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Mr. Chairman and Committee Members, thank you for the opportunity to provide you with written testimony on the Agency for Toxic Substances and Disease Registry's (ATSDR) budget for FY2001.

As you know, under the Superfund legislation, ATSDR was given the important mission of protecting the public's health related to exposure to toxic substances. Our mandate includes determining the nature and extent of health problems at Superfund sites, and advising the U.S. Environmental Protection Agency (EPA) and State environmental agencies on needed clean-up and other actions to protect the public's health. We are also charged with the critical task of determining the relationship between exposure to toxic substances and adverse health effects.

To fulfill our mission, Congress appropriated $76 million to ATSDR in FY 1999, and $70 million in FY 2000. The President's budget for FY 2001 calls for an appropriation of $64 million to fund ATSDR's activities.

In this testimony we would like to focus on three areas which have major budgetary implications - for both current and future program activities.

• We have a substantial and continuing Superfund workload of increasing complexity. ATSDR provides critical health information and services at these sites to community members, EPA and state decision-makers, and health care providers.
• Health concerns continue long after clean up because health conditions often manifest only long after exposure.
• New, significant health problems continue to emerge that need to be addressed. Current cases of lung cancer and other lung impairments at Libby, MT, are a striking example of this.

Providing critical health information and services: Site Evaluations

The volume of ATSDR's workload at sites continues to be substantial. In the last fiscal year alone, ATSDR and our partners produced l,569 health consultations, 108 public health assessments, and 32 exposure investigations. ATSDR has a staff of a little more than 400. To meet the workload demands, we supplement our own staff by funding 28 state health departments to work with us.

ATSDR's site health evaluation and consultation efforts are the starting point for all of the agency's site-specific health activities. Further site activities include epidemiologic health studies, health education and health promotion.

The breadth of ATSDR's activities at sites is matched by the breadth of the kinds of sites we routinely work on. Early in our program the focus was primarily on EPA's National Priorities List (NPL) sites. With time, however, our workload has shifted to a wider array of Superfund-covered sites including emergency removals, petitioned sites, and federal facilities. Examples of the kinds of sites we have worked on recently include:

• NPL Sites -- As mentioned, ATSDR is heavily involved at NPL sites. Among recent examples are Bunker Hill, Idaho; Keil Chemical Manufacturing, Indiana; Brick Township and Toms River, New Jersey; AMOCO Sugar Creek in Kansas City, Missouri; and the Monsanto/Solutia site in Anniston, Alabama.

• Federal Facilities -- Current examples of ATSDR involvement at federal sites are the Hanford Nuclear Facility in Washington; the Kelly U.S. Air Force Base in Texas; Camp LeJeune military base in North Carolina; the Otis Air Force Base in Massachusetts; and the Valley Forge National Historic Park near Philadelphia, Pennsylvania. Our work at federal facilities is funded by the affected federal agencies.

• Emergency Response/Immediate Removal Sites -- Examples of ATSDR emergency assistance is our responses to the Texarkana, Arkansas extensive mercury exposures; the Rhode Island concerns of PCB contamination in the Woonasquatucket River; and the Mississippi, Alabama, Louisiana, Tennessee, Arkansas, Texas, and Illinois methyl parathion exposures.
• Petitioned Sites - Environmental public health expertise also is frequently requested or "petitioned" by concerned citizens. Among the areas where ATSDR has responded to petitions are the U. S. Navy bombing range on Vieques Island, Puerto Rico; the Santa Susana Field Laboratory in Ventura County, California; and the Fresh Kills Landfill in New York.
• Resource Conservation and Recovery Act (RCRA) regulated sites - ATSDR is currently working with EPA to strengthen our support of their RCRA program. Some examples of RCRA sites at which ATSDR has been active include General Electric in Pittsfield, Massachusetts; Bovoni Landfill in St. Thomas, Virgin Islands; Iowa Beef Processing in South Dakota and Nebraska; Pacific Gas and Electric Company in Hinkley, California; and Trinity Foam Processing plant in Archdale, North Carolina.
• Brownfields Re-development Sites - ATSDR has funded public health activities at Brownfields sites in Baltimore, Maryland; Lowell, Massachusetts; Portland, Oregon; Chicago, Illinois; Rhode Island; and Seattle-King County, Washington.

