Volume 20, Issue 2, 1995 June/July 1995

Striving for Healthy Folks and Fish

Editor's note: Human health issues will be among the topics addressed in breakout sessions at the Biennial Meeting and the Forum on Remedial Action Plans, to be held September 24, 1995 in Duluth, Minnesota. See pages 11-14 for program outline.

Are human health issues buried in the Remedial Action Plan (RAP) process because of their complexity? It might seem that way, given the relatively few RAPs that have addressed the problem. In the Cuyahoga River watershed, which drains into Lake Erie by Cleveland, Ohio, the Human Health Effects Work Group was formed after the Stage 1 RAP (problem identification) document was completed. An International Joint Commission (IJC) review of the Stage 1 report noted the limited health data and the absence of public health professionals in the planning process. The work group started life with a couple of handicaps.

The 14 beneficial use impairments listed in the Great Lakes Water Quality Agreement (see page five of this issue) provide a set of goals and a filing system to collect and organize data coherently. Because RAPs were initiated to address these impairments, all of the ills of natural resources -- from water to wildlife and beaches to birds -- can be categorized and classified, even if boundaries cannot always be clearly drawn.

Not so with human health issues. While some impairments have a relationship to human health, such as beach closings and restrictions on drinking water and fish consumption, the connection between the natural environment and human well-being is no longer as obvious as a typhoid epidemic. The linkages tend to be more subtle, although the major outbreak of illness caused by a waterborne organism in Milwaukee during spring 1993 may have reduced our complacency about that as well. For many, the protection of human health is the primary goal of environmental management. Polls have indicated that people are unwilling to accept even minimal additional risks to human health as a result of environmental degradation.

The first issue the work group wrestled with was how to organize available data and information on human health effects. Lacking IJC guidance and with no apparent experience to draw on from other RAPs, the group explored a number of models. There was no lack of information. Media coverage of human health risks from environmental pollution has increased vastly, ranging from newspapers and magazines to a variety of professional and semi-professional journals. Great Lakes health issues are detailed in IJC documents and those of government agencies. Scientific research and assessment have burgeoned. A recent document on the effects of Great Lakes basin contaminants on health cited 227 references. Human health issues are in the public domain and cannot be ignored if RAP solutions are to have credibility.

The work group finally adapted material developed by the Great Lakes Health Effects Program of Health Canada. This provided the basis for a framework that would allow members to plug in various fragments of the health effects puzzle as they were identified and developed. Eight sections of the framework were devoted to problem identification and a ninth to accommodate Stage 2 RAP analysis (identification of cleanup actions). The challenges posed by the framework were to:

• Identify priority contaminants with known or suspected health effects, including chemical, biological and radiological agents and those posing developmental hazards;
• Assess contributions from all media in the watershed -- water, air, soil, sediment, food and consumer products -- and potential pathways;
• Identify exposed populations and the sensitivity to toxic pollutants of babies and children, the elderly, those with damaged immune systems and the chemically hypersensitive;
• Identify and assess biomarkers of exposure such as reproductive health, behavioral studies, neurological testing in children, neurological dysfunction in adults, hospital discharges, wildlife indicators, PCBs in fish and IJC ecosystem health indicators;
• Develop a strategy to assess the contribution of all media to the intake of contaminants and exposure in humans through tissue levels, blood tests, breast milk and other indicators;
• Characterize exposure and health outcomes through review of epidemiological data, hospital morbidity and mortality and other health databases;
• Assess exposure to multiple contaminants, chemical mixtures and interactions and cumulative effects;
• Pursue risk characterization in the watershed while reviewing the adequacy of standards and limitations in current regulatory data and processes.

The Stage 2 goal is to develop strategies to reduce or eliminate risks to human health from environmental contaminants in the watershed. This simple-sounding objective may be more difficult to resolve than Stage 1 problems. We assume that much of the integration with the rest of the RAP plan will take place in a joint analysis of natural resource and health problems, and that the cleanup measures will be revised accordingly. This will require:

• Reviewing the existing institutional structure protecting human health from hazards;
• Identifying generic strategies to reduce exposure and contaminant levels;
• Identifying and assessing alternatives specific to environmental hazards found in the watershed, including potential problems from limitations in environmental management; and
• Identifying communications strategies to foster understanding and changes in perspective among agencies, the media and the various publics in the watershed.

For more information contact Jim Cowden, Chair of the Cuyahoga RAP Human Health Effects Group, 9315 Glenwood Trail, Brecksville, OH 44141-2505. Telephone and fax (216)838-4176.

Sommaire

La complexité du processus qui régit les Plans d'action correctrice (PAC) fait-elle en sorte que les questions relatives à la santé humaine y sont dissimulées? C'est l'impression que l'on peut avoir si on considère le nombre relativement réduit de PAC portant sur le problème. Dans le bassin hydrographique de la rivière Cuyahoga, qui se déverse dans le lac Érié en passant par Cleveland (Ohio), on a formé le Groupe de travail des effets sur la santé humaine une fois que le document sur l'étape 1 des PAC a été complété. Un examen de la première étape effectué par la Commission mixte internationale a relevé le manque de données sur la santé et l'absence de professionnels de la santé publique participant au processus de planification.

Revised: March 20, 1997
Maintained by Kevin McGunagle, mcgunaglek@ijc.wincom.net