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Mr. Walsh: Dr. Falk, as I noted in my opening remarks, the ATSDR budget request of $78.2 million represents an increase of $3.4 million over last year. I believe it is the first increase for your Agency proposed by the Executive branch in several years and, if approved, it also represents the largest budget ATSDR will have in at least seven years. Some $2.5 million of this increase would go to a new program-the National Environmental Surveillance Program at Superfund Sites, or "NESP"-leaving an increase of just $900,000 for your ongoing programs. I will have a number of detailed questions about NESP in a few moments, but first please tell us if you believe that your request is sufficient to carry out your ongoing activities without disruption?
Dr. Falk: The $3.4 million Fiscal Year (FY) 2002 budget increase is comprised of $2.5 million requested for the National Environmental Surveillance Program, $1.4 million for a mandatory pay raise for ATSDR employees, and a reduction of $500,000 for a one-time FY 2001 project, the Alaska Native Subsistence and Dietary Contaminants Program. Funding of the mandatory pay raise allocation helps us carry out our ongoing activities; otherwise this increase would need to be funded from existing programs. We anticipate functioning without disruption.
Mr. Walsh: According to information contained in the 2002 Budget Appendix, you expect to have no unobligated balance at the end of this fiscal year to carry forward into 2002. If this is the case, does your budget request allow you sufficient flexibility should unforeseen situations-such as another Libby, Montana-type problem-require your immediate attention?
Dr. Falk: Yes, the FY 2002 Budget proposes to expand the Secretary's existing transfer authority across all of the HHS discretionary appropriations, including ATSDR, to address unforeseen public health circumstances. Previously, this transfer authority was only applicable to those HHS accounts within the Labor/HHS/Education appropriations bill. The FY 2002 Budget also proposes to increase this authority from 1 to 6 percent of all HHS discretionary appropriations.
Mr. Walsh: It is not readily apparent in your budget justification whether or not you have built some flexibility into your budget request for unforeseen situations, whether they be major or minor in nature. If you have built in such flexibility can you tell us how much you have set aside for such emergencies; and should we assume that it would come out of your account for grants, subsidies and contributions? If you have not built in this flexibility, can you explain for the committee the reasons you have not?
Dr. Falk: ATSDR's FY 2002 budget request level of funding should be sufficient to handle unforseen situations of a minor nature with internal readjustments. The difficulty has been the unanticipated major events that occur periodically but not every year. Historically, unanticipated major events require significant agency resources. Setting aside these resources from our regular appropriation would adversely impact our ability to carry out needed public health programs.
Mr. Walsh: Again according to your budget materials, major elements of your plans for NESP include support for state health departments in establishing pilot surveillance systems and support for states and state-based universities in conducting research associated with Superfund sites. Once again, how do your plans in this regard differ from what you are already doing?
Dr. Falk: ATSDR in the past, particularly in response to state and local health departments and affected communities, has conducted limited and often ad hoc surveillance projects for diseases at increased incidence near Superfund sites. These usually have been pilot or demonstration projects, focused on a specific disease of concern in a local area. This has not been a sustained effort, nor part of a long term plan to improve environmental disease surveillance for communities near Superfund sites. The NESP will be a planned, coordinated program to improve environmental disease surveillance efforts by state health departments, specifically for some of the diseases of greatest concern to communities around Superfund sites. ATSDR will develop standardized case definitions and methods, and uniform approaches to data acquisition and analysis. Demonstration projects in multiple state health departments will enable selection of the most effective strategies. Universities will assist in methods and strategy development, research, and evaluation of the programs. ATSDR will pay close attention to enhancing the ability to link environmental and disease data, including the use of Geographic Information System techniques. ATSDR will also work closely with NIH and CDC to gain from their experience and has already initiated enhanced collaborative efforts with CDC, the NIEHS, and NCI.
Mr. Walsh: Will states and universities have an opportunity to compete to participate in this program? If so, when during the fiscal year would you realistically expect the program to be fully operational?
Dr. Falk: All states and state-based universities or colleges would be eligible to compete under this program. (ATSDR's grant authority is limited under SARA to states and subdivisions thereof). It is anticipated that the grant program will be operational by the end of FY 2002. We anticipate that state health departments will have the primary responsibility for developing surveillance systems within their jurisdiction. We also see a key role for universities particularly in the areas of methods development, program evaluation, technical assistance, and research.
Mr. Walsh: How much of your proposed $2.5 million budget for NESP will go to supporting such state pilot surveillance systems and research activities? At what level are other state and university related programs, research oriented and otherwise, now being funded by ATSDR?
Dr. Falk: Approximately 75% of the dollars in the NESP program will be provided to states and universities. ATSDR provided in excess of $14 million for state and university related programs in FY 2000.
Mr. Walsh: As I mentioned in my earlier remarks, the NESP proposal includes a request for additional personnel as well as for additional dollars. Your budget submission would seem to indicate that two additional FTEs are necessary to implement the program. How many FTEs in total would be assigned to the NESP activity? Would moving personnel from within the Agency to this new project cause a deficiency in other ongoing programs at ATSDR?
Dr. Falk: Implementation of the NESP proposal during FY 2002 will require 2 additional FTEs as requested in addition to utilizing 3 existing FTEs assigned to this new program from other projects that are being completed. Staff may be reassigned in out years as the NESP initiative evolves.
