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Month: September 2024

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Toxic Tuesdays

Racial Disparities in PFAS Exposure Through Drinking Water

Toxic Tuesdays

CHEJ highlights several toxic chemicals and the communities fighting to keep their citizens safe from harm.

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Racial Disparities in PFAS Exposure Through Drinking Water

Per- and polyfluoroalkyl substances (PFAS) are a class of chemicals used in many consumer products and industrial processes since the 1950s. Because there isn’t federal regulation of their use or disposal, PFAS are commonly released into the environment. When PFAS are released, people can be exposed to them through air, dust, food, and water, so PFAS exposure is common in the United States. Biomonitoring studies have found that certain species of PFAS are present in the blood of almost all US residents.

Many species of PFAS are known to have adverse health effects on humans including increased cholesterol levels, changes in liver enzymes, decreased vaccine response in children, increased risk of high blood pressure in pregnant women, and decreased birth weight. Epidemiologic studies also show a link between exposure to certain species of PFAS and increased rates of kidney, prostate, and testicular cancer.

While there many ways to be exposed to PFAS, one of the most common is through contaminated drinking water. It is estimated that 200 million people in the US receive PFAS-contaminated drinking water. In 2018 New Jersey became the first state to adopt enforceable standards for PFAS in drinking water. It established maximum contaminant levels (MCLs) – which are the highest amount of a contaminant allowed in drinking water – for three of the most common species of PFAS: perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), and perfluorononanoic acid (PFNA). In April 2024, the US Environmental Protection Agency (EPA) announced the first federal drinking water standards for six PFAS including PFOS, PFOA, and PFNA.

In establishing MCLs for PFAS, New Jersey mandated statewide testing of all Community Water Systems (CWSs, the government-regulated water utilities) in the state. These CWSs tested by New Jersey serve 77% of the statewide population. A recent study used 2019-2021 CWS testing data along with Census data to evaluate if there are demographic differences in PFAS contamination of New Jersey residents’ drinking water. The study calculated quarterly averages for 491 CWs over this time period. It found that PFAS were detected above New Jersey’s MCL in 14% of CWSs, which serve 23% of the population. 

The study also mapped demographic information from census block groups – which are portions of census tracts and generally contain 600-3,000 people – onto the boundaries of each CWS. This created a map where the demographic makeup and quarterly average PFAS concentrations for each CWS were known. 27% of the non-Hispanic white population were served by CWSs with PFAS above New Jersey’s MCL. In contrast, 52% of the Asian population, 38% of the Hispanic population, and 34% of the Black population were served by CWSs with PFAS above New Jersey’s MCL.

These results demonstrate that not only is PFAS contamination prevalent in drinking water in New Jersey, but that there are racial disparities in PFAS contamination by CWS service area. Compared to white populations, Hispanic, Asian, and Black populations are more likely to receive drinking water that has PFAS contamination above the state’s safe threshold. These racial disparities in drinking water quality mirror racial disparities in the US more generally. Historical and ongoing housing discrimination leads to communities of color being excluded from living in certain areas. Throughout the country, pollution-emitting facilities are disproportionately located in nonwhite neighborhoods, driving health and environmental problems that disproportionately affect people of color. Industrial and military facilities that use PFAS and are located in nonwhite neighborhoods may contaminate the water supplying nearby CWSs, which could explain the racial disparities in drinking water discovered in this study.

It is important to note that EPA’s new MCLs for PFAS species are below New Jersey’s MCLs. Complying with these federal standards could reduce racial disparities in PFAS water contamination in New Jersey, but only with robust federal enforcement. People in New Jersey and across the US – especially people of color who have been disproportionately harmed – need enforceable standards and effective enforcement of those standards in order to be safe from PFAS in their drinking water.

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Climate Change and the Impact on Maternal Health

By Leila Waid.

Climate change is already having an enormous impact on our world. All individuals are at risk from the debilitating effects of climate change due to an increase in events such as heat waves, flooding, wildfires, and other natural disasters. However, some individuals are more at risk than others and face higher disparities, such as pregnant women and neonates. 

One of the most significant consequences of climate change already being felt are the overbearing heat waves that roll in summer after summer. And every year, it just seems to get hotter and hotter. In fact, not only does it “seem” to, but it actually does get warmer. In fact, “summer 2024…was the warmest summer on record for the Northern Hemisphere, beating the previous record set in 2023 by .66 degrees Celsius, or 1.19 degrees Fahrenheit.” What will next year bring? What about the next five or ten years? And how will the most vulnerable among us be able to adapt to these changes?