ATSDR's health consultations, public health assessments and exposure investigations at sites are critical in assisting EPA and state officials on clean-up decisions, addressing community health concerns, and in investigating possible increases in disease rates. The following are a few examples of ATSDR's public health activities around the country where our work has clearly made a difference:

• Concerned about possible exposures, this past year EPA asked ATSDR to review data on the Hudson Oil Refinery site in Cushing, Oklahoma for its public health implications. Based on a site visit and review of the data, ATSDR determined that the site posed an urgent public health hazard and released a public health advisory to that effect on March 4, 1999. In April, EPA successfully used that public health advisory to help them list the site on the National Priorities List which gave them access to necessary funds to continue their removal actions without interruption.
• In conjunction with our state cooperative agreement partner, ATSDR assessed the health concerns of the community living around an inactive metal-plating facility in Vincent, Alabama this past year. The health consultation indicated that there was an urgent health threat posed by deteriorating vats and buildings and chemical hazards on site; and a possible health threat from nearby potentially contaminated water. After Alabama and ATSDR advised the public and EPA of the hazards, EPA took immediate action to fence the site, post warning signs around the perimeter of the site, and sample on-site and off-site areas to better determine the extent of contamination.

The public was extremely responsive as well. The community worked with Alabama's health department and ATSDR to educate residents about the hazards posed by the site through community meetings, a newsletter, and a door-to-door campaign to stop children from playing on or near the site. Preliminary evaluation of these efforts show that 90% of the residents correctly understood the hazards and risks associated with the site.

• Planned incineration of dioxin and other hazardous wastes from Times Beach and other Eastern Missouri contaminated sites created community concerns about potential exposures to these substances. To address these concerns, ATSDR, working with the affected communities and EPA, designed a study to measure blood levels of dioxin and related compounds before, during and after incineration to test the effects of incineration. Results of the ATSDR investigation utilizing blood samples analyzed by the CDC's environmental health lab showed that levels of dioxin and other contaminants in study participants decreased significantly from pre-incineration to mid- and through post-incineration. Because of extensive citizen input and involvement throughout the study, there was wide acceptance of these findings and a very successful test of the efficacy of incineration as a clean-up methodology.

Providing critical health information and services: Health Education

ATSDR's health education and promotion programs focus on educating individuals, communities, and health-care providers about the health effects of hazardous substances in the environment. ATSDR works with affected communities to develop and promote public health strategies to mitigate the health impact of hazardous substances. To ensure effective health care services, our targeted continuing education programs and physician-related partnerships have enabled local physicians, nurses, and other health care providers to better diagnose and treat their patients exposed to toxic substances.

As a result of site-specific lessons, ATSDR has become the leading resource within HHS for educating communities, the general public, and environmental health professionals about the medical and public health impact of toxic chemicals. ATSDR's toxicological profiles, case studies in environmental medicine, and medical management guidelines have become information source of choice for a wide range of audiences - from the lay public to the academician. Our website and toll-free information number provide user friendly access to this information literally hundreds of times per day.

To expand the reach and application of health education and promotion activities, ATSDR has established many partnerships with national organizations of health professionals. ATSDR's partners include the American Academy of Pediatrics, American College of Medical Toxicologists, Association of State and Territorial Health Officials, National Alliance of Hispanic Health, the Migrant Clinicians Network, and the National Environmental Health Association. Partnerships with state and local health departments are particularly critical to accomplishing public health activities at the most local levels.

Following are a few examples of health education and promotion activities that ATSDR has conducted directly and with partner organizations.

• A significant effort to educate health care providers was initiated in the Agricultural Street Landfill (ASL) community in Louisiana. ASL is a 95 acre former municipal landfill that was developed, in part, for residential use. In order to address the residents health and wellness concerns, ATSDR distributed environmental health information to all 462 health care providers who serve that community. In addition, we provided a training seminar that 165 of these health care providers attended -- a group who collectively serves more that 90 percent of the community.

• The agency is working with the Association of Occupational and Environmental Clinics (AOEC). The AOEC 65-clinic network and 300 individual members work with ATSDR to provide responses to health concerns associated with exposure to hazardous substances for local health care providers and community members. This relationship enabled ATSDR to better respond to the community in and around Alberton, Montana, the site of a railroad derailment-caused chlorine spill. ATSDR and an AOEC physician worked with community members to develop criteria for evaluation of a range of health concerns. Thirty-eight residents received health evaluations and several were further referred for pulmonary and neuropsychiatric testing as a result of their exposure.
• The Tar Creek Superfund site is located in the northeastern corner of Oklahoma. Years of mining in the Tri-State Mining District (located at the juncture of Oklahoma, Kansas, and Missouri) has resulted in the accumulation of a large volume of tailings and other mine wastes. Children who live or play near mine tailing piles may ingest or inhale lead-contaminated dust. These piles have also been used by riders of off-road vehicles, and houses have been built on these tailings.

