Testimony

Statement by
Henry Falk, M.D., M.P.H., Assistant Administrator, Agency for Toxic Substance and Disease Registry, Public Health Service Department of Health and Human Services
on
Fiscal Year 2004 Budget Request for ATSDR
before
The Committee on Appropriations

March 20, 2003

Introduction

Good morning, Mr. Chairman and members of the Subcommittee. I am Henry Falk, Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR).

It is a special pleasure to appear before you as ATSDR prepares to mark the 20th anniversary of its creation next month. I am very proud of ATSDR's accomplishments over the past 20 years in advancing both our understanding of the public health impacts of exposure to hazardous substances and our activities to prevent or mitigate disease and other harmful impacts of toxic exposure.

Among the profound changes that have occurred in our country during those 20 years, I would like to note two in particular that have played a significant role in shaping ATSDR's development and activities.

First, it has been widely recognized that the problems posed by hazardous waste sites are more extensive than was understood in the early years of the Superfund program. The number of hazardous waste sites in this country is orders of magnitude larger than contemplated. Sites that present major public health consequences continue to be identified, most notably asbestos contamination from W. R. Grace's vermiculite mine in Libby, Montana, which was first addressed under Superfund in 1999.

Second, terrorist events and the threat of future terrorist events have resulted in growing demand for ATSDR's unique experience and expertise developed over the past 20 years in carrying out mandated Superfund programs. This includes our experience and expertise in chemical toxicology, emergency response, and fostering coordination between public health, environmental and emergency response agencies and organizations at the local, state, and federal levels. In addition to assisting in response activities in connection with the World Trade Center and anthrax, ATSDR has sought to disseminate critical information to agencies and organizations with a role in terrorism preparedness and response.

Through ever-expanding partnerships with other federal, state, tribal, and local agencies and with private and public interest organizations, we have continued to provide the highest quality services to the public in both our traditional Superfund programs and in terrorism-related activities. Innovative partnerships with organizations whose programs complement those of ATSDR have enabled us to more efficiently and effectively achieve our public health mission, both through disseminating critical information and through drawing on the expertise of others. During the past year, in addition to ongoing work with EPA, we have joined forces with organizations as diverse as the Centers for Disease Control and Prevention, the National Institute of Environmental Health Sciences, the Federal Bureau of Investigation, the Federal Emergency Management Agency, the Chemical Safety Board, the American Chemistry Council, colleges and universities, and dozens of state and local public health organizations.

The President's FY 2004 Budget includes $73 million for ATSDR. This funding will support the agency's ongoing activities.

We continue to benefit from ATSDR's longstanding partnerships and programs, such as with the Minority Health Professions Foundation and its research program as well as through the Great Lakes Health Effects Research Program. Such programs help ATSDR fill the gaps in knowledge about the effects of hazardous substances on human health.

We have continued to leverage technology, including the use of sophisticated toxicologic, epidemiologic, and environmental data sets and analytic approaches, to enable us to carry out our mission most effectively. Geographic Information System technology allows us to layer health, demographic, environmental, and other traditional data sources to be analyzed. Improved scientific capacity enables us to track the spread of environmental contamination throughout a community, to identify geographic areas of particular concern, and to identify susceptible populations and potential health effects.

In addition to meeting our mandated Superfund-related obligations, we are also involved in helping communities as well as ourselves address emergency preparedness and response to real and potential acts of terrorism. Finally, we are pursuing a closer and more collaborative relationship with CDC as a mechanism for achieving the kind of synergy that will make us an even more responsive and capable public health agency.

In the time allotted here, I will discuss the activities supported by the FY 2004 Budget, which includes some of the more critical activities under the general headings of fulfilling our mandate under Superfund, preparing to address terrorism, and a proposed enhanced linkage to CDC to strengthen our capacity to respond to environmental and public health problems.

Traditional ATSDR Superfund Activities

The critical core function of our Agency is to assess the public health implications of hazardous waste sites and events involving the emergency release of chemicals. Our public health assessments and health consultations, as well as many of our health studies and surveillance programs, are directed to determining whether or not a site poses a threat to the public's health and working with EPA and States to take needed public health protective actions. A good example of the wide range of site-specific work is our ongoing involvement with tremolite asbestos contamination in Libby, Montana.

As you know, ATSDR has been working with EPA and with other federal as well as state and local public health organizations to address the health threat posed by asbestos contamination in Libby, Montana. We conducted medical testing of over 7,300 residents who were exposed to asbestos in that community, and the findings of the medical screening program revealed that 18 percent of those tested have asbestos-related lung abnormalities as shown on chest X-rays-a much greater rate than exists in the United States as a whole.

