Agency for Toxic Substances and Disease Registry Search  |  Index  |  Home  |  Glossary  |  Contact Us  
 

Congressional Testimony
Public Health Provisions of Superfund - Section 104 (i)

Testimony by
Barry L. Johnson, Ph.D.
Assistant Surgeon General
Assistant Administrator
Agency for Toxic Substances and Disease Registry
Public Health Service
U. S. Department of Health and Human Services

Before the
Subcommittee on Commerce, Trade, and Hazardous Materials
Committee on Commerce
U.S. House of Representatives

October 26, 1995


Oral Presentation:

Good afternoon. I am Barry L. Johnson, Ph.D., Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). Mr. Chairman, we commend the Subcommittee for its concern for the public health impact of Superfund sites and bipartisan efforts to strengthen Superfund.

In testimony presented to the Subcommittee on May 23, 1995, ATSDR described some of the key human health findings collected by our agency under CERCLA. My testimony today will highlight changes we support in ATSDR's principal CERCLA responsibilities, based on data and experience since the Superfund Amendments and Reauthorization Act of 1986. My comments today are confined to provisions that would amend §104(i) of Superfund. Most of these provisions are contained in both H.R. 2500, and H.R. 228. Our testimony today is offered in support for the current public health provisions of §104 (i) but with recommendations for enhancements.

My testimony today addresses four of ATSDR's responsibilities: 1) public health assessments of Superfund sites, 2) health studies of communities, 3) community involvement, and 4) community and physician health education.

Public Health Assessments

Legislative Changes in Public Health Assessments: Given the large number of public health assessments conducted by ATSDR and their importance for determining any community health interventions, ATSDR endorses consideration be given by the Subcommittee to the following aspects of site-specific public health assessments:

  1. Because sites vary in terms of current human health hazard, ATSDR supports referring to EPA those sites which represent the greatest hazard to human health for their earliest consideration for remedial action.

  2. We recommend that each site be given a Preliminary Public Health Assessment and based on the outcome, conduct a full public health assessment when warranted.

  3. Earlier involvement by ATSDR in the site-specific activities of EPA, would enhance ATSDR's ability to work with communities and with EPA in ensuring exposure characterization of populations at potential risk.

  4. We recommend retention in the statute of language that gives ATSDR authority to administer grants and contracts with state and local health agencies.

  5. ATSDR's experience since 1986 shows that citizens' ability to petition ATSDR to conduct public health assessments provides an essential response to their concerns. We urge retention of this authority in Superfund.

  6. Though no change in statutory authority is needed, we would like to state for the record ATSDR's commitment to assessing actual levels of human exposure to hazardous substances in potentially at risk populations.

Health Studies

Based on results from site-specific public health assessments, ATSDR identifies populations in communities who are at potential risk of adverse health effects. Using authorities in Superfund, ATSDR and our state health department partners conduct health studies in such communities.

Legislative Changes in Health Studies: ATSDR believes current authority is sufficient to conduct community health studies when indicated by the findings of public health assessments or similar activities.

Community Involvement

Our agency's experience in conducting public health assessments, health studies, and community education has clearly demonstrated that effective community involvement is integral to successful public health intervention in communities near hazardous waste sites.

Legislative Changes in Community Involvement: ATSDR supports the creation of Community Assistance Groups (CAGs) when of interest to a community, and agrees with EPA that environmental advocacy groups should be included in such CAGs. We also support inclusion of ATSDR as a party to the work of CAGs, because public health issues are always a key concern to Superfund communities.

ATSDR agrees that it is appropriate to broaden technical assistance grants to include the collection by grantees of health data and hiring of expert consultants to advise on health studies and related activities. Our experience with community-retained consultants has been generally positive.

Community and Physician Health Education

The Superfund Amendments and Reauthorization Act of 1986 added physician education language to ATSDR's mandates.

Legislative Changes in Distribution of Materials: Given ATSDR's experience with communities, we support the distribution of educational meetings and other information on human health effects of hazardous substances to the general public and to at-risk populations.

Mr. Chairman, we appreciate the opportunity to testify. I would be happy to answer any questions.