ATSDR, along with the Ottawa County Health Department, has put together a health promotion campaign which includes health care provider and community education, as well as outreach and blood lead testing in nearby communities. Intervention through a mobile blood-testing unit has resulted in seven educational sessions reaching about 400 preschool/kindergarten children. In coordination with Women, Infant and Children's (WIC) services, the county health department has checked for childhood anemia in over 100 blood lead level tests and offered blood lead screening to all pregnant women. A database was created to track blood lead levels and interventions and to provide information to EPA for pathway analysis and cleanup, when necessary. Additionally, parents of children identified with elevated blood lead levels receive proper referrals education and are entered in the database for follow-up. Plans are to expand the blood-lead screening to each Head Start and kindergarten throughout the county's seven school districts in the 2000 school year.

The FY 2001 budget, which is $6 million below the FY 2000 budget, will support such efforts at selected sites, but some reductions will have to be made. (See Program Output Table on the following page for more detail.)

Public health problems persist even after clean-up

There is an almost universally held perception that once a site is cleaned up no health problem exists. Unfortunately that is not the case. For many of the toxic substances found at Superfund sites, there is a long latency period before health conditions manifest themselves. For example, many cancers can take 20 or 30 years after exposure before diagnosis.

This issue has recently been a point of discussion in consideration of the reauthorization of Superfund. In June 1999, Congressman John Dingell's office contacted ATSDR to request that the agency provide information on adverse health effects associated with the top 50 substances on the Priority List with latency periods of six years or greater. In response, ATSDR reviewed and compiled the information available in our existing toxicological profiles. Our report noted that vinyl chloride, benzene, PCBs, trichloroethylene, hexavalent chromium, lead, arsenic, creosote, and benzidine are classified as "known to cause cancer in humans" or "probable human carcinogens," and have a latency period of at least six years, usually 10 to 20 years or more. In addition, a number of other substances on the list are classified as "reasonably anticipated to cause cancer in humans," based on limited evidence in humans, but sufficient evidence in animals. These substances include cadmium, chlordane, beryllium, carbon tetrachloride, and cobalt.

The consultation also summarized the potential for developmental or neurologic effects with a latency of at least six years. Substances associated with these adverse health effects include organochlorine pesticides (e.g., DDT, aldrin, chlordane), some metals (mercury, lead, cadmium), arsenic, and trichloroethylene (TCE).

ATSDR health studies and registry findings lend further evidence of the often lengthy time it takes before health effects are apparent in people exposed to toxic substances at Superfund sites. For example:

• Two ATSDR studies found that people exposed to lead (a common contaminant found at 1/3 of sites) during the 1970s at the Bunker Hill NPL site in Idaho, continue to have long-term health effects. As a result of exposures as children and young adults more than 25 years ago, this population is at risk for manifesting health problems such as neurologic disease, infertility, high blood pressure, and early onset of menopause.

Analyses of self-reported data from the ATSDR Exposure Registry has indicated excesses of a number of health effects. Data from the registrants on the Dioxin Subregistry (which includes registrants from four Missouri NPL sites) and information from the nearly 10,000 people on ATSDR's subregistries on volatile organic compounds of TCE, TCA and benzene show an excess in reports of a variety of illnesses including anemia and respiratory problems. Further studies are underway to validate these reported health effects.

• A follow-up study of people living near the Caldwell Systems, Inc., a former hazardous waste incinerator in North Carolina, found that residents initially found to have respiratory symptoms in an earlier study, continued to have a higher prevalence of respiratory symptoms two years later.

In addition, all of the following specific health conditions have been associated with exposures to hazardous substances -- defective reproductive outcomes, cancer, immune abnormalities, and neurobehavioral effects. Several ATSDR studies have found associations between living near hazardous waste sites or drinking contaminated drinking water and low birth weight in infants. Associations have also been found between exposures and various birth defects, including cardiac, neural tube and oral cleft defects.

It is critical that ATSDR not only continue it's study of the relationship between exposure to toxic substances and resulting disease - but also that we have funding to intervene with early diagnosis and referral wherever possible. Such interventions can and do save lives. A good example of this is the Drake Chemical Site in Pennsylvania:

• In 1986, ATSDR successfully implemented a screening program for former workers exposed to a human bladder carcinogen at the Drake Chemical site in Pennsylvania. These former workers had been exposed to betanaphthylamine a known human carcinogen, specifically linked to bladder cancer. A total of 364 workers were initially eligible for screening; 82% of whom chose to participate. Compliance was high; participation rates ranged between 82% to 92%. Of the workers screened in the first phase, 50 were referred for the second phase which included a laboratory diagnostic work-up (a cystoscopy). As of 1997, two workers have been diagnosed as having early stage cancer, another 13 were diagnosed with varying degrees of dysplasia, and 25 had some type of bladder abnormality diagnosed. This program has clearly been of benefit for detection and treatment of disease for these workers, and has been so successful that it now is continued by the State of Pennsylvania.

