Assessing the Public Assessing the Public Health Impacts of Health Impacts of

Contaminated SitesContaminated Sites

Rick Kreutzer, M.D.Rick Kreutzer, M.D.California Department of California Department of

Health ServicesHealth Services

Environmental HealthEnvironmental Health

Healthy People

Healthy Places

Environmental Health

Environmental Medicine

Society’s Options to Address Society’s Options to Address Public Health Impacts of a Public Health Impacts of a

Contaminated SiteContaminated Site

Prevent such sites from occurringPrevent such sites from occurring

Clean up (i.e., mitigate) sites that Clean up (i.e., mitigate) sites that existexist

Cleaning UpCleaning UpContaminated Sites RequiresContaminated Sites Requires

Creating Environmental quality laws or regulations for sites

Developing procedures to identify sites for assessment

Developing protocols to assess sites and determine clean-up options

Choosing clean-up approach and implement

Establishing definitions of “clean” to determine when clean-up is complete

Overarching need: Resources from responsible parties, taxes and fees, or general fund allocations

Superfund-Comprehensive Superfund-Comprehensive Environmental Response, Environmental Response,

Compensation, and Liability Compensation, and Liability Act (CERCLA) 1980Act (CERCLA) 1980

LocateLocate InvestigateInvestigate Clean upClean up

Placement on the NPL is Placement on the NPL is guided by the Hazard guided by the Hazard Ranking System (HRS)Ranking System (HRS)

A site must be on the A site must be on the National Priorities List (NPL) National Priorities List (NPL) to be subject to CERCLA to be subject to CERCLA action. action.

HRS is calculated fromHRS is calculated from

Whether a site has released or has the Whether a site has released or has the potential to release hazardous substances potential to release hazardous substances into the environment; into the environment;

characteristics of the waste (e.g. toxicity characteristics of the waste (e.g. toxicity and waste quantity); and and waste quantity); and

people or sensitive environments (targets) people or sensitive environments (targets) affected by the release. affected by the release.

Regulatory (USEPA) Activities Regulatory (USEPA) Activities at Superfund Sitesat Superfund Sites

Site characterizationSite characterization Risk AssessmentRisk Assessment Remediation Remediation

Alternatives and their Alternatives and their feasibility feasibility assessmentassessment

Selection of Selection of remediation strategyremediation strategy

Clean upClean up

Number of Superfund Sites Number of Superfund Sites in Californiain California

75

80

85

90

95

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Num

ber o

f NPL

Site

s

Superfund Amendments and Superfund Amendments and Reauthorization Act (SARA) 1986Reauthorization Act (SARA) 1986

Resource Conservation and Recovery Act (RCRA) reauthorization 1984

Agency for Toxic Substances and Disease Registry (ATSDR)

Health Health Assessment Assessment DefinitionDefinition

The evaluation of data and information on The evaluation of data and information on the release of hazardous substances into the release of hazardous substances into the environment in order to: the environment in order to: assess any current or future impact on public assess any current or future impact on public

health, health, develop health advisories or other health develop health advisories or other health

recommendations, and recommendations, and identify studies or actions needed to prevent identify studies or actions needed to prevent

human health effects.human health effects.

Health Assessment v. Risk AssessmentHealth Assessment v. Risk Assessment Identification of Identification of

actual or perceived actual or perceived site-related health site-related health problemsproblems

Recommendations Recommendations for health follow-up for health follow-up activitiesactivities

Recommendations Recommendations to stop or prevent to stop or prevent human exposureshuman exposures

Calculation of Calculation of health risk number health risk number (theoretical)(theoretical)

Establishment of Establishment of site clean-up levelssite clean-up levels

Establishment of Establishment of remediation remediation alternatives listalternatives list

Chemicals in the Environment

Air

Water

Soil

Travel Through…….

Breathing

Eating

Touching

Get into body by…..

Toxicants as Causes of Disease: The General Model

Harmfulness of chemical (toxicity)

Amount of chemical (dose)

Length of exposure to chemical (duration)

HEALTH IMPACT

HOW CHEMICALS CAN AFFECT YOUR BODY

Chemical effects on your body depend on ……

Measured LevelMeasured Level Regulatory Regulatory ActionAction

Assessor ActionAssessor Action

Below Regulatory Below Regulatory numbernumber

Do nothingDo nothing Provide public Provide public information about information about regulations and their regulations and their scientific basisscientific basis

Above regulatory Above regulatory number but below number but below known toxicological known toxicological thresholdthreshold

Require compliance Require compliance with regulation. with regulation. Notify Notify publicpublic

Provide public Provide public information on information on regulations and regulations and toxicologytoxicology

Above toxicological Above toxicological threshold but below threshold but below level of epidemiological level of epidemiological detectiondetection

Require compliance Require compliance with regulations. with regulations. Notify publicNotify public

Provide public Provide public information on information on regulations, toxicology regulations, toxicology and epidemiologyand epidemiology

Above level of Above level of epidemiological epidemiological detectiondetection

Require compliance Require compliance with regulations. with regulations. Notify publicNotify public

Consider a health Consider a health studystudy**

Regulatory Agency and Health Assessor Action Regarding Toxicant Levels

*Must consider how study would be used and its feasibility. Should obtain community and individual informed consent.