We are now providing funding and technical assistance to help the State of Montana implement a follow-up testing program for former residents, workers, household contacts, and other eligible persons. We expect the facility for this testing to be operational by the first of June of this year. A study to determine the rate of abnormalities by use of computed tomography (CT) scans is ongoing. We have encouraged and facilitated efforts by the Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration, both agencies of the Department of Health and Human Services, to establish a community health clinic and to provide mental health services to the community. Such a clinic is especially critical for addressing the health care needs of the medically uninsured, the underinsured, and other persons who lack the resources for primary medical care.

We are creating a registry of former workers and their families, some 10,000 -15,000 people, to help track health conditions of these exposed people and to provide new information as it becomes available that would be of assistance in obtaining optimum medical care and preventive actions.

Our work to address the problem of Libby-related asbestos contamination has expanded to include 244 sites in the United States that received vermiculite ore from Libby. A map included with this testimony indicates the distribution of these sites within the United States. We are coordinating with EPA and other federal, state, and local environmental and public health agencies to evaluate potential public health impacts at these sites. At this point, we have focused our efforts on developing health consultations at 28 priority sites and on working with 11 state health agencies who are assisting in this effort. We will begin releasing the reports of these health consultations in the next couple of months. These 28 sites, which are indicated on a second map provided to you, were chosen because the exposure of former workers, their contacts, and others was deemed significant enough to warrant further evaluation. As these reports become available, we will address the need for further ATSDR health evaluations of former workers or other exposed individuals at these sites. Additional health work at these sites may well involve significant attention in the future.

ATSDR has also provided funding to 9 states to conduct health statistics reviews that offer a way of identifying the higher incidence of disease associated with asbestos exposure at vermiculite sites around the country, and we continue to recruit states to join the effort. An interim report of results of the health statistics reviews is expected to be released by June 30 of the current year.

Our Superfund-related work, of course, encompasses environmental problems and health threats that extend well beyond asbestos contamination. We have a mandate to produce toxicological profiles on the 275 substances thought to pose the greatest hazards and to ensure that needed research is done on those chemicals to fill in key gaps of information.

Two key programs that contribute to that effort include the Great Lakes and the Minority Health Professions Foundation programs.

We have supported the Great Lakes Health Effects Research Program to build on and amplify the results of past and ongoing fish-consumption research in the Great Lakes basin. We have found that serum PCB levels and consumption of Great Lakes fish are significantly associated with lower levels of thyroxine, a hormone secreted by the thyroid, in both women and men. Researchers also found that consumption of fish meals was highest among African Americans, but awareness of the fish advisories was lowest in that group.
Our cooperative agreement with the Minority Health Professions Foundation (MHPF) and its Environmental Health and Toxicology Research Program continues to help us close the information gap in available scientific data on the impact of the release of hazardous wastes, particularly on the health of poor and minority populations. The agreement, which includes as participants such historically black educational institutions as the Morehouse School of Medicine, Charles R. Drew University, Texas Southern University, Florida A & M University, Meharry Medical College, Tuskegee University, and Xavier University of Louisiana, helps underwrite the training of students who will make a major contribution to public health practice. Moreover, the agreement results in filling some of ATSDR's major research needs.

A key mandate of our Superfund program is to conduct studies at sites to further our knowledge about the relationship between exposure to hazardous substances and any resulting disease. Much of this work is done under cooperative agreements with 31 state health departments. Recent examples of some of our ongoing work in this area include:

In Anniston, Alabama, ATSDR has been working in collaboration with local, state, and federal agencies, as well as with community representatives, to address community concerns regarding the potential for exposure to polychlorinated biphenyls (PCBs). We have been working with the Alabama Department of Public Health to gather, analyze, and interpret existing data describing the incidence of cancer and vital statistics for residents of Anniston, and we will be funding multi-year epidemiologic investigations to study the health effects of exposure to PCBs. We will work closely with the institution selected to do that study, providing both technical and administrative support to the researchers. We will also work closely with EPA in further evaluating exposures.
In Herculaneum, Missouri, we are participating in and supporting a project to study the effects of exposure to lead among children, adolescents, and young adults. In a sample of children 72 months and younger living closest to the Doe Run lead smelter, 30 of 67 children, approximately 45%, had blood lead levels of 10 �g/dL or higher, compared to a national prevalence rate of 7.6% and a Missouri rate of 8%.
In Dakota City, Nebraska, we examined the association between hydrogen sulfide, total reduced sulfur levels, and neuro-behavioral activity, on the one hand, and the incidence of hospital visits of children for treatment for asthma and other respiratory illnesses, on the other. We are now involved in a follow-up study in Dakota City and South Sioux City.
In Warren Township, Ohio, we have been involved in investigating hydrogen sulfide exposure in the surrounding air, creating a multi-agency committee to form and carrying out a Public Health Action Plan that addressed recommendations made in the rapid response health consultation.
In Tarpon Springs, Florida, we have been developing a public health assessment and evaluating issues at the Stauffer Chemical Company site, where contaminants are present in the groundwater and the air. We have entered into an agreement with the University of South Florida to identify and locate former employees as well as students who attended the school nearby, and we are working with the Florida Department of Health to review information from the Florida cancer registry.
And in northeast Denver, Colorado, we have been working with the Colorado Department of Public Health & Environment and the University of Colorado to do a study of children potentially exposed to arsenic, also focusing specifically on soil pica behavior, a habit of ingesting soil, in children six months to six years of age. We have also provided comments to EPA on its proposed plan for the so-called VB I-70 site.

Additional research, beyond that of our site-specific studies, is needed to further our knowledge about the relationship between exposure to toxic substances and resulting disease. In the past year we have begun implementing our ATSDR applied public health research agenda. We hope to be able to partner with state-based and academic institutions in development of this program. This research agenda should enable us to answer with greater certainty the questions and concerns raised by communities exposed to toxic substances and hazardous wastes.

We also work to educate both the health community and the general public about the hazards of specific chemicals and waste sites. Recent work in this area has included:

In Marion, Illinois, we have worked with the Illinois Department of Health to educate teachers about and improve storage of potentially dangerous chemicals, including mercury, in schools, and many of these stored chemicals were removed as a result of the project.
In Jasper County, Missouri, we funded a study by the Missouri Department of Health to assess whether public health intervention efforts had been effective in reducing blood lead levels of the community's children. The intervention efforts were found to have reduced blood lead levels significantly.

Targeted efforts to improve the diagnosis and treatment of children exposed to toxic substances have been another priority for ATSDR. We have recently succeeded in helping establish Pediatric Environmental Health Specialty Units (PEHSUs) in all ten of the federal regions. In FY 2002, these clinics evaluated more than 1,500 children by pediatricians specially cross-trained in environmental medicine, and provided an additional 1,500 phone consultations to pediatricians in their region.

Just this past July, the PEHSU clinic in Chicago was contacted by the Chicago Housing Authority concerned about arsenic contamination in the soil of a local playground. The PEHSU, working with the Chicago Department of Public Health, helped screen local children and identified 14 with elevated levels of arsenic in their urine. The PEHSU provided follow-up medical care for affected children and the Chicago Housing Authority began immediate clean-up of the playground. This is an excellent example of how a new - and very needed - resource can help us partner to protect children from the effects of toxic exposure.

ATSDR Challenges Post 9/11 in Preparing to Address Terrorism and Emergency Preparedness

During the past year, ATSDR has continued to address the need to help communities improve emergency preparedness and develop a rapid response capacity to acts of real and potential terrorism. We have addressed this need in a time of national crisis. We thank the Committee for reimbursing our '02 emergency expenditures. We continue to see ATSDR's role in countering health impacts of terrorism, particularly in the areas of chemicals and the environment, as essential to national safety. We continue to participate actively with CDC, EPA, the Department of Homeland Security (DHS), and state and local health organizations in undertaking planning and preparedness in areas that focus on the unique capabilities of ATSDR.

An example of how we have used partnerships to address emergency response capacity is the FEMA Comprehensive HAZMAT Emergency Response-Capability Assessment Program, or CHER-CAP. ATSDR has worked on two local emergency planning exercises (in Tri-town, Connecticut and Boston, Massachusetts) with FEMA to assist those communities and to improve their response to a release of hazardous materials. ATSDR's contributions have included bringing the medical community into the local planning process and assessing hospital emergency response and preparedness through:

on-site evaluation, walk-through, and disaster plan review;
applying lessons learned from the scientific literature to enhance emergency response;
encouraging communication and collaboration among public health and medical officials and community-wide disaster planners regarding preparation for mass-casualty events;
providing assistance and training to community responders as well as supporting preparation for use of technology such as geographic information systems and toxicologic data bases; and
conducting exercises to assess the state of readiness to respond to mass-casualty events.

