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It is a special pleasure to discuss ATSDR's accomplishments and plans, as this month marks the 20th anniversary of ATSDR's creation. I am very proud of ATSDR's progress over the past 20 years in advancing our understanding of the public health impacts of exposure to hazardous substances and in undertaking activities to prevent and 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 much larger than was once thought. 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, a site that 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.

Our experience and expertise in chemical toxicology, in emergency response, and in fostering coordination among public health, environmental, and emergency response agencies, as well as organizations at the local, state, and federal levels, is extensive. In addition, ATSDR has an important role in disseminating critical information to agencies and organizations with a role in terrorism preparedness and response.

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

Through ever-expanding partnerships with other federal, state, tribal and local agencies and with private and public interest organizations, we continue 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 achieve our public health mission more efficiently and effectively, both through disseminating critical information and through drawing on the expertise of others.

During the past year, in addition to ongoing work with the Environmental Protection Agency (EPA), we have collaborated with a broad range of agencies and organizations, including the Centers for Disease Control and Prevention (CDC), the National Institute of Environmental Health Sciences (NIEHS), the Federal Bureau of Investigation, the Federal Emergency Management Agency (FEMA), the Chemical Safety and Hazard Investigation Board, the American Chemistry Council, colleges and universities, and dozens of state and local public health organizations.

We have cooperative agreements with 31 state health departments, under which they conduct health assessments and undertake other environmental health activities. In addition, 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 with a number of universities and state health departments through ATSDR's Great Lakes Human Health Effects Research Program. These programs help ATSDR fill the gaps in knowledge about the effects of hazardous substances on human health.

We continue 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 and facilities of particular concern, and to identify susceptible populations and potential health effects.

In addition to meeting our mandated Superfund-related obligations, we also help communities address emergency preparedness and response to acts of terrorism, while at the same time strengthening preparedness within ATSDR. 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 even more responsive and capable as a public health agency.

This testimony addresses some of the activities that will be supported under the FY 2004 budget. These activities are critical to fulfilling our mandates under Superfund and to enhancing terrorism preparedness.

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 a site poses a threat to the public's health and to taking needed actions to protect public health, working with EPA and states.

A good example of the wide range of site-specific activities undertaken by ATSDR is our ongoing work in addressing tremolite asbestos contamination in Libby, Montana.

ATSDR has been working with EPA and with other federal, state, and local public health agencies to address the health threats posed by asbestos contamination in Libby. We conducted a medical screening program that involved testing of over 7,300 residents who were exposed to asbestos in that community. That 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.

ATSDR is now providing funding and technical assistance to help the State of Montana implement a follow-up testing program for former workers, residents, 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 worked with 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 in Libby and to provide mental health services to the Libby 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, approximately 10,000 -15,000 people, to help track health conditions of these exposed persons and to enable us to provide them any new information that becomes available as part of an effort to assist in obtaining optimum medical care and taking preventive actions.

Our work to assess and address the health problems associated with exposure to asbestos from Libby has expanded to include 244 sites in the United States that received vermiculite ore from the W.R. Grace mine in 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 that 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 with this testimony, were chosen because the exposure of former workers, their household contacts, and other individuals was deemed significant enough to warrant further evaluation. The priority sites include facilities in Beltsville, Maryland; St. Louis, Missouri; Marysville, Ohio; and Dallas, Texas. As reports on these sites become available, we will address the need for further ATSDR health evaluations of former workers or other potentially exposed individuals at these sites. Additional health work at these sites may well be required in the future.

ATSDR has also provided funding to nine states to conduct health statistics reviews, which offer a way of identifying any heightened incidence of disease associated with asbestos exposure at vermiculite sites around the country, and we continue to recruit states to join this effort. ATSDR expects to release an interim report of results of the health statistics reviews by June 30, 2003.

Our Superfund-related work encompasses environmental problems and health threats that extend well beyond those posed by 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 key gaps in information.

Two key programs that contribute to that effort are the Great Lakes Human Health Effects Research Program and the Minority Health Professions Foundation programs.

