Elise Miller, MEd
As the health care reform debate continues, little discussion has focused on the significant cost savings that could be achieved through preventing exposures to toxic chemicals—chemicals that are shown to contribute to numerous health endpoints, including obesity, diabetes, learning and developmental disabilities, Parkinson’s, reproductive health problems, breast cancer, asthma and heart disease. When tobacco use was significantly curtailed, for example, the number of cases of lung cancer and others associated diseases fell dramatically, saving billions of dollars. The downside is that it took decades to persuade industry and government that the scientific data linking smoking and lung cancer was strong enough to warrant such strict regulation—and in the meanwhile, many, many more people became ill.
In this context, we have to ask how much evidence is enough before we switch to safer alternatives and implement regulations that allow only chemicals that have been thoroughly tested for human safety on the market? Do we have to wait years or even decades more, while people become increasingly sick, to reduce toxic exposures? What kind of health care savings might we have if we took preventive action now?
At a meeting of 150 scientists and physicians a couple weeks ago, Dr. Phil Landrigan, from Mount Sinai School of Medicine, stated that chronic childhood diseases linked to exposure to toxic chemicals in the environment have been surging upward, costing the US almost $55 billion a year. Other researchers in children’s environmental health say this number is, in fact, much higher. When you then add in the environmentally attributable fraction of health care costs related to a host of other chronic diseases and disabilities in adults, even conservative estimates suggest that our society could save almost $200 billion a year.
Currently, the proposed health care reform bill in Congress suggests that the expansion of coverage would cost $829 billion over 10 years. Let’s say we could reduce environmental contributors to chronic disease and save $200 billion a year for 10 years. That would mean a total savings $2 trillion, thus making the current acrimonious debate regarding expanded coverage seem hardly worth it. In other words, if we invested in primary prevention—even in this relatively narrow arena of minimizing hazardous environmental exposures without addressing other pressing concerns such as socioeconomic status, access to health care, nutrition, etc., then full health-care coverage would fiscally achievable without dire predictions of bankrupting future generations.
Fortunately, EPA Administrator Lisa Jackson just announced some groundbreaking principles for establishing a system for testing chemicals that would be more protective of human health than current regulations are. She called on Congress to overhaul the woefully inadequate Toxic Substances Control Act, passed in 1976, that was supposed to regulate chemical manufacturing and use. In the past 30-plus years, only five chemicals out of the 80,000 now on the market were determined to put people at “unreasonable risk” under TSCA. Even asbestos, a substance well-studied and known to significantly impact human health, ultimately could not be banned given TSCA’s limited scope. By contrast, Jackson prescribed a new regulatory structure that would, among other features, promote green chemistry and safer alternatives and ensure manufacturers provide EPA with the necessary information to conclude that new and existing chemicals do not endanger public health or the environment (see the full EPA press release).
Now the question is whether Congressional leaders, embroiled in the politics of health care reform, can connect the dots and see that regulating chemicals to protect human health also means substantially reducing health care costs while increasing the capacity of the US to provide health care coverage to all its citizens. Surely that would be a ‘win-win.’