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Congressional Testimony
In Support of the President's FY 1996 Budget Request for ATSDR

Testimony by
David Satcher, M.D., Ph.D.
Administrator
Agency for Toxic Substances and Disease Registry
Public Health Service
U. S. Department of Health and Human Services

Before the
Subcommittee on VA, HUD, and Independent Agencies
Committee on Appropriations
United States Senate

May 12, 1995

As you know, ATSDR is one of eight Public Health Service agencies. The agency was created by the original Superfund legislation in l980, and was expanded under the 1986 Superfund Amendments and Reauthorization Act to fulfill several important public health mandates. The agency has primary responsibility for overall evaluation of the relationship between human exposure to hazardous substances and adverse health effects. ATSDR also provides critical site evaluation to identify health problems in communities around Superfund sites, develops needed information on the health hazards of substances found at sites, and provides information on the diagnosis and treatment of illnesses resulting from exposure to those substances. I would like to highlight some of our findings and accomplishments for each of these public health mandates.

Mandate to Determine the Relationship Between Exposure and Illness

ATSDR's public health assessments and exposure studies at Superfund sites have documented human exposure to contaminants and their association to particular diseases. Although these epidemiologic findings are still unfolding, when sites are evaluated in aggregate (that is, by combining health data from many Superfund sites), proximity to hazardous waste sites seems to be associated with a small to moderate increased risk of some kinds of diseases. The administration's FY 1996 budget request for the health studies, surveillance, and registries is a little over $19 million.

Some recently completed, peer-reviewed site investigations conducted by ATSDR, or by state health departments with ATSDR support, reported the following results:

Respiratory Illness

• Findings from an ATSDR study of residents living near a former hazardous waste incinerator in Caldwell County, North Carolina, show an increased prevalence of respiratory disease in the target population. Follow-up biomarker testing that found decreased pulmonary function among residents living near the site verifies these symptoms.

• At the Brio National Priorities List (NPL) site in Friendswood, Texas, a study of 744 current or former residents showed increased self reports of respiratory and skin problems.

• A 1995 study among residents of Forest City and Glover, Missouri, who lived near NPL sites showed an increase in reports of respiratory problems and decreased pulmonary function, particularly noticeable among non smoking women.

Cancer and Immune System Function

• Testing of approximately 6,000 persons who live near 10 hazardous waste sites and were potentially exposed to volatile organic compounds showed an increased rate of an unusual production of abnormal blood cells that has been associated with chronic lymphocytic leukemia. As a result, ATSDR has arranged for referral of some individuals for extensive clinical examination at the National Institutes of Health.

• Findings from an ATSDR cross-sectional, symptom- and disease-prevalence study of 700 persons exposed to volatile organic compounds in drinking water showed an increased prevalence of the debilitating disease erythematosus lupus.

Birth Defects and Reproductive Disorders

• A study among Texarkana, Texas, residents showed that women living near an abandoned wood treatment facility listed on the NPL had more difficulty becoming pregnant and had fewer pregnancies than a comparison population not living near the site.

• In an ATSDR-funded study, investigators reported the occurrence of birth defects in the children of women living near 700 hazardous waste sites in California. Analysis shows that children of women living near sites where exposure to the solvents toluene and xylene was likely had greater than twice the typical rate of neural tube birth defects, such as spina bifida and anencephaly.

• Findings from an ATSDR-funded study of minority women living near sites in California where exposure to semi-volatile organic chemicals, pesticides, and heavy metals was likely shows elevated rates of limb reduction defects, central nervous system defects, and heart defects in their children compared to the rates of such defects in the children of minority women not living near hazardous waste sites.

• Near the Lipari NPL site in New Jersey, a study by the New Jersey State Health Department (funded by ATSDR) showed an indicator of intrauterine growth retardation resulting in fetuses that are small for their gestational age in children born to women living near the site. An evaluation of the occurrence of this condition from 1961 to 1985 showed that rates were higher in residents living closer to the site.

Neurologic Problems

• An ATSDR study of residents living near a former hazardous waste incinerator in Caldwell County, North Carolina, found increased neurologic symptoms in residents living near the incinerator site.

• When compared with the expected rates of illness among the U.S. population, children listed in ATSDR's National Exposure Registry who were exposed to trichloroethylene through contaminated drinking water had higher rates of speech and hearing impairment.

Site-Specific Mandates

ATSDR has a legislative mandate to conduct a public health assessment on all sites proposed for the NPL. In addition, Superfund legislation provides the opportunity for citizens to petition the agency on any site believed to pose a hazard to public health because of contamination by toxic substances. States may also ask for ATSDR's assistance in responding to concerns about the public health threat posed by hazardous substances in the environment.

As part of our site-specific responsibilities, ATSDR provides critical health information to EPA, states, and affected communities by developing consultations, public health assessments, health studies, medical surveillance, and registries. Approximately $26.5 million of our FY 1996 budget request is devoted to these activities. Following are a few examples of the implications of our work in this area:

• Of the 136 sites for which public health assessments and advisories were issued in fiscal years 1993 and 1994, ATSDR classified 54% as health hazards--5% posed urgent health hazards, and the remaining 49% were classified as sites where there was a potential public health threat from contaminants present at the site.

