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Public Health Practice and Risk Assessment … Limitations and Opportunities. . Tom Sinks, PhD National Center for Environmental Health - and - Agency for Toxic Substances and Disease Registries Centers for Disease Control and Prevention.

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Public Health Practice and Risk Assessment … Limitations and Opportunities.


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public health practice and risk assessment limitations and opportunities
Public Health Practice and Risk Assessment … Limitations and Opportunities.

Tom Sinks, PhD

National Center for Environmental Health - and -

Agency for Toxic Substances and Disease Registries

Centers for Disease Control and Prevention

what i m going to say
Public health practice blends “evidence-based” and “uncertainty-based” decision making.

When faced with uncertainty, risk assessment is useful for decision making.

The greater the uncertainty the less likely we are to be effective.

Opportunities exist to improve hazard and exposure data; by doing so we will improve the accuracy of risk assessment and the effectiveness of public health practice.

What I’m going to say …
how i m going to say it
Review our mission.

Describe our activities involving risk assessment.

Illustrate challenges for risk assessment in applied public health programs.

Highlight opportunities from applied public health for risk assessors.

How I’m going to say it …
at nceh atsdr we don t regulate your environment we
Prevent asthma and childhood Pb poisoning

Measure chemicals and nutritional biomarkers in people’s blood and urine.

Investigate disease outbreaks and exposures

Improve local/state environmental services

Provide laboratory quality assurance programs

Link environmental and health data

Prepare and respond to urgent threats and disasters.

Protect your health on cruise ships

Provide public health for refugees and displaced people

At NCEH/ATSDR We don’t regulate your environment … We...

N

C

E

H

and we
And we …
  • Identify public health hazards at sites (NPL, Federal facilities, and petitions).
  • Publish Toxicological Profiles, Health Assessments, and Consultations.
  • Provide environmental health education at sites and for clinician education.
  • Establish and maintain registries of people exposed to hazardous substances (NER, tremolite asbestos, WTC).
  • Respond to emergencies from chemical releases.
  • Conduct surveillance on chemical emergencies and releases.
  • Fund Great Lakes and Minority Health research

A

T

S

D

R

slide7

Ensure Widespread Adoption

Develop

and Test

Prevention

Strategies

Identify Risk

and Protective

Factors

Define the

Problem

APublic Health Approachto Prevention

New information

slide8

A PUBLIC HEALTH APPROACH TO PREVENTION

Identify Risk

Factors

Etiologic research

Translation research

Develop

and Test

Prevention

Strategies

Define the

Problem

Ensure Widespread Adoption

Cleveland Municipal Stadium

slide9

Risk

Management

The Risk-Assessment Approach

to Prevention

Risk

Characterization

Exposure

Assessment

Hazard

Identification

New Information

slide10

Public Health Practice and Risk Assessment Have a Common Goal

… health

Cleveland Municipal Stadium

nceh atsdr and risk assessment
NCEH/ATSDR and risk assessment
  • Provide data on hazards, exposures, and dose-response.
  • Use standard risk assessment techniques to establish Minimal Risk Limits (MRLs) and safe exposure values for Chemical Demilitarization.
  • Establish public health guidelines and programs (i.e. Pb Poisoning, emergency response, and health assessments)
exposure assessment in risk assessment
Estimate the extent of exposure in the population or among the population at risk.

Quantify relationship between exposure and hazard (dose-response)

Exposure Assessment in Risk Assessment
slide13
In Risk Assessments, useful studies require quantitative exposure information for comparison across all studies.
slide16

Changes in blood lead levels in U.S. children;

1976-1999 NHANES data

18

16

14

12

G. mean blood lead levels (ug/dL)

10

8

6

4

2.7

2.0

2

0

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

Year

Decline in childhood blood levels after banning leaded gas.

division of toxicology

Listing of Hazardous

Substances

Preparation of

Toxicological Profiles

Initiation of Substance-Specific Research

Division of Toxicology
atsdr interim policy guideline for dioxins in soil
Purpose of serving as a guideline for assessing public health implications of dioxins in residential soils

Includes dioxins, dibenzofurans, dioxin-like PCBs as total TEQs (EPA, 1989)