Testimony Submitted by Dr. Barry Johnson for the Record:

SUMMARY

As background, CERCLA, as amended, mandates of ATSDR a broad, national program of Superfund site health assessments, health investigations, surveillance and registries, applied research, emergency response, health education, and toxicological database development. Our work is conducted in close collaboration with the Environmental Protection Agency (EPA), state health departments, and local health agencies.

This testimony highlights changes we support in ATSDR's principal CERCLA responsibilities, based on data and experience accrued since the Superfund Amendments and Reauthorization Act of 1986. ATSDR's testimony is confined to provisions that would amend §104(i) of CERCLA.

The public's continuing health concern reinforces the importance of the public health provisions of Superfund. ATSDR supports the current public health provisions of CERCLA, but recommends enhancements in aspects of these provisions.

The testimony is specific to changes in ATSDR's public health mandates under current law. The testimony addresses: 1) public health assessments of Superfund sites, 2) health studies of communities, 3) community involvement, and 4) community and physician health education.


Good morning. I am Barry L. Johnson, Ph.D., Assistant Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR). We recognize H.R. 2500 seeks to provide needed reform to the Superfund program, however, the Administration believes that this bill will not accomplish its goal of protecting human health and the environment adequately.

In testimony presented to the Subcommittee on May 23, 1995, ATSDR described some of the key human health findings accrued by our agency under the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (CERCLA). My testimony today will highlight changes we support in ATSDR's principal CERCLA responsibilities, based on data and experience since the Superfund Amendments and Reauthorization Act of 1986. My comments today are confined to provisions that would amend §104(i) of Superfund most of which are contained in both H.R. 2500, and H.R. 228 which is supported by the Administration. I defer to EPA for the Administration's overall position on the bill.

As background, CERCLA, as amended, mandates of ATSDR a broad, national program of Superfund site health assessments, health investigations, surveillance and registries, applied research, emergency response, health education, and toxicological database development. Our work is conducted in close collaboration with the Environmental Protection Agency (EPA), state health departments, and local health agencies.

As you know, the American public remains quite concerned about the potential impacts of Superfund sites on public health. Since 1991, ATSDR has received more than 4,000 requests for assistance from concerned citizens potentially affected by more than 1,000 sites. ATSDR has had direct contact since 1991 with more than 300,000 citizens concerned about Superfund and hazardous substances issues through our public meetings and other site-specific activities. Additionally, since February 1, 1995 we have received more than 45,000 requests for information via the Internet.

In ATSDR's testimony of May 23, we highlighted our findings on the impact on public health of hazardous waste sites and emergencies related to unplanned releases of hazardous substances. Five of the summary points are repeated here today for their relevance to changes we endorse in Superfund:

  1. Although epidemiologic findings are still unfolding, when evaluated in aggregate (i.e., 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 birth defects and, less well documented, some specific cancers.

  2. Health investigations of communities around some individual hazardous waste sites have found increases in the risk of birth defects, neurotoxic disorders, dermatitis, leukemia, cardiovascular abnormalities, respiratory dysfunction, and immune disorders.

  3. From what we have learned about 1,309 sites assessed by ATSDR from 1987 through December 1994, completed exposure pathways (i.e., people were in the path of substances released from sites) were identified at about 40% of sites. About 60% of EPA National Priorities List (NPL) sites assessed by ATSDR in fiscal years 1993 and 1994 were found to have completed exposure pathways.

  4. Of the 136 sites for which public health assessments were conducted and advisories were issued in fiscal years 1993 and 1994, ATSDR classified 54% as health hazards. Historically, 23% of 1,719 public health assessments for more than 1,300 Superfund sites represented a health hazard, according to ATSDR's criteria.

  5. Physicians and other health care providers in communities around Superfund sites continue to express a significant need for training and technical assistance in matters of hazardous substances.

We consider these findings and the public's continuing concern as reinforcing the importance of the public health provisions of Superfund. The message that I bring today is support for the current public health provisions of the statute, but with some recommendations for enhancements in aspects of these provisions.