• The Brio site near Houston, Texas, is an example of a site where ATSDR's evaluations identified a health hazard and, as a result, clean-up decisions were focused on health. Residents of the Southbend subdivision adjacent to the site were concerned about the effectiveness of an air monitoring system and the site safety contingency plan being used during the site cleanup. Remediation was stopped. Because of ATSDR's health advice, a fence line air monitoring system was installed that can detect air emissions above safe levels. If problems are detected once remediation resumes, EPA can either close down the operation or relocate residents. ATSDR also conducted a symptom- and disease-prevalence study among residents of Southbend and found that 744 current or former residents reported increased respiratory and skin problems. ATSDR is currently scheduling follow-up pulmonary function testing for those who reported respiratory illness. ATSDR and EPA continue to work with the community to ensure that public health is protected during the cleanup of the site. Agency representatives are part of a task force currently working to decide which clean-up option should be selected for the site.

• ATSDR has issued 21 health advisories on sites considered imminent and urgent threats to public health; those advisories have enabled EPA to initiate emergency removal actions under Superfund authority. Seven sites have been placed on the National Priorities List because ATSDR issued a health advisory.

• For example, in 1993 ATSDR issued a public health advisory for an area of Stratford, Connecticut. City and state authorities had found widespread contamination of school play areas and residential properties because contaminated soil had been used as fill material. The contaminated soil contained large concentrations of lead, PCBs, and asbestos. ATSDR, working with EPA and state and local health and environmental agencies, implemented a number of public health interventions in 1994. These interventions included a voluntary blood lead testing program, in-home dust sampling, physician education on hazardous substances, and EPA's proposed placement of the Stratford site on the National Priorities List. ATSDR continues to consult with EPA as residential yards are cleaned up, ensuring that levels of contamination no longer pose a threat to residents. As a result of ATSDR's work in this community, the Raymark facility in Stratford, the reported source of the contamination, has just been added to the National Priorities List.

• ATSDR has completed an analysis of the demographic characteristics of populations around 93% of the current 1,296 NPL sites. Our data, which are based on 1990 census information, indicate that about 11 million people reside within 1 mile of these sites' borders, and their health is potentially affected by exposure to hazardous substances at these sites.

• ATSDR's analysis of these data show that the percentage of African-American residents is higher near NPL site areas than in areas without NPL sites. ATSDR plans to further analyze these data by including socio-economic and other relevant information needed to better characterize NPL site communities.

• At more than 50% of sites where people are known to be exposed to a contaminant from the site, lead or trichloroethylene or both were identified as hazards. At more than one third of these sites, levels of concern of such substances as benzene and arsenic were also found. Several of these substances are known carcinogens or are reasonably anticipated to be carcinogens, as defined by the Department of Health and Human Services.

• 60% of ATSDR's public health assessments include recommendations to EPA and states to interdict or reduce current, ongoing exposures to hazardous substances.

• The Bunker hill site in Idaho is a good example of how ATSDR's recommendations are used by EPA and states to focus cleanup of a site on addressing health concerns, and how our follow-up studies can be used to show the effectiveness of the cleanup. ATSDR, in conjunction with the Centers for Disease Control and Prevention (CDC) and the Panhandle Health District in Idaho, has conducted an extensive blood lead surveillance program among children exposed to lead from a smelter in Kellogg, Idaho. The smelter closed in 1982 and the area around it became an NPL site. ATSDR identified lead in soil and dust as the principal exposure routes, worked with EPA to target residential homes and yards for remediation, and initiated surveillance and intervention efforts. Since EPA remediation of the site began in 1974, children's mean blood levels have declined steadily. However, more work needs to be done. In 1992, blood lead levels in about 26% of children still exceeded 10 micrograms per deciliter ( µg/dL), the current CDC action level for lead. A follow-up health study by ATSDR showed that where residential yards had been cleaned up, blood lead levels in children had declined -- in other words, remediation efforts were shown to be effective. Efforts are ongoing to reduce all children's blood lead levels to below 10 µg/dL.

• ATSDR has also been an active participant in the Superfund emergency response program. Because of the absence of good data on the deaths, injuries, and illnesses related to emergency toxic releases, ATSDR developed and funded a proactive emergency surveillance system in 11 states. 1993 data reported by these 11 state health departments show that as a result of the almost 4,000 emergency events where hazardous substances were released, there were 16 deaths, 4,063 separate injuries sustained by 2,269 victims, and 496 evacuations of people. The most frequent victims were responders to the event and employees working at a facility. Of the injuries sustained, the most common was respiratory illness (30.7%), followed by eye irritation (16%), nausea (12.3%), and headache (10.6%). Data from this system are being incorporated into state emergency contingency plans by Local Emergency Planning Commissions. States are also using these data to work with industry to educate workers--the populations found to be most at risk during an emergency event. One state has reported that its HazMat team was relocated in response to information received from the surveillance system.

