Chemicals Policy, Politics and Public Health Kristen Welker-Hood, RN, DSc MSN Holly Carpenter, RN BSN Anna Gilmore-Hall, RN, BUS, CAE

AGENDA Links between the public’s health and chemicals Need for well-defined chemical policies and laws to protect the public’s health The role of nurses and nursing groups in achieving national chemical policies that address hazards, testing, regulation and incentives for safer alternatives Why these chemicals are so dangerous Current inadequate US laws Review what the EU is doing Proposals that could work What can you do?

A Snapshot of Where Dangerous Chemicals Lurk Home, work and the community

Body Burden: Are We Exposed? Persistent, Bioaccumulative and Toxic Chemicals are ubiquitous 80,000 chemicals registered in the US U.S. CDC 3rd National Report on Human Exposure to Environmental Chemicals Fetal Exposure Studies State Biomonitoring Projects (CA, ME, WA) Are ubiquitous in the ENVIRONMENT AND IN US!!!!! 116 chemicals, 34 pesticides evaluated in urine and blood (70,000 chemicals in commerce) Approx. 9,000 total participants; 2,000 tested for pesticides Sample population weighted slightly towards minority populations perfluorinated compounds in Teflon and stain-resistant products What is our Chemical Trespass? Phthalates, dioxins, PCBs, PBDE (brominated flame retardants), heavy metals, PVC, and perfluorinated compounds.

Health Effects Linked with or Exacerbated by Chemical Exposure Acute toxicity: Immediate illness—asthma, systemic poisoning Respiratory & Cardio Toxicity: Occupational-induced asthma, emphysema, hypertension, angina Cancer: Childhood leukemia, childhood brain tumors, non-Hodgkin’s lymphoma, testicular cancer, breast cancer Neurotoxicity: Parkinson’s disease, heavy metal poisoning, ADHD? Autism? Reproductive toxicity: Sterility, infertility Developmental toxicity: Birth defects, impaired growth and development Endocrine disruption: Birth defects, infertility

Toxic Substance Control Act: The System Is Broken USA regulation for authorizing, screening, and registering “existing” and “new” industrial chemicals Limitations: “Grandfathered” in 62,000 “existing” chemicals when enacted in 1976 No screening or safety data requirements No chemical use tracking capabilities EPA must first prove chemicals pose “unreasonable risk” Confidential Business Information interferes with community and worker Right-to-Know : Industry is left to only report hazards that they are aware of at time of EPA notification Contrary to popular belief, the chemicals that are used in everyday products, or that are generated as a result of their manufacture, are not regulated by the government in a manner similar to prescription drugs. With a few exceptions, we do not require chemicals to meet specific safety standards set by the government, and chemicals are not evaluated by government scientists prior to their being used in (or generated by) the manufacture of products to which we are widely exposed. Instead of requiring a manufacturer to present evidence of a particular chemical's safety, the Toxic Substances Control Act — notorious for its weakness when compared to other environmental laws — requires the government to prove a chemical is harmful before it can take action. Studies by private groups and by the Environmental Protection Agency have estimated that we have publicly available health-effects data for only a small fraction of the chemicals in commerce. Existing chemicals can only be regulated if the chemical presents an “unreasonable risk”; if the benefits of regulation outweigh the costs to the industry and the lost economic and social value; and if the EPA has chosen the least burdensome way to eliminate only the unreasonable risk. (Fletcher, et al., 2005). This policy weighs more heavily a cost benefit standard that favors industry over a health-based decision-making standard that would protect public health. This point is demonstrated in the US Government Accountability Office to Congress on TSCA that reports that since TSCA was enacted the EPA has only required testing on fewer that 200 of the 62,000 chemicals on the original inventory and has only banned five substances. No chemicals have been banned under this statute since 1990 (Government Accountability Office, 2005). An important limitation to TSCA is that chemical manufacturers registering their products on the TSCA Inventory are able to withhold critical ingredient information under a confidential business clause. The manufacturer can claim that certain ingredients are trade secrets and that they are withholding information to stay competitive. This stipulation in TSCA that allows for confidential business information (CBI) withholding interferes with community and worker right-to-know laws. Thus, the ability of the public and workers to adopt preventative behaviors that would limit exposures to hazardous chemicals is thwarted.

