Environmental Epidemiology of the Great Lakes Basin.ppt

1、1,Environmental Epidemiology of the Great Lakes Basin,Industrial Pollution and Human Health August 1999,2,Overview,1. Pollutants 2. Local examples, reaction of public health officials 3. Medical literature: health effects 4. Economics and politics,3,1968,University of WaterlooDr.Bryce Kendrick, Prof

2、essor of Botany University of TorontoDr. Don Chant, Professor of ZoologyPollution Probe,4,1989,Dr. Paul Connett, Professor of Chemistry St. Lawrence University, New York State dioxin chemistWork on Waste USA,5,500 articles on Environmental toxics , 1992 - 1998,Canadian Medical Association Journal JA

3、MA New England Journal of Medicine British Medical Journal The Lancet (others),6,500 Journal articles on Toxics 1992 - 1998,7,Medline computer search: dioxins and human health 1995 -Dec 1998,217 articles in many other journals: e.g.J. Epidemiology and Community Health Early Human Development Environ

4、mental Health Perspectives Chemosphere Am J of Epidemiology,8,Robert Fletcher, M.D. internist, clinical epidemiologist,Prof, Harvard Medical School Founding editor , Journal of General Internal Medicine Editor, Annals of Internal Medicine author, Clinical Epidemiology,9,Robert Fletcher, II,What is y

5、our greatest concern?“Destruction of the good earth by toxins or nuclear waste.” (or simply too many people)The Lancet, Lifeline, Jan 2, l999,10,“Toxics”,I. Any industrial pollutantsII. Chlorinated Organic chemicals, COCs,11,Environmental Epidemiology of the Great Lakes,Human Health Effects of Indus

6、trial Pollutants, Effluents and ToxicsNovember 1998 presentation, Oakville Ontario, to:,12,Canadian Association of Physicians for the Environment,C.A.P.E.,13,Health Canada, l997,“State of Knowledge Report on Environmental Contaminants and Human Health in the Great Lakes Basin”300 pages,14,Arctic Pol

7、lution Issues,Arctic Pollution Issues, A State of the Arctic Environment Report, Arctic Monitoring and Assessment Program, Oslo, l997Highlights of the Canadian Arctic Contaminants Assessment Report, a community reference manual, Northern Contaminants Program, Ottawa, l997,15,Where do contaminants go

8、 in North America?,Great Lakes Basin St. Lawrence RiverRocky Mountains Arctic,16,Cdn J of Public Health Supplement, May/June l998,What on Earth? A National Symposium on Environmental Contaminants and the Implications for Child Health (selected papers)Canadian Institute of Child HealthMay l997, Ottaw

9、a,17,What are the causes of illnesses?,1. Genes2. Environmental factors,18,McGinnis & Foege, DHSS JAMA, Nov 10, l993 “Actual Causes of Death in U.S.”,2 components to the cause of illness:1. Genes2. Environmental factors,19,Genetic factors in illness,Genetic resistance/susceptibility some individuals

10、 more susceptible than others e. g. cancer:tumor suppressor genescancer families,20,Environmental factors in illness (McGinnis, JAMA, 1993),1. Smoking 2. Animal fat 3. Alcohol 4.infectious disease 5. TOXICS exposure 6. Automobiles 7. Firearms 8.drugs,21,Toxics exposure in the Great Lakes Basin?,How

11、many people?36 million,22,How many chemicals are in the Great Lakes?,800 sources: agriculturalindustrialmunicipal,23,How many chemicals,100,000 3,000 in high volume use 95% have incomplete health data 43% have no health data (Bev Thorpe,1999) present in: dirty dozen: Epstein,24,What chemicals? What

12、pollutants?,1. Organic chemicals:a. non chlorinated:methanol, ammonia toluene, benzene, methyl ethyl ketone, ethylene glycol,25,2. Chlorinated/brominated organic chemicals, COCs“Persistent toxic substances” “Persistent organic pollutants, POPs”e.g. pcbs, dioxins, furans,26,Dioxins,27,Barry Commoner

13、2nd Citizens Conference on Dioxin, St. Louis, Missouri, July, l994,“Dioxin and dioxin-like substances represent the most perilous chemical threat to the health and biological integrity of human beings and the environment.”,28,WHO Tolerable Daily Intake Dioxin, Sept l998,1990: 10 picogram/kg for 2378

