Hazardous-Waste Sites: Priority Health Conditions and Research Strategies -- United States

Uncontrolled disposal sites containing hazardous waste and other contaminants have created national environmental problems (1). Because of potential health problems associated with the more than 33,000 hazardous-waste sites in the United States, the Agency for Toxic Substances and Disease Registry (ATSDR)--as part of its federally legislated mandate--has developed a list of seven priority health conditions (PHCs)* to 1) assist in evaluating potential health risks to persons living near these sites and 2) determine program and applied human health research activities involving hazardous substances identified at the sites. This report summarizes the development and intended applications of the seven PHCs.

ATSDR was created by the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (as amended by the Superfund Amendments and Reauthorization Act of 1986). The mission of ATSDR is to prevent or mitigate adverse human health effects and diminished quality of life resulting from exposure to hazardous substances in the environment (2). Therefore, ATSDR has initiated medical-evaluation efforts and programs to address site- and substance-specific information needs. These programs include conducting public health assessments of individual hazardous-waste sites and health studies and establishing public health surveillance systems and registries of persons exposed to hazardous substances.

Since 1986, ATSDR has conducted public health assessments for more than 1200 of the nearly 1300 sites identified on the Environmental Protection Agency's National Priorities List (NPL) and has conducted more than 85 health-study activities. In addition, ATSDR has evaluated the chemicals that pose the greatest human health hazards at NPL sites; the list of 275 hazardous substances was based on 1) the frequency with which a chemical was found at NPL sites, 2) the chemical's toxicity, and 3) the likelihood of human exposure to the chemical.

ATSDR used information derived from health studies, public health assessments, and toxicologic profiles to develop a list of seven PHCs--birth defects and reproductive disorders, cancers (selected sites), immune function disorders, kidney dysfunction, liver dysfunction, lung and respiratory diseases, and neurotoxic disorders.

In addition, ATSDR determined that the following research approaches should be used to examine PHCs:

• Evaluation of the occurrence of adverse health effects in specific populations. This includes ecologic epidemiology studies and evaluation of the incidence or prevalence of disease; disease symptoms; self-reported health concerns; and biological markers of disease, susceptibility, or exposure.

• Identification of risk factors for adverse health effects from exposure to hazardous-waste sites. This includes hypothesis-generated cohort or case-control studies of potentially affected populations to identify 1) links between exposures and adverse health effects and 2) risk factors that may be mitigated by prevention actions.

• Development of methods to diagnose adverse health effects. This includes medical research to identify and validate new biological tests to be used to evaluate disease occurrence in potentially affected populations.

• Diagnosis of adverse health effects in persons. This includes clinical-based research to identify and evaluate diagnostic and treatment regimens that may benefit persons who develop adverse health effects resulting from exposure to hazardous substances.

Reported by: Div of Health Studies, Agency for Toxic Substances and Disease Registry.

Editorial Note

Editorial Note: In the United States, approximately 2 million persons live within a 1-mile radius of the nearly 1300 hazardous-waste sites on the NPL. One national health objective for the year 2000 is to eliminate substantial health risks from NPL hazardous-waste sites through clean-up efforts that would eliminate immediate and substantial health threats, based on health assessments (objective 11.14) (3).

To further evaluate health risks for exposed populations, ATSDR will use the seven PHCs to assess the occurrence of adverse health effects and the relation between effects and specific exposures to hazardous substances. In addition, the PHCs should assist public health officials in setting priorities and effectively directing national environmental public health epidemiologic research efforts. Further studies should provide critical information that can be used to reduce the burden of adverse health effects resulting from exposures to hazardous substances.

ATSDR encourages public health, medical, and university-based researchers to address these priority health conditions; the results of such research should enable health professionals to provide health information to persons exposed to hazardous substances or affected by adverse health effects. Additional information about the PHC approach is available from the Division of Health Studies, ATSDR, telephone (404) 639-6200.

References

1. Environmental Protection Agency. Environmental progress and challenges: EPA's update. Washington, DC: Environmental Protection Agency, 1988. EPA publication no. EPA-230/0788-033.

2. Public Health Service. Agency for Toxic Substances and Disease Registry annual report, FY90. Atlanta: US Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry, 1991:1.

3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212. *Broad categories of diseases, disorders, or dysfunctions for which human health studies and chemical-specific research are needed.

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