligible." There is a move afoot now in Washington , and.in the mass media, to divert attention away from the problem of toxic wastes. The goal seems to be to cut funding for the federal Superfund program of toxic waste cleanup. It seems clear that such a move, if successful, will result in increased health costs for the American people. Contact:
HEALTH SERVICES TO AFFECTED COMMUNITIES The overriding goal of Superfund is the protection of human health and the environment- Yet the health of those humans most directly impacted are not addressed within the program. The communities may be studied, assessed and analyzed but direct pro-active assistance is not provided. In fact, the only health care that is provided, if provided at all, is through the indirect, uninformed, and haphazard existing health care system. As has been documented many times, poor communities and communities of color which receive a disproportionate number of contaminated sites lack the facilities or economic ability to receive appropriate health care. Inevitably, the discussion about Superfund sites emphasized the benefits to society versus the risk- But, as the studies are demonstrating, none of the benefits go to those communities closest to the sites, while they receive all of the risks. If we are to be serious about wanting to protect human health, we need to institute some programs that address the real needs of these communities. Providing Health care as well as Medical Care In recent years communities living in polluted places have refined "environment" to include everything that impacts their lives (i.e. ,clean water and affordable housing). To begin discussing the health needs of these communities we must clearly define the terms we use. In many settings, the terms "health care" and "medical care" are used interchangeably. To Superfund communities there is a distinct difference between these terms. "Medical care" is only one aspect of "health care" Medical care centers on the diagnosis and treatment of disease after it has developed. It focuses on each disease within the body as a separate event and rarely addresses the person as a whole including the setting within which the person lives. "Health care" on the other hand, permeates all aspects of daily life. It centers on the prevention of illness. Health care is holistic in its approach taking into account all aspects of a persons life that contributes to good health. It includes social elements such as good housing and sanitation, a safe work environment, sufficient income, nutrition and education as well as clean water to drink, clean air to breathe and clean land upon which to live. A healthy community is free from the stress and constant fear of the next explosion or leak at the neighboring facility. Focusing on Health care in these terms brings together the various health providers, which includes - but is not limited to - medical professionals. Included in this model would be social workers, mental health clinicians, school staff, nutritionists, etc. This multi-disciplinary approach allows for coordination of food programs, nutrition programs, well-baby clinics, etc. in an effort to provide all the services necessary for these communities. Medical care - as one aspect, but a critical one - is outside the grasp for many of these contaminated communities. A recommendation by the report, Inconclusive by Design by the Environmental Health Network (EHN) suggests the following: "Congress should establish a system to either provide clinical screening services such as annual physical examinations to communities exposed to toxic releases; or establish a right to medical care for people whose disease are likely to be due to the chemicals to which they were exposed. The presence of exposure to certain chemicals combined with contracting of diseases, which are closely linked, to exposure would trigger the right to care. Examples might include ensuring treatment for bladder cancer for people exposed to betanaphthylamine, and for birth defects or leukemia where there was exposure to tricholorethylene."
Issues of equity have been repeatedly raised in the discussion of Superfund. The majority of contaminated sites are located in communities of color. Poor communities are more at risk due to the long history and number of polluting facilities within their communities. So far, that recognition has not advanced beyond the discussion phase to any significant proposal. In other words, "it's time to put our money where our mouths are". Studies have clearly shown the correlation between higher economic status of people and longevity and good health. In poor communities the lack of good nutrition, poor living conditions, and poor sanitation all contribute to the increased risk that the assault by toxic chemicals adds to the person. Establishing health care centers within these communities could begin to eliminate a portion of the injustices suffered in toxic-exposed communities. Millions of Americans have no medical insurance or access to regular health care. Toxic exposures tend to be the worst in lower income communities of color, where the need for such resources is most acute. In many of the communities, chemical exposures and the lack of available health care together exacerbate the cycle of ill health and financial problems that local residents are unable to escape. This proposal suggests the establishment of a $50 million per year health grant program to fund demonstration projects that provided health services in targeted communities. It would establish an inter-agency, multidisciplinary Board of Directors to include representatives from the appropriate health agencies, other ancillary professionals, and representatives from affected communities. The Board's responsibilities would be to review proposals, select appropriate projects for funding, assist in implementing the proposals and provide oversight to the programs. The grant program would be administered within an appropriate agency with a history of environmental/health service and coordinated efforts with other agencies. The goal would be to bring all agencies providing specific services together in a coordinated manner to deliver the necessary services that truly address the communities needs. Many of these services may already be available locally or through state programs, but are not reaching the population in need. A community submitting a proposal would establish an Advisory Board to oversee the daily operation of the project and to ensure it meets the needs of the community. The Advisory Board may consist of local health professionals, mental health clinicians, educators, etc. but must have a majority membership of local affected community residents. The following are three proposals that illustrate the different ways health services could be implemented to meet the varying needs of