Pregnant individuals and their fetuses are extremely vulnerable to health exhaustion and heat stroke. For example, a study found that exposure to high temperatures during pregnancy was associated with an increased risk of childhood lymphoblastic leukemia. Most alarmingly, the study found that the correlation was strongest during the first trimester – specifically at eight weeks of gestation. At eight weeks of pregnancy many individuals may not even know they are pregnant. Thus, this could potentially lead to higher levels of heat exposure since the pregnant person may not realize that they need to take preventive measures, such as staying hydrated and keeping out of direct sun.

Another study found that exposure to high temperatures during pregnancy was associated with an increased risk of the infant being born low-weight and pre-term. The study also found an association between high-temperature exposure and stillbirth. The risk was most pronounced for women in lower socioeconomic levels, with higher income providing a protective factor against the health risks.

And it is not only the fetus that suffers from exposure to high temperatures, but the pregnant person also faces increased health risks. A study found that heat exposure was associated with a 27% increased risk of severe maternal morbidity (SMM). The study defines SMM as a “near-miss for maternal mortality, referring to severe and unexpected conditions during labor and delivery.” Notedly, the study focused on both short-term and long-term exposure to heat and found that both exposure types were associated with an increase in SMM. These findings suggest that even one exposure to a heat wave could impact a pregnant individual’s health status.

Unfortunately, heat waves are not the only pathway through which climate change harms pregnant women health and well-being. For example, researchers are analyzing the effect that flooding has on pregnancy outcomes. A particular concern, especially in low-and-middle-income countries (LMIC), is how flooding can impede individuals’ ability to access much-needed healthcare services, especially in situations where walking to the healthcare center is the only option – such as in this research study conducted in Zambia. And even if transportation access is usually reliable, resources can still become scarce in emergency situations, with ambulances and medical workers being overwhelmed during flooding events. For example, a study found that pregnant women exposed to extreme floods in South Carolina had increased risk of SMM.

However, even putting aside the practical ways, such as transportation, by which flooding can complicate access to prenatal, labor, and post-natal care needs, there is also the emotional toll that the experience places on the pregnant individual. One study focused on comparing mental health outcomes for women who were pregnant during Hurricane Katrina and women who were not. The researchers found that pregnant people had much higher rates of Post-Traumatic Stress Disorder (PTSD) and depression compared to their non-pregnant counterparts.

As evident, the impact of climate change on pregnant people is multidimensional and compounding. But we are not hopeless or helpless in fighting to address this issue. Advocating for climate change policies is the best way to help address the health inequalities pregnant women face and guarantee they and their children can be healthy and thrive. We must ensure that the next generation is born into a greener, more beautiful world.

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A Compensation Program for First Responders, Cleanup Workers and Others Impacted by the Toxic Cloud Released by the Collapse of the World Trade Center Towers in New York

September 11th
Photo from https://www.loc.gov/pictures/item/2002717279/

By Stephen Lester.

Today marks the 23rd anniversary of the horrific attacks on the United States that resulted in nearly 3,000 deaths and 6,000 injuries when al-Qaida hijackers crashed four jetliners into the twin towers in New York City, the Pentagon and a field in southwest Pennsylvania on Sept. 11, 2001. 

The legacy of the events from that day continues for the first responders, volunteers and nearby residents in New York City who were exposed to the toxic cloud that resulted when the two World Trade Center buildings collapsed. These people were exposed to a mixture of particulate matter and chemical agents, some of which are known human carcinogens or linked to various respiratory illnesses.

To help survivors and first responders involved in the attack, the September 11th Victim Compensation Fund (VCF) was established by the U.S. Department of Justice on Sept. 22, 2001 to provide compensation for individuals who suffered physical injuries or took part in the cleanup efforts in the aftermath of the attacks. The James Zadroga 9/11 Health and Compensation Act of 2010 would later reactivate the VCF and lead to the creation of the CDC’s World Trade Center Health Program (WTCHP) to provide additional medical benefits to victims.

The WTCHP offers medical screening, monitoring, and treatment to 9/11 first responders and survivors with presumptive WTC-related health conditions. The program also covers medically associated conditions that resulted from treatment or progression of WTC-related health conditions. To establish these associated illnesses, the WTCHP’s established a Scientific/ Technical Advisory Committee (STAC) of medical and environmental health specialists who conduct extensive scientific literature reviews to identify health conditions that may be related to the particulates and chemicals present in the toxic cloud. This committee also makes recommendations regarding additions to the program’s eligibility criteria and WTC-Related Health Conditions List. This fund is not only for those who were first responders, but to also for nearby residents and others who were impacted by chemicals in the toxic cloud. 

