Violence: The Connection to Environmental Health and Justice

written by Elise Miller, MEd
Director

Violent events rock families and communities in the U.S. daily. But last week was particularly wrenching as we learned first of two incidents of extrajudicial shootings of black men by police—one in Louisiana, the other in Minnesota—followed by the killing of five police officers by an individual sniper at an otherwise peaceful Black Lives Matter protest in Texas. The complexities and causes of each case may be unique, but at the core is an abiding racism that continues to permeate our country.

Racism is perpetuated in multiple and insidious ways, such as the widening income gap, toxic stress, poor nutrition, lack of access to healthcare and to nature. Another factor intimately interconnected with these, but often overlooked, is exposure to pollutants and other toxic chemicals. We know that being exposed to heavy metals and neurotoxic chemicals can lead to cognitive deficits and developmental delays that in turn have been linked to juvenile delinquency and violent behavior. We know that many kids of color and low-income families are more likely to live in housing stock with lead paint and pipes and close to polluting industries. We know that during pregnancy poorer women are disproportionately exposed to harmful chemicals associated with learning and developmental disorders. We know that working-class parents often have to take the lowest-paying jobs, many of which require regular contact with contaminants linked to cognitive and behavioral problems. We know for most of these families the only food they can afford comes pre-packaged and contains toxic chemicals that can impact neurodevelopment.

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CHE’s Top 10 Environmental Health Stories from Mid 2012

The Collaborative on Health and the Environment initiates a quarterly Top 10 series with this offering of journal articles, news stories, policy recommendations and actions from the last few months.

Given that we all are inundated with dozens of stories—often compelling new science and ideas—every week, if not every day, discerning which ones seem most significant and influential is challenging. This is why we decided to start this service—to help us all figure out which ones seem particularly important to track over time.

Though choosing a “Top 10” is more of an art than a science, we selected these items because we consider them “game-changers” in one way or another: they all have had a significant impact, or are likely to have a significant impact on thinking and action in the field; they’ve changed the conversation on a topic or expanded the scope of the conversation to a new audience or awareness; and/or they are likely to be pivotal in defining a new trend. We have also listed some that reflect a high level of energy and activity in a particular arena. Though the science may still be relatively new or controversial, the level of focus suggests it is worthy of our attention.

We realize articles in addition to the ones we selected could arguably be included. We also may have missed some new publication or story that, in retrospect, will appear to be seminal. We invite comments and look forward to a rich conversation around this.

Finally, we have chosen to focus on stories instead of issues. There are many additional issues of great importance than we could have captured in this brief analysis, but these are the stories we believe are currently making an impact on environmental health thinking and conversations, both for professionals and for the general public.

CHE intends to publish our next quarterly Top 10 in mid January 2013.

Now for this first Top 10, in no particular order:

  1. Chicago Tribune series on flame retardants
    CHE selected this story series because the depth of the investigative reporting was impressive, the conversation as a result of the series was far-reaching (Watchdog Update: Pressure grows for limits on flame retardants), and the repercussions have been significant:

    1. California is reconsidering its 37-year-old regulation on flammability in sofas, easy chairs and baby products in homes (Key agency moves to scrap rules that made toxic flame retardant common in U.S. furniture);
    2. Bipartisan support has emerged for national restrictions on flame retardants (see Changes in chemical safety law getting bipartisan support and Legislators urge ACC to expel firms);
    3. The EPA has promised to look at banning harmful flame retardants (EPA vows investigation of flame retardants, which Tribune investigated and EPA identifies substitutes for toxic flame retardant chemical); and
    4. The Senate passed the Safe Chemicals Act out of committee (Historic vote: oversight of EPA authorities and actions to control exposures to toxic chemicals). Similar bills have been introduced many times over the last dozen years or more, but this is the first time it passed out of committee. While there is no stated connection between the Tribune series and the Senate vote, the news series appeared to elevate general national conversation around chemical regulation, and all of the individuals who testified as part of the Senate hearing specifically mentioned flame retardants in their testimony.
  2. Endocrine-disrupting chemicals and public health protection: a statement of principles from the Endocrine Society
    This position statement from a major medical society guides research and regulation of chemicals that disrupt endocrine function and interfere with the function of other biological systems in the human body. In the paper, the Endocrine Society proposes a simplified definition of an endocrine-disrupting chemical (EDC) as an exogenous chemical or mixture of chemicals that interferes with any aspect of hormone action. The position statement also lays out recommendations for more protective regulation of EDCs including addressing low-dose effects of EDCs.
    Also see