My testimony today will relate these five summary statements to changes in ATSDR's public health mandates under current law. The comments that follow will address: 1) public health assessments of Superfund sites, 2) health studies of communities, 3) community involvement, and 4) community and physician health education. The proposed changes will enable ATSDR to sharpen its focus on human health impacts of Superfund sites and to ensure that real risks to real people are promptly addressed.

Public Health Assessments

Since 1986, the Agency, in cooperation with state health departments, has completed more than 1,700 public health assessments of communities around Superfund sites. The 1986 CERCLA amendments require that ATSDR: a) conduct, within 1 year, a public health assessment of every site placed, or proposed for placement, on the NPL, and b) respond to petitions for public health assessments from individuals. Since 1988, ATSDR has received over 400 petitions for health assessments.

Almost all of ATSDR's public health programs under Superfund revolve around its public health assessments. Public health assessments are our agency's evaluation of the environmental and health data pertaining to communities potentially impacted by releases from NPL sites or sites petitioned of ATSDR. Our public health assessments are conducted using environmental contamination data provided primarily by EPA; health outcome data (e.g., birth defects), which states supply when available; and community-reported health concerns.

Public health assessments are unique in the sense that a multidisciplinary team conducts them and we involve the communities in their conduct. Public health assessments constitute ATSDR's key tool to determine the public health agenda at Superfund sites. Public health assessments are ATSDR's principal device for identifying communities that need public health followup.

The Agency's public health assessments currently place sites in specific categories of public health concern. Data from the 136 sites assessed in fiscal years 1993 and 1994 indicate that about 5% of sites presented an Imminent and Urgent Public Health Hazard. With regard to the remaining sites, ATSDR classified 49% of them as Public Health Hazards, 34% as Indeterminate (sites where key environmental data are lacking to adequately determine if persons are being exposed), 10% as No Apparent Public Health Hazard (sites where past and current exposures have been indicated but where current data indicate those exposures are no longer of public health concern), and 2% as No Public Health Hazard. Ranking and classification of sites are not precise sciences; as databases have improved in quality, so has the ranking and categorization of sites.

Legislative Changes in Public Health Assessments: Given the large number of public health assessments conducted by ATSDR and the data accrued from them, ATSDR endorses certain changes in the conduct of site-specific public health assessments:

Health Studies

Based on results from site-specific public health assessments, ATSDR identifies populations in communities who are at potential risk of adverse health effects. Using authorities in Superfund, ATSDR and our state health department partners conduct health studies in such communities. These human health investigations are essential for determining the health impact of individual sites on the health of community residents. The site-specific health information becomes the source for public health interventions, like interdicting exposure to substances and alerting local physicians and health departments.

ATSDR's experience indicates communities want to know their health status and willingly participate in health studies. Participation rates typically exceed 70 percent of eligible persons.

Legislative Changes in Health Studies: ATSDR believes current authority is sufficient to conduct community health studies when indicated by the findings of public health assessments or similar reasons.

Community Involvement

Our agency's experience in conducting public health assessments, health studies, and community education has clearly demonstrated that effective community involvement is integral to successful public health intervention in communities near hazardous waste sites. One of our agency's most effective ways in interacting with communities is through what we call Community Assistance Panels (CAPs). ATSDR's CAPs typically involve 10 persons or more who reside in the community and represent local health concerns. Membership includes local residents, health care providers, political leaders, and members of the business community. Our work with CAPs has been important to assure community health concerns are addressed.

As an example, in 1992 ATSDR established a Community Assistance Panel (CAP) for the Brio NPL site in Friendswood, Texas. The Panel was formed because of community concerns about birth defects and other health problems in the area adjacent to the Superfund site. The panel consists of 15 people and includes homemakers, a school teacher, a hospital administrator, real estate agents, a newspaper publisher, and at one time, a local elected official. As ATSDR commenced its response to the community's health concerns, we sought and received advice from the CAP on the nature of their concerns. They shared data with ATSDR and we discussed study protocols and data collection methods with the CAP. The end result was an open, public process that developed trust between the parties. In addition, the CAP became the key community conduit for other agencies involved at the site, including the EPA and state and local health agencies.