Contaminated Site ImpactsContaminated Site Impacts

Physiological/toxicological Physiological/toxicological Psychological Psychological SociologicalSociological EconomicEconomic PoliticalPolitical

Slow Motion Technological Slow Motion Technological Disaster (SMTD)Disaster (SMTD)

Has a slow onset and course, as opposed Has a slow onset and course, as opposed to the sudden nature of most disasters. to the sudden nature of most disasters.

The slow onset leads to a very different The slow onset leads to a very different disaster experience than other types of disaster experience than other types of technological disasters. technological disasters.

Technological disasters are very different Technological disasters are very different than natural disasters due to the fact that than natural disasters due to the fact that the disaster results from some kind of the disaster results from some kind of human failure (accidental or intentional) human failure (accidental or intentional) that could have possibly been avoided. that could have possibly been avoided.

Individual health and community health is affected by more than direct exposure to toxic chemicals associated with these sites. When hazardous materials are discovered to have been on these sites, sometimes for many years, there are a number of psychological and community stressors:

Fear and uncertainty over the possible effects of exposure.

Feeling a loss of control over the present situation and future.

Anger over loss of security and safety within the community.

Confusion over agency roles. Community conflict over who is to blame

and what actions to take.

The long history of these sites and the lengthy political process required to resolve issues, along with uncertainty about exposures and subsequent latent health effects, may lead to social andpolitical turmoil, which in turn leads to more stress.

BrownfieldsBrownfields Brownfields are real Brownfields are real property,property,

Expansion, Expansion, redevelopment, or reuse redevelopment, or reuse may be complicated by may be complicated by the presence or the presence or potential presence of a potential presence of a hazardous substancehazardous substance

Cleaning up and Cleaning up and reinvesting in these reinvesting in these properties takes properties takes development pressures development pressures off of undeveloped, off of undeveloped, open land, and both open land, and both improves and protects improves and protects the environment.the environment.

Brownfields site Brownfields site re-development (St. Louis, MO)re-development (St. Louis, MO)

Brownfields site Brownfields site re-development (Kansas City, re-development (Kansas City,

MO)MO)

Environmental JusticeEnvironmental Justice ““The fair treatment of people of all The fair treatment of people of all

races, cultures, and incomes with races, cultures, and incomes with respect to the development, adoption, respect to the development, adoption, implementation, and enforcement of all implementation, and enforcement of all environmental laws, regulations, and environmental laws, regulations, and policies” policies”

[CA Government Code Section 65040.12(e)][CA Government Code Section 65040.12(e)]

Unequal exposure to hazardous waste sites, compared with an average of 4.94 Unequal exposure to hazardous waste sites, compared with an average of 4.94 sites per square mile for all 368 Massachusetts communities in 2000. sites per square mile for all 368 Massachusetts communities in 2000.

Exposure to hazardous waste sites by race.Exposure to hazardous waste sites by race.

Unequal exposure to hazardous waste sites, compared with an average of 4.94 Unequal exposure to hazardous waste sites, compared with an average of 4.94 sites per square mile for all 368 Massachusetts communities in 2000. sites per square mile for all 368 Massachusetts communities in 2000.

Exposure to hazardous waste sites by class.Exposure to hazardous waste sites by class.

Environmental Justice-further Environmental Justice-further considersconsiders

Cumulative ImpactsCumulative Impacts

Sensitive PopulationsSensitive Populations

Public Health Site Public Health Site Assessment Now IncludesAssessment Now Includes

Place-focused assessment- EPA/CERCLAPlace-focused assessment- EPA/CERCLA People-focused assessment- ATSDRPeople-focused assessment- ATSDR

Physiological/toxicological- CERCLAPhysiological/toxicological- CERCLA Psychological- SMTD’sPsychological- SMTD’s Sociological- SMTD’s, EJSociological- SMTD’s, EJ Economic- Brownfields,Economic- Brownfields, Political- Superfund, Political- Superfund,

Brownfields, Brownfields, EJ EJ