    1. Experts say protocols for identifying endocrine-disrupting chemicals inadequate
    2. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses
    3. International Workshop: Low Dose Effects and Non-Monotonic Dose Responses for Endocrine Active Chemicals: Science to Practice, held in Berlin September 11 – 13, 2012
  3. Fracking
    Heightened attention has been given to scientific studies and news stories in the US and in Europe regarding health and safety concerns around hydraulic fracturing, commonly known as fracking. Of particular concern is the negative repercussions fracking can have on the quality of our drinking and irrigation water, for air and soils, for human health and regarding earthquakes and climate change. See, for example:

    1. Impacts of gas drilling on human and animal health
    2. Polluted water fuels a battle for answers
    3. Nurses promote healthier energy choices
    4. There goes paradise
    5. ‘Fracking’ could get UK approval
    6. Fracking: boom or doom
    7. Fracking poses risk to water systems, research suggests
    8. Unconventional natural gas development and infant health: evidence from Pennsylvania
    9. The fracking of Rachel Carson
    10. Three studies from the European Commission on environmental impacts and risks of energy resources.

    CHE applauds this ongoing discussion, the continued investigation of adverse effects, and the spotlight on public health and safety.

  4. Environmental Justice, led by a series published by Environmental Health news (EHN)
    As Marla Cone, editor-in-chief of Environmental Health News, stated in an interview about the series, the reporters were instructed “to give their stories a strong sense of place and a compelling voice of the people—but also to be well grounded in the science.” As a result, this series is not only piercing and thought-provoking, documenting “the triple whammy of race, poverty and environment converging nationwide to create communities near pollution sources where nobody else wants to live”, but also prescient. Published two months before the Chevron refinery explosion in Richmond, California, the first article quotes a resident of North Richmond: “People still wonder when the next big accident is going to happen.” It happened on August 6th. The community was not taken by surprise, and there are many, many similar communities throughout the country wondering when, how and how much they will be impacted by neighboring factories, refineries, waste dumps, transmission lines and other toxic sites. A related article, Slow and underfunded, EPA program falls short in toxic site cleanups, also addresses many of the same core problems, as applied to brownfields. These quotes from this article sum up CHE’s reason for this selection: “The shortcomings are due to limited funds, a lack of federal oversight, seemingly endless waits for approvals and dense bureaucratic processes that make it difficult for poor and sparsely populated neighborhoods to compete against larger and middle-class communities that have the means to figure them out, an investigation by six nonprofit newsrooms has found… As a result, poor Americans are both more likely to live with polluted sites and less likely to be able to attract a means to turn them around, despite the existence of the brownfields program.”
  5. Studies of transgenerational effects of chemical or nutritional exposures in laboratory animals, in all likelihood acting through heritable epigenetic mechanisms. This is a relatively new field of research that is gaining a lot of traction. The science is still evolving, with many studies needing to be replicated and consensus reached regarding the methodology. However, several recent studies show apparent passing of traits and effects down one or more generation without DNA mutation, such as through heritable DNA methylation changes. Although further research is necessary to confirm these effects in animals, to determine the real-world implications in humans, and to better understand the mechanisms involved, these epigenetic effects provide greater reason for reducing or eliminating toxic environmental exposures in our lives.
    1. High-fat or ethinyl-oestradiol intake during pregnancy increases mammary cancer risk in several generations of offspring
    2. Epigenetic transgenerational inheritance of altered stress responses
    3. Environmentally induced epigenetic transgenerational inheritance of ovarian disease
    4. Transgenerational actions of environmental compounds on reproductive disease and identification of epigenetic biomarkers of ancestral exposures
    5. Gestational exposure to bisphenol A produces transgenerational changes in behaviors and gene expression
    6. Dioxin (TCDD) induces epigenetic transgenerational inheritance of adult onset disease and sperm epimutations
  6. Father’s health and exposures contribute to a child’s health and development
    The idea that the effects of a father’s exposures before or close to the time of conception can affect the health of the child is building evidence, as in this article: Father’s occupation can affect health of newborn. It’s been accepted for decades that the mother’s exposures, health status and environment can affect fetal growth and development, but the idea that a father’s exposures before and around the time of conception may alter the baby’s health and development is much more recent. This study found a correlation between the father’s occupation and birth defects. While not designed to determine a causal relationship, this is a step toward identifying the contributions of the father’s exposures to fetal health. Also see

