Barry L. Johnson, Ph.D., F.C.R.
Assistant Surgeon General (ret.)
Department of Environmental and Occupational Health
Rollins School of Public Health
Physicians for Social Responsibility
Environment & Health Program
Superfund, Toxics, Risk and Waste Management Subcommittee
Senate Environment and Public Works Committee
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 publicís 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 publicís 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 publicís 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 publicís 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 Subcommitteeís 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 childrenís 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 childrenís 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 childrenís chronic exposures in southern California areas of air pollution. Approximately 5,500 children in 12 communities were enrolled in the study. The childrenís health status was assessed through questionnaires, pulmonary function testing, and monitoring of school absences. The studyís 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 publicís 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.