Division of Health Assessment and Consultation

William Cibulas, Jr., Ph.D., Director

The Agency currently must address federally owned as well as privately owned NPL sites. U.S. Department of Defense (DOD) sites frequently involve munitions, propellants, and mixed wastes; many of the sites are made up of hundreds of operable units that must be individually addressed. US Department of Energy (DOE) sites range in size from several acres to nearly 1,000 square miles. Larger DOE sites contain inactive nuclear reactors used during World War II through the end of the Cold War; two sites have operating nuclear reactors. Contaminants at DOE sites include radioactive materials and massive amounts of organic and inorganic materials. The levels of contaminants detected at DOE sites are often much greater than those measured at other sites. ATSDR is one of a few federal agencies that directly address public health issues related to environmental insults associated with such sites.

In 1990, the Health Activities Recommendation Panel (HARP) was created to evaluate the data and information discussed in public health assessment-related documents. During FY 1993, HARP estimates the data and information developed in 150 public health assessments, health consultations, and public health advisories will be evaluated. Those evaluations will determine what public health actions are needed for populations living or working near hazardous waste sites. DHAC health assessors will then develop and coordinate the public health actions determined by HARP. Public health actions include health studies, substance-specific applied research, community health education, and health professional education.

In addition to conducting public health assessments and related activities, DHAC manages the emergency response and site-specific health consultation program. Through health consultations, DHAC staff routinely provide advice on specific public health issues related to actual or potential human exposure to hazardous materials. DHAC expects to complete approximately 500 oral and written health consultations during FY 1993. In addition to consultations, the Division will respond to 300 requests for technical assistance.

An important component of the ATSDR emergency response program is training the people who are first responders to hazardous materials releases into the environment. DHAC has developed two guidance documents (with companion videotapes) for release in FY 1993 that address the proper handling, decontamination, and treatment of chemically contaminated patients.

DHAC staff actively encourage community involvement in the public health assessment and consultation (emergency response) programs. Building trust and gaining the support of the community often leads to better cooperation and participation by residents in follow-up activities such as health studies, surveillance programs, and exposure registries. In FY 1993, DHAC will sponsor two ATSDR-Community Health Assessment Workshops. The workshops increase the public's awareness of ATSDR and the public health assessment process and also provide a forum for the public's input and advice. Community involvement begins with effective communication; this year, health assessors will learn through DHAC-sponsored workshops how to improve their communication skills.

ATSDR managers continually seek opportunities to expand the expertise and knowledge of state health departments with cooperative agreements to conduct public health assessments and to respond to emergencies. DHAC expects to continue cooperative agreements for the conduct of public health assessments with 22 states during FY 1993. Those 22 states have within their boundaries more than 80% of the 1,331 NPL sites (and 80% of the 33,000 Comprehensive Environmental Response, Compensation, and Liability Information System [CERCLIS] inventory sites). DHAC also supports biologic monitoring at sites (as needed) through cooperative agreements with states.

The DHAC Lead Initiative is a systematic review of public health assessments at which site-related lead contamination has been documented. The goal of the Lead Initiative is to prevent lead toxicity in children who contact lead released from Superfund sites. In fiscal years 1991 and 1992, 27 sites were reviewed, and public health actions were determined. In FY 1993, past actions will be evaluated and future plans for the approximately 500 sites awaiting evaluation will be determined. Another initiative that DHAC is involved in is the ATSDR Minority Health Initiative, which is the Agency' s response to inequities experienced by minority Americans who are disproportionately represented in high-risk populations that live or work near hazardous waste sites. During this fiscal year, DHAC staff will focus on developing a discussion paper on health perspectives, identifying preexisting health factors that may exacerbate the toxic effects of exposures to environmental contaminants, and determining the demographics of populations in proximity to some 600 hazardous waste sites.