In addition, in June, ATSDR will participate in a large-scale regional emergency preparedness exercise in Louisville, Kentucky with EPA, FEMA, CDC, and state and local public health agencies as well as hospitals, physicians, and fire departments. We will provide answers to toxicological as well as medical questions that arise, and we will help maintain a "victim's registry" in this simulation.

We have also partnered with the private sector to expand the utilization of our products. In conjunction with the American Chemistry Council, we distributed the Managing Hazardous Materials Incidents (including the medical management guidelines) on CD-ROMs to states and communities to educate first-responders to the adverse health effects of specific chemicals.

We are providing communities with access to geographic information systems to map localities and to model the dispersion of chemicals in the event of an uncontrolled release.

Our Hazardous Substances Emergency Events Surveillance system (HSEES) has become a major resource in our efforts to reduce and even prevent the morbidity (injury) and death that result from hazardous substances events. It may also be a good tool for addressing incidents of terrorism. The system captures incident and facility data as well as data on health outcomes from HazMat accidents and other uncontrolled releases. To date, fifteen states have cooperative agreements with ATSDR to participate in HSEES. State health departments enter data into a web-based application to enable ATSDR to access data instantly for analysis. We are working to use HSEES as a key source of health information to enable us to respond to emergency events. The recent fire at a plastics factory in Kinston, North Carolina, for example, provided us with an opportunity to evaluate the use of HSEES as a means of assessing past experience and trends in fires in similar types of facilities. Data from HSEES has also provided us with information which has been used to ensure first responders know the appropriate personal protective gear to use in dealing with the clean-up of clandestine meth labs.

A quick and by no means comprehensive listing of some of our activities will indicate our commitment to improving community emergency preparedness and to developing a rapid response capacity to terrorism.

Staff members worked with the Federal Bureau of Investigation to collect anthrax spore samples as evidence in the American Media Inc. office building in Boca Raton, Florida, where the index case of inhalation anthrax occurred in an employee. ATSDR scientists and FBI investigators worked together in building entry and medical monitoring teams throughout the field investigation. The field investigation team successfully applied a new combination of scientific techniques to locate, quantify, and collect concentrations of anthrax spores within the building.
Working with funding from FEMA, we are helping the New York City Department of Health develop a registry of 150,000-200,000 workers and residents to track the health of people exposed to contaminants from the World Trade Center site.
We also rapidly assembled toxicologic guidance for NASA, EPA, and local first responders on the potential for exposures to toxic substances in connection with the Columbia shuttle disaster.
We have linked our emergency response staff with the new CDC Emergency Operations Center so that we have a rapid and seamless public health response to emergency events involving chemicals, including any terrorist attack.

Since the events of 9/11/2001, ATSDR has initiated several activities designed to apply existing tools to aid preparedness in the event of a chemical attack. The distribution of a CD-ROM version of our toxicological profiles and medical management guidelines to state and local agencies as well as to first-responders is one example of those activities. In addition, ATSDR toxicologists, in conjunction with scientists at CDC, have evaluated chemicals that are the most likely to be used in a terrorist attack. Although we have information on how to diagnose and treat people exposed to some of these chemicals, we recognize that huge gaps in information still exist. We must start filling those gaps so that we can be even better prepared. We are first working to make sure that we share the information we have with all relevant parties, including first-responders, hospital emergency rooms, poison control centers, clinicians, and the general public.

ATSDR will continue to work closely

with EPA to develop data and distribute information on chemicals and other hazards;
with our sister agency CDC, with other agencies within the Department of Health and Human Services, and with state and local agencies to help train health responders to deal with chemical, radiologic, and environmental terrorist threats and;
with DHS to assure that public health responders are integrated into local emergency planning.

Mr. Chairman and members of the subcommittee, our 20th year of service to the American public has been the most productive of all, and I expect that increase in productivity to continue. I can say to you that we have been good stewards of the public funds that Congress has entrusted to us. As you will remember from last year's testimony, ATSDR has undertaken a major internal initiative in strategic planning for the next five years. We've added to that work this year by tying our budget and staffing levels to specific performance planning goals and objectives, and are striving to improve our program performance measures with more outcome and impact data. We want to be able to give you and the public a full accounting of our programs in terms of the difference we have made and the unique expertise and services we offer. And we continue to look for ways to maximize our contribution to the public's health through getting the most out of our resources by leveraging partnerships and technology.

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

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