Toxins Are a Global Problem… …Requiring a Global Solution

Alternative Vision for Chemicals Close the Data, Safety, Technology Gaps Require safety test data and chemical use information Prove chemical safety before market entry Move towards comprehensive reform Move away from chemical specific campaigns Paradigm Shift: Hazard Assessment not Risk Assessment

The “New” European Union Europe enacted Legislation in June 2007 to tackle 10,000+ chemicals! 25 Nations 450 million people World’s Largest Chemical Industry

The Intended Spirit of REACH: “No Data, No Market” Registration, Evaluation, Authorization and Restriction of Chemicals Companies Bear More Responsibility Data Gaps Filled on Hazards, Uses EU to “Authorize” Chemicals of Concern Market Rewards for Safer Substitutes It also allows the public to request information about the presence of a limited number of hazardous chemicals in products. In the past, companies could sell whichever chemical they liked without providing health and safety information; and hazardous chemicals were only restricted in response to scandal on a case-by-case basis. Major loopholes in REACH will still allow many chemicals that can cause serious health problems, including cancer, birth defects and reproductive illnesses, to continue being used in manufacturing and consumer goods. Further concessions exempt companies which import and manufacture chemicals in volumes below 10 tonnes a year - 60% of chemicals covered by REACH - from the requirement to provide any meaningful safety data. Under REACH, many ‘high-concern’ chemicals will be allowed onto the market if producers claim that they can ‘adequately control’ them. The approach of adequate control – and safe thresholds - is premised on a risky gamble, given the unknown effects of chemicals in combination, on vulnerable hormone functions, and on the development of children from the earliest stages of life.

Louisville Charter Require safer substitutes & solutions Phase out persistent, bioaccumulative or highly toxic chemicals (3,000) Give the public and workers the right to know and participate Act with foresight Require comprehensive safety data for all chemicals Take immediate action to protect communities & workers www.louisvillecharter.org

ANA and Chemicals Policy Nursing Practice, Chemical Exposure and Right-to-Know Resolution 2006 Reduce use of toxic chemicals Educate legislators Educate nurses about hazardous chemicals and workplace exposures Integration of Environmental Health Principles for Nurses Require that less harmful/toxic chemicals be substituted whenever feasible Demand adequate information on the health effects of chemicals before they are introduced on the market “National Campaign for Safe Cosmetics” (http://www.safecosmetics.org/index.cfm) In part, because of the strong need to update and strengthen Right to Know laws, such as OSHA’s Hazard Communication Standard, ANA advocates a national and global course of action to reduce the use of toxic chemicals. To show this support the HOD in 2006 passed the Nursing Practice, Chemical Exposure and Right to Know position statement, Some important parts of this include: Hazardous chemicals substituted with less toxic alternatives, ANA will work with legislators informing them of nursing’s concerns regarding the links between chemical exposures and the public’s health ANA supports research efforts in environmental health ANA will advance initiatives to educate nurses on potentially hazardous chemicals in health care, ANA is in the process of endorsing the National Campaign for Safe Cosmetics, This is a exciting market based campaign aimed at education consumers about their day to day exposures to hazardous chemicals through their personal care product use. Through consumer education is intends to leverage the adoption of safer chemicals in products by asking the health and beauty industry to phase out the use of chemicals linked to cancer, birth defects and other health problems and replace them with safer alternatives.

What can you do to promote chemicals policy reform? Educate yourself and colleagues about chemical hazards Educate legislators Advocate for Environmental Justice Disaster preparedness: chemical security and first receiver training Support protection for children and other vulnerable populations from exposures to toxic chemicals Get involved in your professional organizations Participate in your state’s ANA Environmental Health Task Force

Nursing is the Most Trusted Voice for Health Issues: We Must Advocate for Change! Advocate for the Profession Disaster preparedness & First Receiver Training Be an institution driver for change Adopt safer products in the health care setting Support Labeling and Full Disclosure Advocate for change in our communities Deliver the health message related to hazardous chemicals Educate and ask policy makers to adopt safer chemicals legislation Advocate for Green Chemistry funding and research

Toxic Chemical Reduction Practices Look for these products: Medical devices free of DEHP/PVC Medical devices, immunizations and medications free of mercury Green cleaners Produce free of pesticides Meat and dairy free of growth hormones and non-therapeutic antibiotics Electronics, furniture, etc. that do not contain BFRs (brominated flame retardants) Ensure your healthcare facility is: Following integrated pest management protocol Reducing/eliminating unnecessary fragrances Avoiding use of medical waste incinerators Recycling batteries, plastics, aluminum, glass, paper, OR blue wrap, etc. Reducing hazardous chemicals, replacing them with safer alternatives

For More Information American Nurses Association Holly Carpenter Senior Staff Specialist holly.carpenter@ana.org Physicians for Social Responsibility Kristen Welker-Hood Director of Environment & Health Programs Kwelker-hood@psr.org Health Care Without Harm Anna Gilmore Hall Co-Executive Director of HCWH agilmorehall@hcwh.org