The main criteria for people to receive assistance through the Victim Compensation Fund are:

  1. Proof certified by a program-affiliated physician of 9/11-related physical injury or condition listed as WTCHP’s eligible presumptive illnesses. Certification indicates that an applicant’s condition is among one of the WTCHP’s presumptive conditions and their exposure to the 9/11 attacks likely caused, aggravated or contributed to that condition.
  2. Proof of presence at one of the attack sites or along debris removal routes during Sept. 11, 2001 through May 30, 2002.
  3. Proof that they belong to an eligible group (first responders and/or survivors).

Importantly, people do not have to show proof that their presence at an attack site or debris removal site caused their illness or injury in order to receive assistance.

The September 11th Victim Compensation Fund (VCF) has been extended to 2090 and plans to continue to secure funding. Officials at the Department of Justice, which runs the program warned in Time magazine in 2019 “that people exposed to the toxins released during the Sept, 11th attacks and their aftermath may not even be experiencing the full health effects yet. For instance, the world Trade Center was known to contain asbestos which causes mesothelioma, a deadly disease that can take decades to appear.” This stark observation has been borne out by researchers at the Mount Sinai World Trade Center Health Program Clinical Center of Excellence at the Mount Sinai School of Medicine who reported 

a 219% increased risk of thyroid cancer, a 41% higher risk of leukemia and a 25% increased risk of prostate cancer for workers involved in the response and cleanup. This study covered 12 years post exposure. Long-term effects are likely to continue well into the future. 

To date, the more than $12.9 billion in financial compensation was been given out through these programs. If you know anyone who was in New York on that day who feels they were exposed to the toxic cloud that engulfed lower Manhattan when the buildings collapsed, ask them to reach out to the September 11th Victim Compensation Fund (VCF). There’s may be an opportunity to be evaluated by medical experts familiar with chemical exposures.  

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Toxic Tuesdays

The Government’s Approach to Evaluating Health Problems in Communities

Toxic Tuesdays

CHEJ highlights several toxic chemicals and the communities fighting to keep their citizens safe from harm.

< Back to Toxic Tuesdays

The Government’s Approach to Evaluating Health Problems in Communities

Communities exposed to toxic chemicals from industrial pollution struggle to get answers about whether the pollution has caused the health problems in their community. Groups organize to pressure the government to stop the pollution and to clean up the contamination. But these agencies have few answers and often little is done. Frequently states ask the Agency for Toxic Substances and Disease Registry (ATSDR) to investigate the health problems reported in a community. Initially, ATSDR is welcomed because people think that someone is finally going to provide some answers about the health problems in the community.

The Agency for Toxic Substances and Disease Registry (ATSDR) was created in 1980 to address health problems at Superfund sites. Their mission is to protect communities from harmful health effects related to exposure to both natural and man-made hazardous substances. ATSDR is the right agency to evaluate health complaints in a community and they have been doing so for more than 30 years. And for most of this time, the agency has repeatedly failed to answer the questions people raise about whether there’s a link between health problems and the pollution in the community. CHEJ has written much about ATSDR over the years1.

Last month an investigative report by the news service Reuters took an extensive look at ATSDR’s work. The report, “How a US health agency became a shield for polluters,” analyzed 428 reports issued by the agency from 2012 to 2023. Those reports contained 1,582 conclusions about potential harms at contaminated sites. Reuters found that in 68% of its findings, the ATSDR declared communities safe from hazards or did not make any determination at all. That record of finding little harm “strains credulity,” said one former EPA official quoted in the report.

Other key findings included:

  • The agency’s frequent declarations of no harm often are rooted in faulty research. At least 38% of the time, agency reports show, its researchers relied on old or flawed data.
  • At least 20 times from 1996 to 2017 the agency declared that a potential hazard posed no health risk – only to be refuted later by other government agencies or the ATSDR itself. The errors impact communities in Alabama, California, Missouri, New York and North Carolina.
  • Despite decades of criticism, the agency continues to publish research that relies upon practices its own review board called “virtually useless.”
  • The agency’s common practice of publishing inconclusive reports feeds a long-standing corporate strategy of using scientific uncertainty to deflect regulation and liability for polluted sites.

How is it possible that ATSDR has operated like this for so long? Some answers come from a symposium hosted by ATSDR in 2012 on the Future of Science at ATSDR2:

“In conducting its core work of assessing health risks at contaminated sites, ATSDR has faced a large workload with limited authority and resources to collect needed data. Moreover, concerned communities have voiced legitimate public health questions that ATSDR could not answer fully with existing scientific tools and knowledge.

