1. A Public Health Response to Mercury in Fish Suzanne K. Condon, Assistant Commissioner Bureau of Environmental Health Assessment

2. Outline of Presentation ä ä Introduction to mercury in fish and public health intervention. ä ä Issuance of 1994 statewide advisory ä ä Increasing evidence of pollution and health effects ä ä Mass Mercury Reduction Plan - DPH focus on Merrimack Valley ä ä Expanded Statewide Advisory

3. 1986: Sudbury River Advisory ä ä Mercury levels in Sudbury River fish prompts the 1st MDPH advisory. ä ä The general public was advised not to consume any fish from this water body. ä ä The advisory covered the length of the Sudbury River from Ashland, MA to its confluence with the Assabet and Concord Rivers. ä ä Contamination thought to be related to Nyanza Superfund Site.

4. 1994: Statewide Fish Advisory ä ä Pregnant women are advised of the possible health risks from eating fish from Massachusetts freshwater bodies in order to prevent exposure of the developing fetus to mercury. ä ä MDPH continued to recognize the substantial benefits of fish consumption by the general population. ä ä The advisory did not apply to fish stocked in freshwater bodies by Division of Fish and Wildlife.

5. Mercury Studies Faroe Islands Study (1999) ä ä located between Iceland and Scotland. ä ä High dependence on seafood based diet. ä ä Low dose exposure to pregnant women. ä ä Health effects observed in their children. New Zealand Study (1989) ä Seafood based diet. ä Low dose exposure to pregnant women. ä Health effects observed in their children. ä Children exhibited effects years after exposure ended.

6. Mercury: Low Dose Health Effects The fetus is much more sensitive than the adult. Health effects in children include: The fetus is much more sensitive than the adult. Health effects in children include: ä I.Q. deficits ä Delayed developmental milestones ä Impaired motor function ä Attention and behavioral problems ä Decreased visuospatial performance

7. Mercury in Fish in Massachusetts

8. Focus on the Merrimack Valley ä ä Subsistence fishing, especially among immigrant and minority populations. ä ä Focus on subsistence fishers and their families. ä ä Grand Rounds at the Community Health Centers: physicians, nurses, health educators. ä ä Focus group meetings with immigrant and minority residents. ä ä Outreach to local health departments.

9. 2001 Expanded Fish Advisory ä ä Expanded 1994 Statewide Advisory to include women of childbearing age, nursing mothers and children under 12 years old. ä ä Includes marine fish listed in recently released FDA advisory: shark, swordfish, king mackerel, tilefish ä ä Massachusetts advisory includes tuna steak and advice on canned tuna.

13. Planned Follow-up Outreach Activities ä Mailings to community health centers, local health officials and health care providers. ä Coordination with WIC program. ä Grand Round programs at Massachusetts hospitals with a focus on OB/GYN and pediatricians. ä Coordination with various media outlets. ä Various advertising initiatives (e.g. MBTA)