different communities. Silver Valley, ID A proposal has been presented to ATSDR for the establishment of a Health Center for the Silver Valley Superfund site. Silver Valley has some of the highest recorded blood lead levels in the nation. The former lead smelter has contaminated 25 square miles of land in Idaho. Their proposal calls for the Health Center to coordinate the various health services in the valley. A trust fund of $5 million would be established to assist the community in dealing with severe lead poisoning. Keeping in mind the impacts of lead poisoning, they suggested that the Health Center would provide a coordinated effort between the school nurse, special education programs, public health programs and nutrition programs. Simply knowing the importance of good nutrition is not enough in the Silver Valley. Due to the high levels of lead on their property, they can not grow a garden in order to obtain fresh produce. And with an unemployment rate of over 25%, few can afford to buy produce. Part of the program would be issuing vouchers for food to assure proper nutrition and hosting farmers markets to bring in fresh, clean produce from outside the contaminated area. The center would host medical experts three times a year for the purpose of examining and updating the health status of the community. It would also be a Lead Clearinghouse for the accumulation of the latest information on lead and heavy metal poisoning. The final component would be a tracking of the health status and response to treatment over time. The clinic would have a Board of Directors with representatives from ATSDR, local physicians and community people. An Advisory Board would be established for the day-to-day operation. It would consist of local affected people like some of the mothers of "leaded" children, retired miners, and local health professionals. (No PRPS). The building to house the center would need three areas: a reception area, waiting room and examination room. It is suggested that one full-time staff person would be needed. Stringfollow Health Monitoring and Education Program The frustrations of being studied and assessed for years without receiving any assistance with health concerns led the community around the Stringfellow Acid pits site to propose the Stringfellow Health Monitoring and Educational Program. The program would have three components: 1) a health clinic 2) a registry of exposed residents and 3) education of local physicians to health impacts from toxic chemicals.
No one to date has established a listing of people that have been exposed to the Stringfellow Acid Pits. This omission has made it impossible to gather any credible information about health impacts from the site or to communicate to people that they have been exposed or update information that could assist them in their health care. A health registry would be established to track exposed people who lived or worked in the affected area over the years. This registry would allow a centralized point for recording changes in health status and incidence of disease. This critical element has been the barrier in our ability to even begin gathering information about the long-term, low level exposure to chemicals.
The health clinic would provide a mechanism for health monitoring for early identification and intervention of diseases. It could provide long-term monitoring with baseline information of affected people. This provides a central location for records of exposed persons allowing for identification of health trends, disease clusters, etc. The Glen Avon community is privileged to have a major medical facility and teaching university nearby. Utilizing this facility for the clinic would be preferred to instituting a new facility. It provides the staffing, expertise and facilities necessary for a successful program. The clinic could also be a centralized clearinghouse for the latest information on chemical exposure to contaminants and a training facility for future physicians likely to encounter chemically exposed persons. The clinic through it residency/inter programs could provide residents with current information about treatments and issues that can advance their health care (e.g.. the need for women exposed to DDT to receive mammograms more frequently than previously believed). The clinic would also share new information with local physicians to keep all medical professionals up to date. The clinic would begin with an initial screening session where specialists (medical toxicologist, neurologists, etc.) would develop an annual medical monitoring protocol based on the types of chemicals found at Stringfellow. This session would begin the registry with participants receiving the health care in return for agreeing to participate in the ongoing registry. Test results would be shared with the person's treating physician with recommendations for further follow-up treatment.
The third area outlined was to educate treating physicians to the health impacts from toxic chemicals. Over and over residents experienced the inability of their treating physicians to recognize or even discuss toxic exposure as a possible cause of their medical problems. [ATSDR claims to be doing this, a closer examination of their process might be helpful.] This educational program would bring together experts on chemical exposure from around the country to conduct workshops for local physicians on the health impacts from toxic chemicals exposure. It would be established in a manner to meet the continuing education requirements in the medical field. [This portion of the program has been completed. Co-sponsored by the California Medical Association and the health Officers Association of California, the symposium was held in 1989.] Tucson, AZ Health Clinic Residents of the south side of Tucson near the Hughes Aircraft Superfund site have received funding for a health clinic - $250,000 from the county and $250,000 from the city. This area of the city is a low-income Latino community with no health care facilities. The clinic would provide direct medical care and coordinate other health services to residents impacted by the TCE water contamination. Their proposal would call for a full-time physician (medical toxicologist or environmental physician) and a nurse practitioner. Beyond medical treatment for this area, the clinic would coordinate health services through the schools, churches and other institutions already in the area. A Governing Board of community members has been selected. They are currently developing eligibility criteria for receiving health care services. This sampling of ideas for health services at Superfund site communities is presented to illustrate possible proposals for funding from the suggested grant program. We welcome your ideas, comments and suggestions.
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