• We support the Great Lakes Human Health Effects Research Program in its efforts to build on and amplify the results of past and ongoing fish-consumption research in the Great Lakes basin. One of the significant findings under this program is that serum polychlorinated biphenyl (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 and its Environmental Health and Toxicology Research Program continues to help us close the information gap in available scientific data on the health impacts of exposure to 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 areas.

To further assist communities and apply the benefits from increasing knowledge about the relationship between exposure to toxic substances and resulting disease, in the past year ATSDR has begun implementing an applied public health environmental research agenda. In developing this program ATSDR has been working closely with other federal agencies, including the National Institute of Environmental Health Sciences, to best leverage resources and develop collaborative approaches to address common research needs. As part of this extramural research initiative ATSDR will pursue new partnerships with state-based and academic institutions. This research agenda will enable us to answer with greater certainty the questions and concerns raised by communities exposed to toxic substances and hazardous wastes, and to improve our ability to provide the best service to communities in the vicinity of Superfund sites.

Site specific health studies are another important tool in advancing our knowledge about the relationship between exposure to hazardous substances and any resulting disease. 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 PCBs. We have been working with the Alabama Department of Public Health to gather, analyze, and interpret vital statistics and existing data describing the incidence of cancer for residents of Anniston, and we will be funding multi-year epidemiologic investigations to study the health effects of exposure to PCBs in this community. We will work closely with the institution(s) 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 have invited a panel of experts to assist us in developing an appropriate health study design to address the lead exposures experienced in this community. We are particularly interested in studying the effects of exposure to lead among children, adolescents, and young adults. In a blood lead screening effort conducted in 2001, 30 of 67 children six years old or younger living closest to the Doe Run lead smelter had blood lead levels at or above the CDC action level for lead of 10 ug/dL. A preliminary review of available blood lead data from testing in 2002 of 58 children under 6 years old indicate elevated blood lead levels in 17% of those children. Further study is warranted in view of the fact that these levels are more than double the national prevalence rate of 7.6% and the Missouri rate of 8%. Factors contributing to the reduction may include community education regarding possible pathways of exposure, health effects of exposure and measures to reduce exposure.
• In Fallon, Nevada, ATSDR worked closely with CDC's National Center for Environmental Health (NCEH), the Nevada State Health Division (NSHD), and other agencies to investigate a broad range of possible environmental causes of an unusually high number of childhood leukemia cases there. ATSDR conducted a comprehensive public health assessment process, consulting with community members to identify their health and environmental concerns and then examining a variety of possible environmental pathways through which people might have been exposed to hazardous substances. Earlier this year, ATSDR, CDC/NCEH and NSHD issued reports on the findings of this investigation and held a number of public meetings with the Fallon community. Despite extensive investigation, the agencies have not found a relationship between environmental exposures to contaminants and the leukemia cases.
• In San Antonio, Texas, we evaluated potential releases of hazardous substances from Kelly Air Force Base, on-base drinking water, and current and past air emissions for associations with health concerns of communities surrounding the base. We are now assisting the Air Force in evaluating a case series of amyotrophic lateral sclerosis, a motor neuron disease, in this community.
• 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 by children for treatment of 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 carry out a Public Health Action Plan to address recommendations made in a rapid response health consultation.
• In Elmore, Ohio, we investigated whether beryllium air emissions and possible worker take-home contamination from the Brush Wellman Elmore plant present a health hazard to the community. Working with the Ohio Environmental Protection Agency, Ohio Citizen Action, and Brush Wellman, we issued a health consultation and conducted several public meetings to address community concerns.
• In El Paso, Texas, we worked with the Texas Department of Health to address that city's concerns about heavy metal contamination near Sun Bowl stadium. The health department, which receives funding from ATSDR, conducted a series of health consultations looking at lead and arsenic levels in soil. Several residential yards and a daycare facility were found to have amounts of lead and arsenic that exceeded health based screening values. Exposure to lead and arsenic at some of these areas could pose an unacceptable public health hazard to children.
• In Tarpon Springs, Florida, we recently issued for public comment a public health assessment for 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.
• In northeast Denver, Colorado, we have been working with the Colorado Department of Public Health & Environment and the University of Colorado to conduct 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 cleaning up the so-called VB I-70 site.