14、 tet dioxin new epidemiologic data on effects on nervous and endocrine systems new TDI, tolerable daily intake 1 to 4 pg/kg Medical Post,Sept 22, l998,29,Source of Daily Intake,Food90%,30,Dioxin intake: Breast feeding,“In the Great Lakes Basin exposure to TCDD during Breast feeding exceeds the estab

15、lished TDI for this contaminant.”Cdn J of Public Health, May/June l997, from Haines et al, Environ Res, 1998,31,Canadian Breast milk survey,Twenty five Years of Surveillance forContaminants in Human Breast MilkA. G Craan, D. A. Haines, Great Lakes Health Effects Program, Health Canada,Archives of En

16、viron Contam and Toxicology. 35, 702 - 710 (1998),32,Misleading?,“There are indications that dioxin and furan levels in breast milk are decreasing (see Table 4 of the Craan and Haines article.) Further monitoring over the next ten years will be needed to confirm this trend.”D. Haines, personal commu

17、nication, January 29, 1999,33,Daily Intake of Dioxin/furan from Breast milk ( pg/kg bw/day),34,Concentrations of dioxins and furans in Canadian human milk pg/Kg Whole milk,35,1992 estimated daily intake of dioxin from breast milk/formula pg TEQ/Kg body wgt/day,36,WHO TDI Dioxin 1998 1 - 4 (2.5) pg/k

18、g body wgt/day,5 - 6 month Canadian infant taking in 750 ml milk daily:Breast milk: 25 times TDI formula: 5 times,37,Misleading?,“Table 6-5 shows that the mean levels ofd total PCDDs/PCDFs in adipose tissue of Canadians are comparable to those reported for other countries.” Page 65, State of Knowled

19、ge Report on Environmental Contaminants and Human Health in the Great Lakes Basin , Health Canada, 1997,38,Table 6-5,Ryan, 1985, Canadian samples collected in 1976 throughout Canada , post mortem. U.S. samples collected l983-84,NY state Schecter, 1986, Vietnam. Southern areas were sprayed with Agent

20、 Orange while northern areas were not. 1029, 985, 1577, 147 respectively. (see also Sweden, Japan, East Germany,39,Mean levels of PCDDs and PCDFs in Human Adipose Tissue,40,countries,Sweden, 1986, Dsgren (some exposed) New York State, USA , Ryan, 1983 (MVA) Canada, Ryan, 1976, &Teschke, 1992 ( “ ) J

21、apan, 1986, Ono North Vietnam, Schecter, 1986 (no AO) South Vietnam, “ (Agent Orange) Fed Rep Germany, Rappe, 1987 (exposed),41,“comparable”,Levels in Canadians/ NY State residents sampled from accidental death (“unexposed”) victims comparable to: countries where residents were exposed to dioxins,42

22、,What pollutants? II,2. Heavy Metals:Mercury, lead, arsenic, cadmium Copper, zinc(No discussion of health effects),43,What pollutants? III,3. Classic Air PollutantsParticulates (PM 10, PM 50) Ozone Acid Gases (Sox, Nox, HCl) CO,44,What pollutants? IV,4. CO2Global Warming,45,Sources,Industrial proces

23、ses, e.g. petrochemical industry e.g. PVC coal fired power plants automobile engines, (gas, diesel) pulp and paper industry waste incineration (3) cement kilns hazardous waste landfilling, dumping,46,Municipal Solid Waste: backyard barrel burning,PVC plastic significant source of dioxin,47,Incinerat

24、ion of Medical Waste, I,U. S. E. P. A.3rd largest source of Dioxinmajor source of MercuryNorth American environment,48,Incineration of hospital/medical waste, II,Lynn R. Goldman, MD, JAMA, Aug 12,98EPA: assistant administrator for toxic substances 2% of hospital waste needs incineration75% -100% act

25、ual,49,What is the Current toxic load entering the Great Lakes Basin?,Canadian NPRI, (1993) U. S. EPA TRI , (l990)1000 tonnes per weekUS GAO: 5% of total:20,000 tonnes per week,50,What is the Current toxic load entering the Great Lakes Basin?,Great Lakes United, 19972500 tonnes per week (100 truck l