Legislative Changes in Community Involvement: ATSDR supports the creation of Community Assistance Groups (CAGs) when of interest to a community, and agrees with EPA that environmental advocacy groups should be included in such CAGs. We also support inclusion of ATSDR as a party to the work of CAGs, because public health issues are always a key concern to Superfund communities. We also believe that it is important for ATSDR to collect and consider health and environmental data supplied by CAGs.

ATSDR agrees that it is appropriate to broaden technical assistance grants to include the collection by grantees of health data and hiring of expert consultants to advise on health studies and related activities. Our experience with community-retained consultants has been generally positive. They provide a technical resource to the community and often help clarify difficult technical issues between government agencies and a community.

Community and Physician Health Education

The Superfund Amendments and Reauthorization Act of 1986 added physician education language to ATSDR's mandates. Specifically, ATSDR was mandated to "..assemble, develop as necessary, and distribute to the States, and upon request to medical colleges, physicians, and other health professionals, appropriate educational materials (including short courses) on the medical surveillance, screening, and methods of diagnosis and treatment of injury or disease related to exposure to hazardous substances..".

ATSDR has responded to this mandate by developing training courses and materials on hazardous substances, diagnostic methods, and surveillance. Local physicians who practice medicine in communities around Superfund sites, in particular, have indicated the importance of credible information on the health effects of hazardous substances.

We estimate over 100,000 physicians and other health care providers have enhanced their health care practices through these courses and materials as the result of Superfund. We believe the ultimate goal of health professions education under Superfund is to integrate environmental medicine as a core element of community-oriented public health practice at the local level.

In addition to physician education, ATSDR has identified the need for community health education. For some sites, education about avoiding identified health hazards is the most effective intervention. ATSDR works closely with state and local health agencies to provide the materials and resources for use by community groups and local authorities. Our experience has been quite positive.

Some examples of this include our work at the Chattanooga Creek Site in Tennessee where ATSDR staff worked with the local health department and school system to educate children about the dangers in swimming in the contaminated creek; another is Wisconsin State Health Department's work with Hmong anglers teaching them how to avoid consumption of the most contaminated part of fish by filleting them; and a third is our work with the Panhandle Health Department in Idaho working with the community to stop planting vegetable gardens in soil contaminated with lead.

Legislative Changes in Distribution of Materials: Given ATSDR's experience with communities, we support the distribution of educational meetings and other information on human health effects of hazardous substances to the general public and to at-risk populations.

In closing, let me also note that ATSDR is one of eight agencies comprising the Public Health Service; we are the principal federal public health agency involved with hazardous waste issues. Our headquarters are in Atlanta. The ATSDR Administrator also serves as the Director of the Centers for Disease Control and Prevention (CDC). Recently, the Department has proposed to merge ATSDR with CDC under the President's reinventing government initiative. Public access to environmental health information and expertise currently available from CDC and ATSDR would be facilitated by merging these organizations. The growing expertise gained from ATSDR's work in hazardous waste sites should be applied to other environmental public health problems. Conversely, CDC is a visible and widely known public resource for technical expertise and quick response to public health problems. Incorporating ATSDR into CDC would reduce the fragmentation of environmental health expertise and would be beneficial for the Nation's environmental health programs. Legislation will be proposed to the Congress to effect this change. At that time, more specific details will be available to the Congress.

Mr. Chairman, we appreciate the opportunity to testify. I would be happy to answer any questions.



Copies of ATSDR documents are available from the ATSDR Information Center.
Call toll-free 1 (888) 42-ATSDR or e-mail ATSDRIC@CDC.GOV

See the ATSDR News Archive for previous news items.

Back to ATSDR Home page


This page last reviewed on March 8, 2002

Joanne Cox: JDCox@cdc.gov


ATSDR Home  |  Search  |  Index  |  Glossary  |  Contact Us
About ATSDR  |  News Archive  |  ToxFAQs  |  Public Health Assessments
Privacy Policy  |  External Links Disclaimer  |  Accessibility
U.S. Department of Health and Human Services