Another key function of ATSDR's Superfund program is to educate both the health community and the general public about the hazards of specific chemicals and waste sites. Recent work in this area includes:

• In Marion, Illinois, we have worked with the Illinois Department of Health to educate teachers about and improve storage and handling of potentially dangerous chemicals, including mercury, in schools. 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 fiscal year 2002, pediatricians at these clinics who are especially cross-trained in environmental medicine evaluated more than 1,500 children and provided an additional 1,500 phone consultations to other pediatricians in their regions.

In July of 2002, the PEHSU clinic in Chicago was contacted by the Chicago Housing Authority, which was 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 much needed- resource can help us partner to protect children from the effects of toxic exposure.

During the past year, ATSDR has continued to help communities improve emergency preparedness and develop a capacity for rapid response to acts of terrorism. ATSDR's role in countering health impacts of terrorism, particularly in the areas of chemicals and the environment, is essential to national safety. We continue to participate actively with CDC, EPA, the Department of Homeland Security (DHS), and state and local health agencies in undertaking planning and preparedness in areas that focus on the unique capabilities of ATSDR.

For example, we have used partnerships to address emergency response capacity in our work with the FEMA/DHS Comprehensive HAZMAT Emergency Response-Capability Assessment Program, or CHER-CAP. ATSDR has worked with FEMA/DHS on two local emergency planning exercises (the so-called "Tri-town" exercise in Connecticut, and one in Boston, Massachusetts) to assist those communities in improving their response to a release of hazardous materials. ATSDR's contributions included bringing the medical community into the local planning process and assessing hospital emergency preparedness and response 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 of this year ATSDR will participate in a large-scale regional emergency preparedness exercise in Louisville, Kentucky with EPA, FEMA/DHS, CDC, and state and local public health agencies as well as hospitals, physicians, and fire departments. In this simulation, we will provide answers to toxicological and medical questions and help maintain a "victim's registry".

We also partner with the private sector to expand the utilization of our products. In conjunction with the American Chemistry Council, we distributed the document 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 provide 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) is a major resource in our efforts to reduce and even prevent the injury and death that result from hazardous substances events. The system captures incident and facility data as well as data on health outcomes from hazardous material (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, including incidents of terrorism. 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 that has been used to help ensure that first responders know the appropriate personal protective gear to use in dealing with the clean-up of clandestine methamphetamine labs.

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. For example, ATSDR distributed a CD-ROM version of our toxicological profiles and medical management guidelines to state and local agencies and to first-responders. 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 are working to fill the gaps in information that still exist so that we can be even better prepared. At the same time, we are sharing the information that we do currently have with all relevant parties, including first-responders, hospital emergency rooms, poison control centers, clinicians, and the general public.

Other activities that demonstrate ATSDR's commitment to improving community emergency preparedness and to developing a rapid response capacity to terrorism include the following:

• 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 as members of 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/DHS, we are helping the New York City Department of Health and Mental Hygiene 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.
• ATSDR 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.
• ATSDR has 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.

• EPA, to develop data and distribute information on chemicals and other hazards;
• our sister agency CDC, other agencies within the Department of Health and Human Services, and state and local agencies to help train health responders, to deal with chemical, radiologic, and environmental terrorist threats; and
• 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 productivity to continue. We have been good stewards of the public funds that Congress has entrusted to us. We continue to look for ways to maximize our contribution to the public's health through leveraging partnerships and technology. And, ATSDR has undertaken a major internal initiative in strategic planning for the next five years. We are tying our budget and staffing levels to specific performance planning goals and objectives, and striving to improve our program performance measures with more outcome and impact data, in an effort to provide Congress 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.

Thank you for the opportunity to provide this testimony.

This page last updated on May 1, 2003

Joanne Cox / ATSDR-OpeaMail@cdc.gov

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