26、oads),51,Provincial Auditor of Ontario 1996,1200 tonnes in Province of Ontario /week(1000 tonnes into the air),52,NAFTA: CEC Toxic Load in North America 1998,1 million tonnes per year,53,54,What are (or could be) the Human Health Effects of Toxics?,1. Proven 2. Speculative/unproven,55,Public health

27、Officials,Concerned citizens ask questions about hazardous chemicals in their communities,56,Public health officials offer Reassurance,The following are some local, provincial, national and international examples,57,Bay of Quinte Hazardous Waste Sites,1. Trenton Norampac: Dombind 2. Aikens Road land

28、fill 3. Zwicks Island Park landfill 4. Meyers Pier coal gasification site, pahs 5. Bakelite plant, phenols 6. Deloro mines: arsenic/radioactivity 7. Rednersville Road , TCE 8. Richmond municipal landfill site, Napanee,58,Other Hazardous Waste Sites,West Lincoln, Ontario (incinerator)East Liverpool,

29、Ohio ( “ )Times Beach, Missouri (dioxin in waste oil dust suppressant) Sydney Mines, Cape Breton Island (PAHs),59,#1,Rednersville, Ontario,60,Rednersville, Ontario, 1990,Illegal hazardous waste site 200 barrels of VOCs: TCE, benzene 1973-1988: 15 years 16 (25) families: contaminated water compare Wo

30、burn, Mass caseMoH Health Study,61,Woburn, Massachusetts 1970 - 1990,Drinking water contamination with TCE 2 local plants: W.R.Grace, Beatrice Foods 12 children died of leukemia (70s) civil action by citizens, EPA action, 1990 $70,000,000 liability, cleanup operation Civil Action, Jonathan Harr,62,R

31、ednersville Health Study, 1990,“no evidence of human health effects”.,63,#2,Zwicks Island landfill, Meiers Pier Belleville, Ontario,64,Zwicks Island Park, Meyers Pier Belleville, l998,Municipal/hazardous waste landfill Creasy engineering Report leaking : PAHs (benzo (a) pyrene), VOCs (chloroform) co

32、mpare NY State and Eurohazcon studiesMunicipal Health study: risk assessment shows elevated cancer risk at Meiers Pier,65,NY State ATSDR June l998: cancerEurohazcon study, Dolk,1998: congenital defects(The Lancet),66,Zwicks Island/Meyers Pier Creasy (Engineering), 1998,Belleville City Council says r

33、eports show the following compounds in the landfill sites:sodium chloride, “table salt”(Belleville Intelligencer)“ammonia” (smelling salts) (Community Press, Dec.24, 98),67,Zwicks Island/Meyers Pier Health Study, 1998,“These places are not unsafe for people.”City Administrator,Belleville Intelligenc

34、er, Nov.3,98,68,#3,Dombind, Eastern Ontario,69,Dombind, 1993 - 98 Hastings/Northumberland/Peterborough Trent River-Moira watershed,Dust suppressant in 90 townships Domtar spent black liquor 50 million litres/yr (6100 tanker trucks) Dioxins, furans, metals, phenols compare Times Beach, MissouriMoH He

35、alth Study (Hukowich):,70,1994, Times Beach, Missouri,2nd Citizens Conference on Dioxin St. Louis/Times Beach 1970s dioxin-contaminated waste oil asdust suppressant on roads,71,Dombind Health Study, 1998,“On the very narrow issue of whether the use of Dombind constitutes a health hazard within the H

36、ealth Protection and Promotion Act, I have concluded that it does not.”Alex Hukowich, MOH, PeterboroughBelleville Intelligencer, Oct 21, l998,72,Norampac Inc, Trenton,Dombind disposal problem consideration underway (1999) for hazardous waste incinerator construction as an alternative to Dombind meth

37、od of disposal of pulp liquor,73,#4,Richmond landfill site, Napanee, Ont,74,Richmond (Napanee) landfill site,2 million tonnes existing Canadian Waste Services application for 750,000 more annual tonnes leachate flow into:Marysville,Sucker Creek thence into Bay of Quinte Committee of Concerned Reside

