Testimony
of
Barry L.
Johnson, Ph.D., F.C.R.
Assistant
Surgeon General (ret.)
Adjunct
Professor
Department
of Environmental and Occupational Health
Rollins
School of Public Health
Emory
University
Atlanta,
Georgia
Representing
Physicians
for Social Responsibility
Environment
& Health Program
Washington,
DC
Before
the
Superfund,
Toxics, Risk and Waste Management Subcommittee
Senate
Environment and Public Works Committee
U.S.
Senate
March
12, 2002
Good morning. I am Barry Johnson,
Ph.D., representing the Environmental and Health Program, Physicians for Social
Responsibility (PSR). PSR has had a long-standing concern about hazards in the
environment and the importance of physician education about them. We welcome
the opportunity to brief the Subcommittee on matters of environmental health.
Prior to my retirement in 1999 as a commissioned officer in the Public Health
Service, I served as Assistant Administrator of the Agency for Toxic Substances
and Disease Registry (ATSDR), which was created under the Superfund Law of
1980. I am currently Adjunct Professor of Public Health, Emory University,
Rollins School of Public Health in Atlanta. I am also Editor-in-Chief, Journal
of Human and Ecological Risk Assessment.
I have previously testified several
times before Congress on matters of hazardous substances in the environment and
their consequences to the public’s health. My testimonies have always been
based on current scientific findings and their implications for human health.
In particular, my testimonies have presented Congress with specific information
about the effects on the public’s health of long-term exposure to contaminants
released from hazardous waste sites and other sources of release. My testimony
today will not depart from previous testimonies. My purpose today is to update
you on recent research findings from several sources. The findings, PSR
believes, are of great import to the public’s health and support the need for
greater actions by government, private industry, and non-government
organizations to reduce the pollution load experienced by the American public.
In previous testimonies to Congress,
I summarized findings about the hazard to human health posed by hazardous waste
sites. In particular, I noted that the body of published epidemiological
research points to an increase in reproductive disorders in children born to
parents who resided near Superfund and similar hazardous waste sites. The
overall pattern of reproductive disorders included birth defects of the heart,
neural tubes, and oral cleft palate, and reduced birthweight has been reported
in several studies. Of note, British investigators, using data from registers
of congenital anomalies in five European countries, reported in 1998 that
residence within 3 km of a landfill was associated with increased risks of
neural tube anomalies, defects of the heart, and anomalies of arteries and
veins. These findings from European investigators are quite similar to findings
from studies of American Superfund and similar sites and suggest that landfills
containing hazardous waste are a general public health concern. The gravity of
the adverse reproductive outcomes from exposure to hazardous substances in the
environment led PSR to develop its Birth Defects & Other Reproductive
Disorders brochure and distribute it to more than 20,000 medical
specialists in obstetrics and family medicine.
More
than 60 studies of communities residing near hazardous waste sites are
summarized in my 1999 book Impact of Hazardous Waste on Human Health. As
an example of the impact of specific Superfund sites, both the Lipari site in
New Jersey and the Love Canal site in New York share a common outcome: during
the period of documented, greatest release of hazardous substances from these
sites, the incidence increased of reduced birthweights of babies born to
parents residing nearest the sites. When the releases were interdicted,
birthweights returned to a normal pattern. This is a noteworthy observation
implying that public health assessment of hazardous waste sites and site
remediation are vital public health actions.
The effects of release of hazardous
substances from hazardous waste sites on cancer rates of communities near the
sites are less clear than for reproductive outcomes. There are some published studies
that show increased rates of cancers of the stomach, gastrointestinal tract,
and urinary bladder, but in my opinion, there is not a current consistent
pattern of association of various cancers with proximity to hazardous waste
sites. As you know, most cancers have a relatively long latency, 20 to 40
years, typically, perhaps contributing to lack of better understanding about
any association between cancer rates and hazardous waste sites. However, the
published work by ATSDR provides a basis for public health concern. Of the 30
hazardous substances most often released from Superfund sites, 18 are known
human carcinogens or are reasonably anticipated to be. This knowledge is of
great import to public health because it points us toward community and physician
education programs and remediation priorities for EPA Superfund site clean-ups
and other actions bearing on protecting the public’s health.