Continually emerging health problems at Superfund sites

The health screening activities begun at the Drake Chemical site more than a decade ago and continuing even today, underscore the need for long-term public health attention and intervention. Currently, ATSDR is involved in a number of sites where the long latency of diseases potentially associated with exposure to toxic substances have appeared. The situation in Libby, Montana offers a dramatic example of past exposure resulting in serious disease.

Commercial vermiculite mining and processing facilities operated for more than 60 years (until 1990) in and near the city of Libby, Montana. Recent reports have documented cases of non-occupational asbestosis-related pulmonary impairment among family members of former mine employees and others in the community with no connection to the mining operations. They are suffering (or dying) from asbestosis, mesothelioma, and lung cancers related to their asbestos exposure. Finding non-occupational asbestos-related pulmonary disease is extremely unusual and suggests that dangerous levels of asbestos exposure have occurred within the Libby community.

Once these reports became known to EPA at the end of last year, they requested ATSDR's assistance in responding to the very real concerns of the community. In the course of the last couple of months ATSDR has designed a medical testing program to address the public health implications of past human exposure to tremolite asbestos in Libby.

• The principal goal of the medical testing program is to identify asbestos-related health effects among people exposed to asbestos from the Libby vermiculite mine and refer them for additional evaluation and treatment.
• Another important goal of the testing program is to assess the prevalence of asbestos-related conditions in the study area as a whole. This will be performed in order to:   (a) identify the types of illnesses experienced by these exposed people and better educate local physicians; (b) provide the local medical community with an estimate of the additional medical care the community will need over the next 10-20 years, and; (c) provide the EPA with information needed to identify and eliminate current exposures to asbestos in the community.

The first phase of the medical testing program involving both chest x-rays and pulmonary function tests will be directed at the 3,000 - 5,000 people currently living in Libby who were potentially exposed. The cost of this first phase is approximately $4.5 million - an amount that could not be funded within ATSDR's FY 2000 budget. Because EPA recognized the extreme importance of this medical testing program, they have allocated the $4.5 million to reimburse ATSDR to carry out this work.

As this medical testing program progresses, it may well need to be expanded to former residents of Libby who now reside in other parts of the country. EPA also is investigating scores of other sites throughout the United States that have utilized vermiculite from Libby. As EPA investigates these sites, public health actions at other sites with significant exposure patterns - including replicating the medical testing program - may be necessary. Epidemiologic studies to investigate the linkage of different exposure patterns to the development of disease may also be needed.

Another emerging health problem is the increase in brain cancer in children nationwide. In 1997, ATSDR initiated activities to investigate possible links between elevated rates of children's cancers in Toms River and exposures to hazardous substances. These actions include: a multi-site study examining the rates of brain cancer among residents, a multi-state case control study of childhood brain cancers, a review of available chemical data for the Dover Township area, and public health intervention activities including health care provider updates. Elevations in overall cancer incidence were confirmed for Dover Township and the Toms River section, particularly among female children under 5 years of age. Funding for this effort, and similar investigations at other sites, will be curtailed in FY2001.

Finally, there is some suspicion that increased liver cancers in the Southwest and increased cases of multiple sclerosis may be linked to exposures to toxic chemicals. The cost of investigating these illnesses is not included in our budget.

ATSDR has for more than 15 years applied the disciplines of environmental health science, epidemiology, toxicology, and health education to assess real and potential human health effects as related to hazardous substances. The agency has learned valuable information about the association of certain diseases and exposure to toxic substances and has used this information to help communities and environmental and health organizations to prevent and reduce potentially hazardous exposures. The agency has made a difference in the daily lives of many communities and in the body of knowledge in environmental health science. As the principal public health agency charged with determining the nature and extent of health problems at Superfund sites we will continue to strive to prevent exposures to hazardous substances and adverse human health effects.

Mr. Chairman and Committee members we would be happy to respond to any questions you might have about our testimony or any of our program activities. Please direct your questions to ATSDR's Assistant Administrator, Dr. Henry Falk, by writing him at MS E-28, 1600 Clifton Road, Atlanta, GA 30333, or phoning (404) 639-0700.

This page last updated on May 31, 2000

Joanne Cox / JDCox@cdc.gov

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