    1. The study referenced in the article: Paternal occupation and birth defects: findings from the National Birth Defects Prevention Study
    2. Why fathers really matter
    3. Rate of de novo mutations and the importance of father’s age to disease risk and a CHE commentary on this study: Paternal age, de novo mutations and autism risk
  7. American Thyroid Association (ATA) issues policy statement on minimizing radiation exposure from medical, dental diagnostics‎
    While some risks of diagnostic medical radiation exposures have been acknowledged for decades, there has generally been an assumption that the benefits of diagnostic exposures outweigh the risks. New thinking is challenging that assumption. The American Thyroid Association’s policy statement formalizes concern that has been growing about the cumulative risks of exposures and about the increasing use of alternate technologies such as computed tomography, in this case as related to the thyroid gland. “Increased radiation exposure among both children and adults is of primary concern to the ATA because the thyroid gland is among the most susceptible sites of radiation-induced cancer,” said Dr. Elizabeth Pearce, a member of the Board of Directors of the American Thyroid Association. See also the statement: Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology and Medical radiation soars, with risks often overlooked.
  8. CDC updates guidelines for children’s lead exposure
    This change from the Centers for Disease Control and Prevention (CDC) follows several years of advocacy from environmental health researchers. It  is at least the fourth time the CDC has lowered the acceptable blood-lead level since 1975 in response to new evidence that ever-lower exposures continue to harm health and development. The acknowledgement that exposures considerably lower than the previous acceptable level—10 micrograms per deciliter (µg/dL)—cause cognitive impairment and other adverse health outcomes will help alert parents and health professionals that screening and corrective action are necessary. The CDC has now set the reference level at 5 µg/dL and will re-evaluate it every four years. See also New health issues tied to low-level lead exposure, describing evidence that even very low levels of exposure to lead are associated with kidney damage and hypertension in adults and hearing impairment, reduced growth and delayed onset of puberty in children.
  9. ACOG District IX Clinicians’ Guide
    This clinician’s guide is the first document produced by an American Congress of Obstetricians and Gynecologists (ACOG) regional office recommending that physicians screen patients for environmental exposures, provide anticipatory guidance on risk reduction, and become involved in health policy. CHE views having a major medical society regional office, especially a society focused on pregnant women and infant development, formally recommend environmental health screenings is a tremendous step forward.
  10.  Preventing dementia: two new lines of research
    Combined, these new approaches represent a sea change from past years that there was nothing individuals could do to prevent dementia.

    1. Exercise and dementia: four new studies
      Quite a number of recent studies show that exercise can affect cognitive function late in life. From first assuming that there was no way to prevent dementia, we came to think that exercising your brain will keep it fit. Now evidence shows that exercising your body may also keep your brain fit. This is a breakthrough for improving quality of life for seniors and their families.
    2. Insulin resistance and Alzheimer’s disease
      See, for example, Can Alzheimer disease be a form of type 3 diabetes?, Link between metabolic disorders and Alzheimer’s disease examined, Link between brain insulin resistance, neuronal stress in worsening Alzheimer’s disease and a collection of journal articles from the Journal of Alzheimer’s Disease, plus a study showing a link between glucose control and dementia (but not necessarily Alzheimer’s): Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. All these studies add to the conversations about Alzheimer’s and dementia an understanding of the role of food, nutrition and insulin in cognitive well being. If insulin resistance does play a role in Alzheimer’s, further possibilities for preventive action and treatment may be possible, since insulin resistance can be influenced by nutrition, obesity, environmental chemical exposures, exercise and more.

The Science Behind Unconventional Connections

What do contaminants in cord blood and climate change have in common? One answer: fossil fuels. Last week, a study published in Environmental Science and Technology showed how 87 commonly found chemicals pass efficiently from mother to fetus during pregnancy, and a vast majority of those chemicals are derived from petroleum. Last month, at the UN climate change talks in Cancun, side events sponsored by NGOs highlighted rising health concerns for children and other vulnerable populations related to climate change. Climate change, as scientists have demonstrated repeatedly, has in large part been catalyzed by the widespread development and use of petrochemicals and their by products, which are fast changing the delicate balance of our earth’s systems. In other words, fossil fuels are us, inside and out – with huge economic and social consequences for human and ecological health.

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Preventing Cancer: A Call to Action

Ted Schettler, MD, MPH
Science Director

reprinted with the author’s permission from the Science and Environmental Network’s Networker

Identifying the causes of cancer, in order to help develop preventive strategies, has been of great interest for a long time. Almost 30 years ago, the Office of Technology Assessment of the US Congress commissioned two British epidemiologists, Richard Doll and Richard Peto, to quantify the avoidable risks of cancer in the US. They limited their evaluation to cancer deaths in people under age 65 and, using epidemiologic data, estimated the largest contributors to be tobacco (30%) and diet (35%). Far down on the list were environmental pollution (2%) and occupational exposures (4%).

