Comment: Is the future of Pittslyvania County, VA, cancer, ruin soil, water & Air!
August 13, 1998
Prepared for the International Conference on Children’s Health and the Environment, 11-13 August 1998, Amsterdam
Epidemiology arose primarily out of the study of work place hazards. However, as these hazards encroach more and more on living spaces, we are being pressed to directly assess the effects of workplace hazards on children, and, even on the embryo and fetus. Moreover, the mixture of workplace hazards is often highly specific to the place being studied, and general research (for example, general research such as exposure to one specific chemical through a water pathway) can no longer be undertaken. This means that the classical epidemiological study fails to be relevant on two scores: first, it usually deals with only one hazard at a time, and secondly, it requires large populations, which are seldom available in residential exposure situations. Studying a mobile residential population living near to a toxic waste dump is very different from studying workers who are of a similar age and health status, and who spend some forty hours a week in a very specific industrial environment. An eight- hour workplace exposure allows for a sixteen-hour recovery period away from both the workplace and the exposure. There is no such respite period for a child living in a contaminated residential environment.
Because of the specificity of the mixture of hazards in any one residential area, together with the specificity of the ethnic backgrounds and occupations of the residents, findings in any studies that are undertaken will of necessity be highly site-specific. This means that results are not easily transferred to experiences of other communities, since these new communities will have inevitable differences both in the mixture of hazards and the vulnerability of hosts.
Because of these new complications, it is my opinion that we are on the verge of developing a new medical discipline, which I will tentatively call Community Health Care, and which I see as an expansion of Public Health. It will be important to collect careful Case Studies of Community Diagnoses, Interventions and Outcomes so that commonalties and differences can be analyzed, helpful medical interventions can be assessed and basic theories developed. These Case Studies will provide the input for Preventive Health Action on the community level. My model assumes a community-level parallel to the doctor-patient relationship. The Community Health Care professional will translate the findings of epidemiology into beneficial interventions on the community level to improve the health of the community. These interventions are site specific, and it will take time to develop general principles of care.
Several such Community Health Case Studies are briefly presented here. In no case is there a complete case history including the intervention and outcome results. However, I think that you will be able to follow the deliberate change in attitude which I am proposing, namely, that we no longer consider a community in crisis because of pollution only as an opportunity for studying the health consequences of the exposure and adding to universal epidemiological knowledge. Rather, I am considering the community as patient in need of the epidemiological information gained elsewhere for understanding whether or not its health has been compromised, and whether or not there are remedies which will restore quality of life. Obviously at times both approaches will be legitimate. However, today I will stress the second approach, which has been neglected for too long.
Remember that because this is a new approach, I too am learning!
FIRST CASE STUDY: McCLURE CRESCENT
McClure Crescent is a housing development built on a farm used by the Radium Luminous Industries (RLI), which operated in Toronto in the 1940’s painting radium on dials to make them glow in the dark. They painted the cockpit dials for the bombers in World War II. After the war, RLI was shut down, and the area was used as a disposal site for the radium source, its decay products and contaminated work place materials. The contamination was first identified in 1945 by the Canadian Foreign Exchange Control Board, which had been investigating the RLI for the National Research Council. There was incomplete follow up of the concerns.
The Province of Ontario was warned again about the potentially serious contamination in 1975, and then again in I980, when two Ryerson University Journalism students, tipped off by former RLI workers, brought the problem to public attention. The Housing Subdivision, McClure Crescent, was built by the Ontario Housing Corp., which had not been told about the contamination. Homes on the contaminated land were sold under a Home Ownership Made Easy Lottery in 1973. There were 270 homes allocated through the lottery, most of which were won by young couples just starting their families.
