Environmental Epidemiology of the Great Lakes Basin

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 Waterloo • Dr.Bryce Kendrick, Professor of Botany • University of Toronto • Dr. Don Chant, Professor of Zoology • Pollution Probe

4. 1989 • Dr. Paul Connett, Professor of Chemistry St. Lawrence University, New York State • dioxin chemist • Work on Waste USA

5. 500 articles on Environmental toxics , 1992 - 1998 • Canadian Medical Association Journal • JAMA • New England Journal of Medicine • British Medical Journal • The Lancet • (others)

6. 500 Journal articles on Toxics1992 - 1998

7. Medline computer search:dioxins and human health1995 -Dec 1998 • 217 articles in many other journals: e.g. • J. Epidemiology and Community Health • Early Human Development • Environmental 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 your greatest concern? • “Destruction of the good earth by toxins or nuclear waste.” (or simply too many people) TheLancet, Lifeline, Jan 2, l999

10. “Toxics” I. Any industrial pollutants II. Chlorinated Organic chemicals, COC’s

11. Environmental Epidemiology of the Great Lakes Human Health Effects of Industrial Pollutants, Effluents and Toxics November 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 Pollution Issues • Arctic Pollution Issues, A State of the Arctic Environment Report, Arctic Monitoring and Assessment Program, Oslo, l997 • Highlights of the Canadian Arctic Contaminants Assessment Report, a community reference manual, Northern Contaminants Program, Ottawa, l997

15. Where do contaminants goin North America? • Great Lakes Basin • St. Lawrence River • Rocky Mountains • Arctic

16. Cdn J of Public HealthSupplement, May/June l998 • What on Earth? A National Symposium on Environmental Contaminants and the Implications for Child Health (selected papers) • Canadian Institute of Child Health • May l997, Ottawa

17. What are the causes of illnesses? 1. Genes 2. Environmental factors

18. McGinnis & Foege, DHSSJAMA, Nov 10, l993“Actual Causes of Death in U.S.” 2 components to the cause of illness: 1. Genes 2. Environmental factors

19. Genetic factors in illness • Genetic resistance/susceptibility • some individuals more susceptible than others • e. g. cancer: tumor suppressor genes cancer 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 theGreat Lakes Basin? • How many people? 36 million

22. How many chemicals are in the Great Lakes? 800 sources: agricultural industrial municipal

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 pollutants?? 1. Organic chemicals: a. non chlorinated: methanol, ammonia toluene, benzene, methyl ethyl ketone, ethylene glycol

25. 2. Chlorinated/brominated organic chemicals, COC’s “Persistent toxic substances” “Persistent organic pollutants, POPs” e.g. pcb’s, dioxins, furans

26. Dioxins

27. Barry Commoner2nd 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 IntakeDioxin, Sept l998 • 1990: 10 picogram/kg for 2378 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 Food 90%

30. Dioxin intake: Breast feeding “In the Great Lakes Basin exposure to TCDD during Breast feeding exceeds the established 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 for Contaminants in Human Breast Milk • A. G Craan, D. A. Haines, Great Lakes Health Effects Program, Health Canada, • Archives of Environ 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 communication, 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 milkpg/Kg Whole milk

35. 1992 estimated daily intake of dioxin from breast milk/formulapg TEQ/Kg body wgt/day

36. WHO TDI Dioxin 19981 - 4 (2.5) pg/kg body wgt/day • 5 - 6 month Canadian infant taking in 750 ml milk daily: • Breast milk: 25times TDI • formula: 5times

37. Misleading? • “Table 6-5 shows that the mean levels ofd total PCDDs/PCDFs in adipose tissue of Canadians are comparableto those reported for other countries.” Page 65, • State of Knowledge 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 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 ( “ ) • Japan, 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. What pollutants? II 2. Heavy Metals: Mercury, lead, arsenic, cadmium Copper, zinc (No discussion of health effects)

43. What pollutants? III 3. Classic Air Pollutants • Particulates (PM 10, PM 50) • Ozone • Acid Gases (Sox, Nox, HCl) • CO

44. What pollutants? IV 4.CO2 Global Warming

45. Sources • Industrial processes, 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. Incineration of Medical Waste, I • U. S. E. P. A. • 3rd largest source of Dioxin • major source of Mercury • North American environment

48. Incineration of hospital/medical waste, II • Lynn R. Goldman, MD, JAMA, Aug 12,98 • EPA: assistant administrator for toxic substances • 2% of hospital waste needs incineration • 75% -100% actual

49. What is the Current toxic load entering the Great Lakes Basin? • Canadian NPRI, (1993) • U. S. EPA TRI , (l990) • 1000 tonnes per week • US GAO: 5% of total: • 20,000 tonnes per week

50. What is the Current toxic load entering the Great Lakes Basin? Great Lakes United, 1997 2500 tonnes per week (100 truck loads)