Doll and Peto were fairly confident about their estimates for tobacco and less so about diet. They acknowledged that estimating other factors, including pollutants, was hampered even more by a number of assumptions, data gaps, and uncertainties. Despite these limits, which other analysts have repeatedly pointed out over the ensuing years, many scientists and policy makers continue to accept Doll and Peto’s estimates as fact. Their numbers have supported arguments against spending time and resources to reduce exposures to environmental contaminants, emphasizing instead the importance of personal lifestyle choices.

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Cumulative Exposures and Impacts: An Overview

The issue of cumulative exposures and impacts is not a new concept in environmental justice. Rather, it is a cornerstone notion by which low-income communities and communities of color have described their everyday lived experience. For more than fifteen years, communities living in the shadow of refineries, manufacturing plants, and other major sources of pollution have recognized and documented the onslaught of multiple sources of pollution on their bodies, their families, and their communities. Further, the environmental justice movement has clearly articulated “multiple, synergistic, and cumulative impacts” to be inclusive of social and economic disenfranchisement. The disproportionate levels of pollution faced by these communities can be historically linked to a breach of civil rights and continues to be a civil rights issue.

Cumulative exposures and impacts are also not a new concept to environmentalists. The National Environmental Policy Act, signed into law in 1970, established national policy to protect the environment, created a Council on Environmental Quality (CEQ), and required that environmental impact statements be prepared for major federal actions having a significant effect on the environment. Guidelines prepared by CEQ for implementing NEPA broadly define both secondary and cumulative impacts. Secondary effects are those that are “caused by an action and are later in time or farther removed in distance but are still reasonably foreseeable” (40 CFR 1508.8). Generally, the later impacts stem from the initial action and comprise a wide variety of secondary effects such as changes in land use, water quality, economic vitality, and population density. The formal definition for cumulative effects is “impacts that result from the incremental consequences of an action when added to other past and reasonably foreseeable future actions” (40 CFR 1508.7). NEPA notes that cumulative effects of an action may at first be undetectable when viewed individually but nonetheless can multiply and eventually lead to a measurable environmental change. This important law expressed a commitment to accounting for interrelated factors.

More recently, the National Environmental Justice Advisory Council, a federal advisory committee formed by the EPA to address issues of environmental justice, convened a Cumulative Risks/Impacts Work Group. This work group grappled on a national level with the question of how to address cumulative impacts as a key to remedying environmental injustice. Key concepts forwarded in their analysis include stressors, which are not only chemicals but can be socioeconomic in nature; vulnerability, which recognizes that, “disadvantaged, underserved, and overburdened communities come to the table with pre-existing deficits both of a physical and social nature that make the effects of environmental pollution more, and in some cases unacceptably, burdensome”; community-based participatory research; proportional response, which matches community needs with an appropriate level of action; and qualitative analysis. Using these key concepts, NEJAC lays out a set of recommendations and measures for implementation by the EPA.

Locally across the country, both environmental and environmental-justice organizations have combated the tendency for an increasingly narrow definition of cumulative impacts. Regulatory agencies, entrenched in long histories of decisionmaking through risk assessment, have remained reticent to providing analyses of cumulative exposures and impacts that contain qualitative as well as quantitative analyses. Further, regulatory agencies and their scientific staff continue to try to capture the issues of cumulative exposures and impacts within a risk-assessment methodology, which is often not a tool trusted by communities who have been subject to poor decisions justified by a risk assessment.

This tension makes a recent California process to define cumulative impacts at the state level an important victory for communities. Through a three-year process to implement environmental justice in all of the boards, offices, and departments of the California Environmental Protection Agency, an advisory committee guided Cal EPA through a comprehensive process inclusive of community voices. Recently, the Advisory Committee landed on a definition of cumulative impacts for the State of California to use as it implements environmental justice. They defined cumulative impacts to mean “exposures, public health or environmental effects from the combined emissions and discharges, in a geographic area, including environmental pollution from all sources, whether single or multi-media, routinely, accidentally, or otherwise released. Impacts will take into account sensitive populations and socioeconomic factors, where applicable and to the extent data are available”. This definition provides important guidance for the Cal EPA as it begins the process of taking action to remedy environmental injustice. Additionally, communities are relieved to see a regulatory definition of cumulative impacts that takes into account their lived reality.

Urban Habitat and the Collaborative on Health and the Environment have convened a call to learn from the debate on cumulative exposures and impacts. We also see this issue as a bridge between environmental justice communities and health-affected populations as we collectively work towards healthy communities and environments.