This meeting documented many scientific limitations and challenges facing the agency. ATSDR’s Board of Scientific Counselors hired a consultant who reviewed the agency’s scientific work and came to these conclusions and observations:

  • An alarming gap persists between public expectations and the limited tools available to scientists to assess the public health effects of hazardous waste sites and uncontrolled releases. This gap is due, in part, to the inherently complex and uncertain relationship between diseases and chemicals emanating from hazardous waste sites and uncontrolled releases. Many substances commonly found at hazardous waste sites and in uncontrolled releases may also emanate from other sources and are routinely detected at low levels in air, water, food, consumer products, or other media. No field-based methods are readily available for measuring the portion of a particular ambient exposure or internal dose that is attributable to a specific hazardous waste site or uncontrolled release.
  • In the absence of scientific methods for assessing the unique contribution of releases from hazardous waste sites and uncontrolled exposures to disease, ATSDR scientists rely upon surrogate methods and designs (e.g., comparing exposures to disease rates in communities with a hazardous waste site with “background” levels). Such approaches, although squarely within the mainstream of environmental science, typically are not robust enough to detect adverse health effects caused by site-specific exposures to toxic chemicals.
  • EPA and ATSDR scientists calculate theoretical risk estimates based on a host of assumptions about contaminant concentrations, exposure duration, characteristics of the exposed population, acute and long-term health risks and other factors.
  • ATSDR relies predominately on environmental data collected by other agencies (primarily EPA and state agencies) for its health assessments. Such data often are not adequate or appropriate for addressing specific questions about current exposures and pathways.

Without good tools to evaluate the impact of chemical exposures on people, ATSDR, EPA and other government agencies will continue to struggle to address pollution and contamination in communities. It’s time to recognize and to acknowledge that scientists know very little about how exposures to toxic chemicals, especially to low level mixtures, lead to adverse health outcomes.

Instead of trying to link cause and effect (the agencies default approach), which is virtually impossible to achieve because of the inherently complex and uncertain relationship between disease and chemical exposure and the limited tools to evaluate health effects, isn’t it time to consider whether there’s enough information and evidence about exposure and adverse health problems in a community to take action to protect people exposed to toxic chemicals?

Until there is a change in how government approaches health problems in a community, you can expect ATSDR to continue to investigate health problems in communities using the same approach that’s reflected in the Reuters article.

(1)  – CHEJ, Assessing Health Problems in Communities, S, Lester, Updated Jan 2010; CHEJ,  ATSDR: Don’t Ask… Don’t tell… Don’t Pursue, S. Lester, 1994 (available from CHEJ).

(2) ATSDR: The Basics, The Future of Science at ATSDR: A Symposium, Atlanta, GA, April 11-12, 2012 (available from CHEJ).

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“A National Sacrifice Zone” Radioactive Waste Problems In St. Louis

Photo Credit: SCFiasco/Flickr

By Sharon Franklin.

Reporters have found an increased cancer risk for some people who, as children, played in a creek contaminated with uranium waste.  This has caused a grade school to close amid radiation concerns. A landfill operator is spending millions to keep underground smoldering from reaching nuclear waste illegally dumped in the 1970s, according to documents reviewed by The Associated Press.  Both the federal government and companies responsible for nuclear bomb production and atomic waste storage sites in the St. Louis. Missouri area in the mid-20th century were aware of health effects that haunt this region.

Recent articles published by the Associated Press AP “How America’s push for the atomic bomb spawned enduring radioactive waste problems in St. Louis” and  Environmental Health News “A Forgotten Chapter: Downwinders Fight For Recognition and Justice”  highlights the risks, about spills, improperly stored contaminants and other problems that have been often ignored by both the federal government and the polluting companies. 

The government cleanup is complete, but the site is considered permanently damaged and will require oversight into perpetuity. Rather than remove the waste, the government built a 75-foot-tall mound, covered in rock, to serve as a permanent disposal cell for much of the waste. The government said the site is safe, but local residents remain worried, because they live near contamination sites and the uncertainty, because many grew up in the area and weren’t told about the risks for decades.  People in the St. Louis area remain concerned that more illnesses are caused by the contamination and some are pushing for legislation to compensate those who are sick.

Karen Nickel, left, and Dawn Chapman, co-founders of Just Moms STL
Photo Credit: (AP Photo/Jeff Roberson)

Citizen Activists Dawn Chapman and Karen Nickel were so concerned about cancer and other unusual illnesses in their St. Louis County neighborhoods formed Just Moms STL.  Dawn Chapman of the activist group stated they are pushing for cleanup and federal buyouts in an area near the airport.  She said the region “saved our country” with its work on the nuclear program but paid a terrible cost.”  “We are a national sacrifice zone”.