After the 1980 public disclosure, MacLaren Engineers tested the area for the Atomic Energy Control Board (AECB), the Federal Regulatory Agency in Canada. It found one place, behind the homes at 110 and 112 McClure, with gamma radiation levels 50 x normal soil levels (50 mSv), and many other homes with levels 2 – 3 x normal (2 to 3 mSv per year). The AECB agreed to remove 4000 tons of contaminated backyard soil from the area. At the same time, it declared that there was no threat to the health of anyone in the neighborhood. At the time the AECB maximum permissible radiation exposure level was five times normal terrestrial background (5 mSv per year). In 1990, this recommended permissible maximum level was reduced to about one times background (one mSv per year). This means that in 1980, except for the buried radium source, the pollution was legal, and after 1990, although it was still technically legal, the Government had declared its intention to implement the new lower standards, which would make the contamination illegal.
EDA Engineering was brought in by individual families to determine the extent of contamination on their property, and they confirmed the MacLaren findings. The Nuclear chemistry laboratory at the University of Waterloo confirmed that the radium in the soil was about one tenth the concentration found in uranium mine tailings piles, which are considered to be quite dangerous. However, unlike uranium mine tailings, this radioactive debris was in the backyard of homes containing young children.
COMMUNITY DIAGNOSIS: At the request of parents who were worried about possible health effects on their children, IICPH undertook urine analysis for polonium 210, a decay product of radium, and blood counts with differential. Blood changes are known to occur at low level radiation exposure. Uranium or radium that is not excreted from the body, becomes incorporated in bone. Its decay product, radon gas, is able to escape the bone and both radon and its decay products can be excreted in urine. Through chemical and radiochemical techniques, it is possible to test for a decay product of the radon gas, polonium 210, as an indicator of the incorporation of uranium or radium in bone. Each participant also completed a short questionnaire, noting the length of residency, age, sex, ethnicity and relevant socioeconomic information.
URINE ANALYSIS: In the first test, urine samples were collected from about 12 children, and the samples combined. The AECB had refused to have the urine measured at the government laboratory, so IICPH requested measurement at the University of Waterloo laboratory. Dr. Sharma, who did the chemical analysis, combined the samples. He did not expect to find anything, and was surprised to find high gross alpha and beta radiation counts. Because of this positive finding we again collected 24-hour urine samples for three exposed children, one control adult and one control child. The children were designated low or high exposed based on the engineering analysis of their family home property. However, it is acknowledged that children are quite mobile in a neighborhood. The measurements were as follows:
CONTROL ADULT 0.1 (+ or 0.12) pCi per 24 hours
CONTROL CHILD 0.0 (+ or 0.12) pCi per 24 hours
FIRST LOW EXPOSED CHILD 0.17 (+ or 0.12) pCi per 24 hours
SECOND LOW EXPOSED CHILD 0.40 (+ or 0.13) pCi per 24 hours
HIGH EXPOSED CHILD 2.30 (+ or 0.15) pCi per 24 hours
Uranium workers’ levels of Lead 210 in urine is reported in the literature as between 0.47 and 5.0 pCi per sample, with an average of 1.16 pCi per sample. The expected value of lead 210 in urine for an adult non-smoker is 0.05 pCi per sample. In a study undertaken in Elliot Lake for adults, including smokers and non-smokers, researchers found an average of 0.2 pCi per sample of Lead 210. The McClure Crescent children had levels of Lead 210 in urine, which indicated above normal, even comparable to a uranium miner’s exposure to the decay product of radium.
BLOOD COUNT: Fifty-eight children, between ages 5 and 15 years, gave blood samples to the MDS laboratory for Complete Blood Counts and Differentials. The Laboratory handled the blood in the same way for each child’s count. Each child had three tests, done one week apart and the findings in absolute count were averaged for the study. Children with a sore throat, fever or possible cold/flu at the time of testing or within two weeks prior to the testing were eliminated from the study by the MDS professional who took the blood. Exposure level for the child was estimated on the basis of the engineering findings on the child’s home property. Children were divided into two categories, except for the preliminary study of trend with dose, in which case three categories were used.