• An example of ATSDR's role in response to chemical emergencies is the Burlington Northern Train Derailment episode, which occurred near Superior, Wisconsin. In June 1992, three tank cars plunged into the Nemadji River, spilling 26,000 gallons of chemicals into the river and producing a vapor cloud over the area. Almost 50,000 people were evacuated from their homes that night. One hundred and three residents were sent to local emergency rooms for treatment. ATSDR emergency responders were on the scene within hours providing critical health information that local officials used to order the evacuation and to notify residents when it was safe to return to their homes. ATSDR also provided diagnosis and treatment information to local hospital personnel who were treating people suffering illness related to their exposure. ATSDR is currently funding a follow-up study by the Wisconsin Department of Health to address the health effects suffered by residents living in the vicinity of the derailment.

Substance-Specific Mandate

Our substance-specific mandates provide for the identification of priority hazardous substances, development of toxicological profiles on those substances, and research to answer major unknown questions about health effects. Approximately $16 million of our FY 1996 budget request is directed at these activities. Following are some of our accomplishments in this area:

• ATSDR is directed to prepare a Toxicological Profile for each priority hazardous substance. The priority of substances is determined by the potential for people to be exposed, toxicity, and frequency of occurrence. We have developed profiles on 200 hazardous substances to date; these profiles are up-to-date compilations of all that is known about the health effects of these substances. These profiles are used by ATSDR, states, other public and environmental health officials, and EPA and its contractors to 1) assess health effects resulting from exposure, 2) educate the public about a chemical, and 3) help physicians diagnose human health effects caused by exposure to hazardous substances.

• ATSDR is further tasked to identify priority data needs for these substances. We have recently published a list of 117 priority data needs for 38 top-ranked substances. These data needs are being filled in a variety of ways. ATSDR has referred 60 key data gaps to EPA for handling under its Toxic Substances Control Act authorities.

• Other key data gaps are being filled, using funding from ATSDR as directed by Congress, through research grants to academic institutions in the Association of Minority Health Professions Schools and to academic and state health departments in support of health research mandated by the Great Lakes Critical Programs Act.

• Finally, additional data gaps will be filled voluntarily by private industry through arrangements with ATSDR. We have signed agreements with the General Electric Company and the Halogenated Solvents Industry Alliance to conduct research into the human health effects of exposure to PCBs, methylene chloride, trichloroethylene, and tetrachloroethylene. We also have a letter of intent from the Chemical Manufacturers Association to conduct research on vinyl chloride.

Health Education Mandate

The ATSDR health education mandate provides for dissemination of health effects information to physicians and other health care providers so they may be better able to diagnose and treat exposed patients.

Since 1986, as part of our educational efforts, we have:

• provided training to more than 30,000 health professionals, including physicians, nurses, pharmacists, and other health care providers,

• distributed more than 140,000 copies of the Case Studies in Environmental Medicine, and

• distributed to physicians and hospitals more than 60,000 copies of medical management guidelines for use in responding to emergency events.

For fiscal year 1996, the administration's request for health education is approximately $6 million.

Partnerships

Many of ATSDR's accomplishments are due in large part to our strong public health partnerships, especially with state health departments. In 1986 when Congress reauthorized Superfund, they strengthened the statute's health section, and it was clear to ATSDR that Congress envisioned a partnership between states and ATSDR in implementing these health provisions. In 1987, the agency committed itself to a goal of building or enhancing state health departments' capacity in environmental health. From fiscal year 1987 through fiscal year 1994, we provided approximately $62,600,000 to 36 states. This figure represents approximately 18% of ATSDR's total budget during this period a substantial figure, given other budgetary demands on the agency. These dollars have translated into the addition of 128 professional staff to the environmental health components of state health departments.

Clearly, an important partner of ATSDR over the years has been its sister agency, the Centers for Disease Control and Prevention (CDC). As you may be aware, I am also the Director of CDC and would like you to know that the Administration is currently proposing merging ATSDR with CDC. ATSDR and CDC have complementary expertise in epidemiology, laboratory science, surveillance, and applied research. I strongly support this merger and believe it will lead to an even more effective utilization of resources. By merging ATSDR into CDC, the functions of ATSDR will benefit from the scientific, organizational, and administrative support provided by CDC. Public access to environmental health information and expertise currently available from CDC and ATSDR will be facilitated by merging these organizations. Incorporating ATSDR into CDC will reduce the fragmentation of environmental health expertise, thereby making it easier for the public and health professionals to know "where to go" for advice. The high-quality staff that ATSDR has recruited from a broad spectrum of disciplines will enhance CDC's capabilities in environmental health. Similarly, CDC's strength in epidemiology, surveillance, and applied research will further enhance the quality of ATSDR's science.

Mr. Chairman, this concludes my testimony, I would be pleased to answer any questions you may have.

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