Published in Toxicology and Industrial Health 13:759-768, 1997

ATSDR Interim Policy Guideline for Dioxins in Soil
50 ppt screening level
Based on Intermediate Minimal Risk Level (MRL) of 1 pg/kg/day for reproductive effects in rats

Used to develop an Environmental Media Evaluation Guide value (EMEG) of 50 ppt (0.05 ppb) in residential soil

50 ppt Screening Level
1 ppb action level
Based on analysis by Kimbrough et al., 1984 of Kociba et al., 1978 rat cancer study

1 ppb considered to be a “level of concern” and recommended as “a reasonable level to begin consideration of action to limit exposure”

1 ppb Action Level
health assessment decision process
If total [soil] TEQ < 50 ppt: no further evaluation

If > 50 ppt, but < 1000 ppt (1 ppb), then evaluate site-specific exposure factors (i.e. bioavailability, ingestion rates, pathway analysis, soil cover)

If > 1000 ppt, then consider potential public health actions (e.g. surveillance, research, health studies, education, exposure investigation)

Health Assessment Decision Process
division of health assessment and consultation
Division of Health Assessment and Consultation

Evaluate releases of a hazardous substance into the environment and determine what actions are needed to reduce exposures.

Health Consultations for

Dioxin Contamination:

City of Midland and the

Tittabawassee River

Floodplain

slide26
Michigan standards on cleanup of dioxin stir fierce debate … Residents split on idea of a big dig. (Tim Martin / Associated Press)

Michigan SENATE BILL No. 1276 … A bill to amend 1994 PA 451, entitled "Natural resources and environmental protection act,“ …(establishing cleanup criteria and approving remedial actions) …

If the hazardous substance is a dioxin, the cleanup criteria shall be the action level provided (by) the agency for toxic substances and disease registry,…

university of michigan dioxin exposure investigation
UM School of Public Health has been funded by Dow Chemical to conduct a dioxin exposure investigation

Objective of the investigation are to identify the factors that contribute to the variability in serum dioxin levels

Study populations (estimated 600-700 total participants):

a. Residents of the floodplain

b. Residents of the affected counties outside the floodplain

c. Residents outside of Saginaw and Midland counties

Each participant will have an exposure interview and serum sample taken

House dust and soil samples to be taken from each residence

University of Michigan Dioxin Exposure Investigation
challenges for risk assessment
Accurate data on exposure and hazard.

Differences between assumptions and reality.

Evaluating risk management strategies.

Expanding one chemical one hazard to multiple chemicals and multiple risks.

Challengesfor Risk Assessment
slide30

Exposure Assessment -

National Report on Human Exposure to Environmental Chemicals

Biomonitoring provides answers …

Who is exposed?

How exposed are they?

If exposure causes disease?

If exposure varies

across populations?

If interventions work?

  • 2003 Report: > 120 chemicals
  • www.cdc.gov/nceh/dls/report
bad exposure information
Bad Exposure information …

Indicates there is no emergency

when an emergency exists.

Indicates there is an emergency

even though there isn’t.

Identifies the wrong priorities.

Fails to identify cause and effect

associations.

assessing people s exposure to methyl mercury from fish consumption
Assessing People’s Exposure to Methyl Mercury from Fish Consumption
  • EPA – 1999 Report
    • 7% women and 19% children above EPA RfD - 5.8 ppb Hg in blood.
  • National Exposure Report
    • 8% of women above EPA RfD
    • Children’s levels are 1/3 those of women
    • No observations above the BMDL
  • Fish are a healthy source of nutrients and proteins.
what i said
Public health practice blends “evidence-based” and “uncertainty-based” decision making.

When faced with uncertainty, risk assessment is useful for decision making.

The greater the uncertainty the less likely we are to be effective.

Opportunities exist to improve hazard and exposure data; by doing so we will improve the accuracy of risk assessment and the effectiveness of public health practice.

What I said …
how environmental exposures lead to human illness
How environmental exposures lead to human illness.

Emission

Source

Environmental

Concentration

Exposure

Environment / Human Interface

Dose

Biological

Effects

Adverse

Outcomes