In the preliminary examination of the data, we separated the exposed group into three categories: those with buried radioactivity on their home property (HIGHER EXPOSURE), those with only surface contamination as determined by the engineering study (MEDIUM EXPOSURE), and those with no contamination on home property, designated LOW EXPOSURE. The average white blood counts for children in the three exposure categories in the preliminary test were:
NORMAL 4,300 TO 10,800 per microlitre of blood
LOW EXPOSURE 7,552 per microlitre of blood
MEDIUM EXPOSURE: 6,409 per microlitre of blood
HIGH EXPOSURE 6,323 per microlitre of blood
An F-test showed that the linear trend with dose was significant (probability of 0.02). The differences were most dramatic for the monocyte, a type of white cell produced by stem cells located in bone marrow. The Lead 210 is stored by the body in bone, and the monocyte stem cells are know to be highly radio-sensitive. The trend with dose for monocyte count was statistically significant by an F- test on the 1 % level (probability 0.006).
AVERAGE MONOCYTE COUNT PER MICROLITRE OF BLOOD:
LOW EXPOSURE 386
MEDIUM EXPOSURE 346
HIGHER EXPOSURE 271
These findings were unaffected when controlled for race, age or ethnicity. Socioeconomic status in the neighborhood was uniform.
Some children had clinically low monocyte counts, below 200 per microlitre of blood. Four children were referred to medical follow up.
There were 24 children on uncontaminated property (called lower exposure) and 34 living on contaminated property (the combined medium and high exposure groups). Our findings of the differences in monocyte counts for unexposed vs exposed children were as follows:
CATEGORY MEASURED Contaminated Property Uncontaminated Property
Number of Children 34 24
Number with at least one low monocyte count 26(76.5%) 10(41.7%)
Number with at least two low monocyte counts 26(76.5%) 10(41.7%)
Number with at least two low monocyte counts 11(32.4%) 2(8.3%)
Number with three low monocyte counts 2(5.9%) None
A zero monocyte count 8(23.5%) None
Total number of observations 101 64
Number of observation monocyte counts <200>1.5 miles from dump. 7 0.087 pCi/sample
All non-smokers in home. 20 0.162 pCi/sample
Smoker(s) in home. 4 0.140 pCi/sample
Missing answer. 10 0.371 pCi/sample
There was no follow up to this study. In fact, the US government opposed the testing of the children and went so far as to; cancel urine testing for the site clean up workers; close the urine analysis laboratory at Argonne National Laboratory (which was doing all of the urine analysis for uranium workers in the US); and, fire the researcher who had been doing the analyses. This action was taken subsequent to the researcher agreement to test the children. This researcher taught Dr. Hari Sharma, a nuclear chemist at the University of Waterloo, Canada, to do the Lead 210 testing so that all of our analyses used his methodology. The findings are therefore comparable with published data on uranium workers in the US.
There was an unusually high number of childhood cancers reported for the Canonsburg community prior to the clean up, but no thorough study of this was done. The dump had been in the neighborhood since about 1910. Dr. Radford, then at the University of Pittsburgh, included the community in a thyroid abnormality and cancer study he was supervising for student researchers at the time. The Canonsburg population showed a higher than expected level of thyroid abnormalities and cancers. (Evelyn O. Talbott et al, Problems in Determining Health Effects of a Community Exposed to Toxic Waste, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh.) However, no distinction was made in this study between those born in the area, and therefore potentially exposed in utero, and those born elsewhere. No mechanism for this effect was given.
THIRD CASE STUDY: BROCK WEST MUNICIPAL WASTE LANDFILL
This municipal landfill, located in a rural area of Pickering, outside of Toronto, was given a Certificate of Approval in April 1973. The area was later developed, and the landfill site is now within 500 meters of homes. According to the original plans, the landfill would be open for five years. However, it was used for more than twenty years and, in 1988 it was reported to be seriously leaking. Plumes were identified moving through Metro Toronto Conservation Authority lands to the Duffins Creek. Area children were known to play near or even in the Creek.
A random sample of residents was chosen to fill out a questionnaire which included socioeconomic information on the family, life-style and hobby questions, detailed information on potential household pollutants, school information, outdoor habits and local area potential hazards. A sub-study was included with one child per household chosen in a systematic way so as to neither over-represent those with medical problems nor to over-emphasize households, which might have indoor pollution problems. Detailed medical and life style information on this representative child was collected.
