1. Assessing the Public Health Impacts of Contaminated Sites Rick Kreutzer, M.D. California Department of Health Services

2. Environmental Health Healthy People Healthy Places Environmental Health Environmental Medicine

3. Society’s Options to Address Public Health Impacts of a Contaminated Site Prevent such sites from occurring Prevent such sites from occurring Clean up (i.e., mitigate) sites that exist Clean up (i.e., mitigate) sites that exist

4. Cleaning Up Contaminated 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

5. Superfund-Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) 1980 Locate Locate Investigate Investigate Clean up Clean up

6. Placement on the NPL is guided by the Hazard Ranking System (HRS) A site must be on the National Priorities List (NPL) to be subject to CERCLA action.

7. HRS is calculated from Whether a site has released or has the potential to release hazardous substances into the environment; Whether a site has released or has the potential to release hazardous substances into the environment; characteristics of the waste (e.g. toxicity and waste quantity); and characteristics of the waste (e.g. toxicity and waste quantity); and people or sensitive environments (targets) affected by the release. people or sensitive environments (targets) affected by the release.

8. Regulatory (USEPA) Activities at Superfund Sites Site characterization Site characterization Risk Assessment Risk Assessment Remediation Alternatives and their feasibility assessment Remediation Alternatives and their feasibility assessment Selection of remediation strategy Selection of remediation strategy Clean up Clean up

9. Number of Superfund Sites in California

11. Superfund Amendments and Reauthorization Act (SARA) 1986 Resource Conservation and Recovery Act (RCRA) reauthorization 1984 Agency for Toxic Substances and Disease Registry (ATSDR)

12. Health Assessment Definition  The evaluation of data and information on the release of hazardous substances into the environment in order to:  assess any current or future impact on public health,  develop health advisories or other health recommendations, and  identify studies or actions needed to prevent human health effects.

13. Health Assessment v. Risk Assessment Identification of actual or perceived site-related health problems Identification of actual or perceived site-related health problems Recommendations for health follow-up activities Recommendations for health follow-up activities Recommendations to stop or prevent human exposures Recommendations to stop or prevent human exposures Calculation of health risk number (theoretical) Calculation of health risk number (theoretical) Establishment of site clean-up levels Establishment of site clean-up levels Establishment of remediation alternatives list Establishment of remediation alternatives list

14. 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 ……

15. Measured Level Regulatory Action Assessor Action Below Regulatory number Do nothing Provide public information about regulations and their scientific basis Above regulatory number but below known toxicological threshold Require compliance with regulation. Notify public Provide public information on regulations and toxicology Above toxicological threshold but below level of epidemiological detection Require compliance with regulations. Notify public Provide public information on regulations, toxicology and epidemiology Above level of epidemiological detection Require compliance with regulations. Notify public Consider a health study* 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.

16. Contaminated Site Impacts Physiological/toxicological Physiological/toxicological Psychological Psychological Sociological Sociological Economic Economic Political Political

17. Slow Motion Technological Disaster (SMTD) Has a slow onset and course, as opposed to the sudden nature of most disasters. Has a slow onset and course, as opposed to the sudden nature of most disasters. The slow onset leads to a very different disaster experience than other types of technological disasters. The slow onset leads to a very different disaster experience than other types of technological disasters. Technological disasters are very different than natural disasters due to the fact that the disaster results from some kind of human failure (accidental or intentional) that could have possibly been avoided. Technological disasters are very different than natural disasters due to the fact that the disaster results from some kind of human failure (accidental or intentional) that could have possibly been avoided.

18. 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.

19. 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 and political turmoil, which in turn leads to more stress.

20. Brownfields Brownfields are real property, Brownfields are real property, Expansion, redevelopment, or reuse may be complicated by the presence or potential presence of a hazardous substance Expansion, redevelopment, or reuse may be complicated by the presence or potential presence of a hazardous substance Cleaning up and reinvesting in these properties takes development pressures off of undeveloped, open land, and both improves and protects the environment. Cleaning up and reinvesting in these properties takes development pressures off of undeveloped, open land, and both improves and protects the environment.

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

22. Brownfields site re-development (Kansas City, MO)

23. Environmental Justice “The fair treatment of people of all races, cultures, and incomes with respect to the development, adoption, implementation, and enforcement of all environmental laws, regulations, and policies” [CA Government Code Section 65040.12(e)] “The fair treatment of people of all races, cultures, and incomes with respect to the development, adoption, implementation, and enforcement of all environmental laws, regulations, and policies” [CA Government Code Section 65040.12(e)]

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

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

26. Environmental Justice-further considers Cumulative Impacts Cumulative Impacts Sensitive Populations Sensitive Populations

27. Public Health Site Assessment Now Includes Place-focused assessment- EPA/CERCLA Place-focused assessment- EPA/CERCLA People-focused assessment- ATSDR People-focused assessment- ATSDR Physiological/toxicological- CERCLA Physiological/toxicological- CERCLA Psychological- SMTD’s Psychological- SMTD’s Sociological- SMTD’s, EJ Sociological- SMTD’s, EJ Economic- Brownfields, Economic- Brownfields, Political- Superfund, Brownfields, EJ Political- Superfund, Brownfields, EJ