38、nts Paul Finkle, Stephen Geneja, Residentscommunity press, April 2, 1999,75,#5,Kingston landfill site,76,Kingston landfill case, 1999,Janet Fletcher private prosecution, federal Fisheries Act joined eventually by MoE who initially declined the opportunity guilty finesee 1999 press file,77,#6,Arsenic

39、 leakage into Moira River Deloro, Ontario,78,Deloro, Ontario,Arsenic leakage into river at Deloro 100,000 tonnes of arsenic tailings 10 tonnes per yr leak into Moira R Deloro human health Risk study,1999: no human health effects Moira River Impact study, 1999, screening human health risk assessment

40、under way,79,Deloro hazardous waste site,Spring, 1999 MoE health study urine samples control urines: ?neighbouring community number of people: ?200 MoE toxicologist: likelihood of stat sign findings: low “crackerjack teams of experts in Toronto”,80,#7,Peterborough,Ontario,81,Peterborough, Ontario,Fe

41、asibility hearings for municipal incinerator construction, April 1999,82,#8,Cornwall, Ontario Material resources recovery unit,83,Cornwall, Ontario material resources recovery unit,Public hearings, attended by Ellen and Paul Connett, August 1999 application for permit to burn 30,000 ppm PCBs, curren

42、t permitted for 50 ppm Cornwall/Massena area already heavily contaminated with PCBs,84,Cornwall hazardous waste incinerator,October 1998, began operation PCBs from fluorescent light ballast In the new permit they also want to burn: pharmaceuticals, chloroflurocarbons, electrical equipment, poisonous

43、 and reactive gasses, “controlled substances” and waste oils.,85,Response of Medical Officer of Health,Dr. Bourdeau: 5 county Eastern Ontario Health Unit, quoted the: 1996 Harvard Report on Cancer Prevention (R. Clapp) to explain cancers: 30% from smoking, 30% from obesity and fat and lack of exerci

44、se and 2% from environmental sources. (noted lower male:female birth ratio in Cornwall in passing),86,#9,West Lincoln, Ontario failed proposal of 1980s,87,OWMC hazardous waste facility West Lincoln, Ontario, 1980s,Hazardous waste incinerator 60,000 tonnes per year Joint Board Hearings, Oakville Onta

45、rio 1991 - 1993Health Risk Assessment,88,West Lincoln Risk Assessment,Negligible Cancer risks No Non Cancer health effects“No evidence of significant health effects”,89,Examples from elsewhere in Canada and United States,90,# 1,Sydney Tar Ponds, Nova Scotia,91,Sydney Mines, Cape Breton, NS Tar ponds

46、, 1995,CMAJ, March l5, l995 cokes ovens, steel plants PAHs in tar ponds (700,000 tonnes sediment) Cancer mortality: 25% higher in women, 49% higher in men than provincial averageProvincial Epidemiologist:,92,Sydney tar ponds,Lifestyle factors, namely smoking and poor diet, were said to be responsibl

47、e by public health officials,93,#2,East Liverpool, Ohio hazardous waste incinerator,94,WTI hazardous waste incinerator East Liverpool, Ohio, 1997,Hazardous waste incinerator 200 miles south of Oakville 60,000 to 170,000 tonnes per year EPA hearings, East Liverpool, 1997Dioxin output ? (UNKNOWN)Healt

48、h Risk Assessment, 3500 pages,95,East Liverpool Risk Assessment,Negligible Cancer risk No additional Non Cancer health effects“No evidence of significant health effects”,96,Citizens ask questions about toxic substances in their communities,Public health officials 1. Epidemiology2. Risk Assessment,97

49、,“No evidence of human health risk.”,98,Hamilton, March 1999 EverydayCarcinogens conference,Dr. Richard Schabas head, cancer prevention, CCO keynote speaker did not address the issue of environmental carcinogenscitizen delegation to CCO, July 1999, presentation made to Dr. Ken Shumak,99,Reassurance,Pattern of Denial ?by public health authorities,100,Denial by developers,Royal Group Technologies, Woodbridge “plastic houses” PVC interlocking panels for wall construction filled with cement since 1996,