A trend toward more asthma and more eczema was found with three surrogate levels of exposure to the landfill leachate: 1. Plays in or near the Duffin Creek; 2. Does not play near Duffin Creek, but Mother reports odors from the landfill detected in the home, 3. Neither of these two reported. All questionnaires were filled out by the mothers in the randomly chosen households.
The risk of asthma in children who play in or near the Duffin Creek is twice the asthma risk for children who do not play in or near the Duffin creek. This finding was statistically significant on the 5% level. The risk of eczema of these children was also doubled, and was statistically significant on the 5% level. The intermediate level of exposure had an intermediate rate of asthma and eczema.
This research was also resisted by governments. Because of this resistance, the methodology which had consisted of participatory research using local health professionals and volunteers, was scrutinized by the local University Environmental Health Department. They found a potential bias in collection, since the citizens had tired of keeping records on responses. However, internal checks on the data showed that the data was most likely randomly collected since the randomly designated children had a normal sex ratio. There had been no mandate to assure this outcome.
Although the government did not accept the study, they acted to close the landfill.
OTHER RESEARCH:
The International Institute of Concern for Public Health has undertaken other research on the environmental influence on the health of children, which can be found in publications referenced below. The Wisconsin study of the death rate of low-birth-rate babies seems to indicate that separating infant mortality rate by birth weight category in routine vital statistics reporting would (unfortunately) be helpful in assessing air pollution. Since a baby’s death certificate does not ordinarily contain the birth weight, this would require a simple change of forms.
The research which the Institute undertook in the Marshall Islands, where residents tried to inhabit Islands which had heavy nuclear fallout after the atmospheric tests at Bikini, showed the same monocyte abnormalities noted at McClure Crescent and Canonsburg.
These residents were not in the initial fallout and did not live on the contaminated Island until after the US Government had declared them safe.
A major study of uranium contamination on the Mississauga Reserve in Northern Ontario is unpublished at the request of the Native Band involved in the study. However, requests for copies the study can be made to the Chief, only if the findings will assist other communities struggling with uranium pollution. The Mississauga Reserve is across the highway and down wind from a uranium processing plant. In this investigation, a grid over the reserve was used to determine the pattern of deposition of the uranium dust and isopleths were made to guide the People in locating their homes and vegetable gardens and in choosing areas for picking herbal medicines and sweet grass for their ceremonies.
Studies of the Mississauga Reserve residents for monocyte depletion and uranium in urine were undertaken and indicated residential contamination, which was internal, and especially affecting the children. In this case study the Band used several interventions including:
Moving the children’s daycare centre away from a contaminated area; Substituting distilled water for drinking and cooking purposes in homes for all children. Within three months on the distilled water, the monocytopenia on the Reserve disappeared. The children’s counts had averaged 270 per microlitre blood, and they were raised to an averaged 690 per microlitre of blood. This was more than a substitution for local water, since the main pathways for internal contamination on the Reserve were via air and local produce, not water. Distilled water is known to leach inorganic heavy metals from organic material. This increase is also too large an increase to be attributed solely to a placebo effect.
In another project which the Institute undertook in Bukit Merah, Malaysia, a community exposed to the Asian Rare Earth Co., a subsidiary of the Mitsubishi Company, the primary exposures of the community were to radon gas and thorium, both wastes of the chemical separating process. The 60 children, who were tested for total blood count and differential, had an average monocyte count of 207 per microlitre of blood. The expected average for children would be 325. The range of monocyte counts was 72 to 495, as against the normal 200 to 800 per microlitre of blood. One hundred seventy one (171) children in a neighboring village, Carey Island, were also tested. These children were exposed to a palm oil factory, and agricultural pesticides and herbicides, but not radioactive heavy metals. These children had a lower socioeconomic status than the study group, and their nutritional status was lower. However, their blood counts, and the monocyte count in particular, were normally distributed.
The IPOH High Court in Malaysia closed down the Asian Rare Earth factory for two years, for the cleanup and construction of a waste disposal building. The Bukit Merah children were tested three months after the factory-resumed operations (1987) and then again one year later (1988). The progressive deterioration was astonishing:
Characteristic 1987 1988
of Children tested
60 44
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