Since 1999, additional studies have
been published in the scientific literature that associate specific health
effects with residential proximity to hazardous waste sites. For example,
British investigators reported small excess risks of congenital anomalies and
low and very low birthweight in populations living near 9,565 landfill sites
operating in Great Britain between 1982 and 1997. The anomalies included small,
elevated risks for neural tube defects, hypospadies, and abdominal wall
defects. In a different investigation,
European researchers studied 245 cases of chromosomal anomalies and 2,412
controls who lived near 23 hazardous waste sites in Europe. This year, the
investigators reported an increase in chromosomal anomalies in persons living
closest to the sites.
These studies from European
investigators add further scientific weight to previous studies that living
near hazardous waste sites is associated with an increased risk of adverse
reproductive outcomes, including birth defects and reduced birthweight babies.
These are matters of serious public health concern and argue for a strong
program of remediation of Superfund and other hazardous waste sites.
At this point in my testimony, I
want to bring some quite recent studies to the Subcommittee’s attention. These studies report serious public health
consequences of air pollution. There are common themes across these studies.
First, these studies have included data on the levels of toxicants in the
environment of the populations studied. Second, these are studies of long-term,
chronic exposure of the populations at risk. Such studies are difficult to conduct
because the exposure levels are generally low, difficult to estimate or
measure, and health outcome data may be hard to obtain. In other words, these
kinds of longitudinal studies that engage both health data and environmental
pollution levels are particularly valuable for public health purposes and for
policies on environmental remediation.
The effect of air pollution on children’s health is a
particularly important subject. Any disease or disability in children reduces
their quality of life and brings expensive health care costs. Knowing the
effects of environmental hazards on children’s health is important because they
are preventable: reduce the level of pollution. In regard to outdoor air
pollution, one major study has reported serious consequences to children who
resided in areas in California with measured levels of air pollutants. In 1992,
the California Air Resources Board commenced a large-scale, long-term study of
the health effects of children’s chronic exposures in southern California areas
of air pollution. Approximately 5,500 children in 12 communities were enrolled
in the study. The children’s health status was assessed through questionnaires,
pulmonary function testing, and monitoring of school absences. The study’s major
findings to date include: correlation between lower lung function and more
intense air pollution; slower lung growth associated with high levels of
nitrogen dioxide and particulate matter (2.5 and 10 micrometers); lower
breathing capacity for girls living in the most polluted communities; and more
evident wheezing in boys exposed to higher levels of nitrogen dioxide and acid
vapor. These findings are obviously of great concern to public health and raise
the obvious question about whether air quality standards for air pollutants are
adequately protective of human health.
Another very recent study, conducted by the American Cancer
Society (ACS) and associated investigators, assessed the association between
long-term exposure to fine particulate air pollution and causes of death. Using
vital status and mortality data collected by the ACS and by administering a
survey questionnaire, risk factor data for approximately 500,000 adults were
linked with air pollution data for metropolitan areas throughout the U.S. The investigators found fine particulate and
sulfur oxide-related air pollution were associated with lung cancer,
cardiopulmonary, and from all causes of death combined. Each 10-microgram/m3
increase in fine particulate air pollution was associated with about a 4%, 6%,
and 8% increased risk of all-cause, cardiopulmonary, and lung cancer mortality.
While the effects
of air pollutants on lungs are, and will remain, significant in terms of the
public’s health, scientific evidence is emerging that air pollutants may exert
an even greater public health burden as a contributor to heart disease.
Particularly alarming is the reported association between very small particles
in air and their contribution to sudden heart failure. As examples of research
findings, researchers examined air pollution levels for the years 1980-1989 in
Milan, Italy, for association with deaths on days of elevated pollution. Among
the findings, a significant association was found for heart-failure deaths (7%
increase/100-micrograms/m3 increase in total suspended particulate
[TSP]). Similarly, another investigator analyzed daily mortality from
nonexternal causes among Philadelphia, Pennsylvania, residents from 1973-1980.
They found that a 100-micrograms/m3 increase in the 48-hr mean level
of TSP was associated with deaths due to cardiovascular disease.
Other
investigators suggest that exposure to fine (i.e., 2.5 micrometer in
diameter or less) particulate matter (PM2.5) decreases heart rate
variability, possibly contributing to myocardial infarction. Although further
research is needed to clarify the association between air pollution and fatal
heart attacks, there is already sufficient data, I believe, to move forward
with public health prevention actions, such as public awareness and physician
education campaigns.