Mr. Walsh: You have reported that the cost of these two new FTEs will be $160,400. Both employees would be rated as GS-12s with salaries and benefits totaling $80,200 each. One is listed as a computer programmer and one is listed as an epidemiologist. Is this information found in your budget submission accurate? Are computer programmers and epidemiologists truly paid on the same scale? Does ATSDR have trouble recruiting epidemiologists at the GS-12 pay level?
Dr. Falk: ATSDR plans to recruit both of these positions at the GS-12 level. The payroll information contained in the budget request includes an amount projected to cover not only salary but employee benefits. Additionally, the computer specialist may be eligible for a higher pay amount in accordance with the recently revised pay schedule for information technology employees. It should be noted that due to job market competition both computer specialists and epidemiologists are positions that are difficult to recruit in the Atlanta area and may merit starting salaries above the minimum entry step.
Mr. Walsh: For a number of years now the Committee has provided either a specific dollar amount or directed the Agency to provide up to a certain level of funding for the Great Lakes Fish Consumption study. Can you give us an idea of the funding, federal and otherwise, that has to date been provided to this project as well as an update on what we have so far learned?
Dr. Falk: ATSDR is unaware of other funding for this project. In 1990, Congress amended the Great Lakes Critical Programs Act that required EPA, in consultation with ATSDR to submit a report assessing the harmful health effects of water pollutants in the Great Lakes basin. In support of the directive, ATSDR developed a Great Lakes Human Health Effects Research Program (GLHHERP) that has supported up to 10 research grants annually to State health departments or academic institutions. ATSDR has provided approximately $23.6 million for the GLHHERP during Fiscal Years 1992-2000.
Key findings from ATSDR's GLHHERP indicate:ATSDR is using these findings to work with State health departments and other critical groups and to develop materials that enable Great Lakes states to protect susceptible populations, especially women of reproductive age and young children about safe fish consumption. This activity has the potential for protecting future generations from adverse developmental effects.
Mr. Walsh: What remains to be studied to complete this project? How long would you expect this project to continue to its completion, and how much additional would you anticipate it will cost?
Dr. Falk: Key follow ups are necessary at this time to complete the research phase of this project. These include:
FY 2001 begins the 4th 3-year project period (or cycle). Completing this cycle and probably one additional is needed to bring closure to the key public health questions or follow ups identified above.
The ATSDR Great Lakes Human Health Effects Research Program (GLHHERP) supports nine cohort studies of vulnerable communities. These cohorts include about 10,000 individuals such as young children first studied at birth, subsistence anglers, Native Americans, reproductive aged men and women, and the elderly.
In the FY 2002 Budget request, the Administration has stressed fiscal discipline and has worked with Congress through Budget Resolution to set a reasonable funding level for FY 2002. Any increases above the budget request would have to be funded within the available totals for discretionary spending.
Mr. Walsh: Do you plan or should you plan additional related studies as a follow-on, once the Fish Consumption project is completed?
Dr. Falk: Research findings from ATSDR's Great Lakes Human Health Effects Research Program (GLHHERP) show compelling evidence of adverse health effects associated with consumption of contaminated Great Lakes sport fish for some vulnerable communities. To assure sound public health practice, ATSDR has initiated prevention and intervention efforts with state and community-based organizations that target the most susceptible, or vulnerable population. One ongoing strategy that ATSDR anticipates additional follow-up involves determining the community's level of awareness about health advisories for fish consumption. Based on our findings, ATSDR is working with a number of partners to help educate those vulnerable populations with limited awareness about safe fish consumption.
In addition, as part of its intervention strategy, ATSDR plans to conduct additional biomarkers research that will result in the early identification of vulnerable populations before the development of adverse, and possible irreversible, health effects develop. Further research on established cohorts is a possibility, and this aspect will be evaluated after the Great Lakes Fish Consumption project is concluded.
Mr. Walsh: In a similar vein, the Congress has provided several million dollars over the past five years for the Toms River Cancer Cluster Study in New Jersey. Last year we provided what was announced to be the final increment to complete the study. First, will the study in fact be completed this year?
Dr. Falk: The on-going Case Control Study for Childhood Cancer in Dover Township, New Jersey will be completed this calendar year. This epidemiological investigation will examine the relationship between cases of childhood leukemia and central nervous system cancers and environmental and other risk factors. It is scheduled to be released in December 2001. Additionally, because ATSDR was approached by other states to assist in similar cancer incidence investigations, the agency is also conducting a multi-state case control study of childhood brain cancers in Pennsylvania, Florida, New Jersey, and New York. This study is designed to identify risk factors applicable to diverse areas and populations and enhance the scientific understanding of the relationship between childhood brain cancer and exposure to toxic substances. Data collection for this ongoing study will be completed in 2001 and a final report is scheduled to be released in 2002.
The New Jersey DHSS and ATSDR released the Childhood Cancer Incidence Analysis Health Consultation which confirmed the elevated rates of childhood leukemia and central nervous system cancers in Dover Township over the 17 year period of 1979 to 1995. In Dover Township, overall childhood cancer incidence was higher than expected and the leukemia incidence was elevated in females, particularly under the age of five. In the Toms River section, overall cancer incidence was also elevated. This elevation was seen in female children under age five, especially for leukemia and brain and central nervous system cancer.
Because of the elevated rates of childhood cancers and exposure assessment results, NJDHSS and ATSDR as well as other environmental agencies have implemented a number of intervention measures. These ranged from additional drinking water monitoring and treatment, to community and health care provider education all aimed at reducing exposure and adverse outcomes. Additional environmental and public health interventions and follow up actions may be warranted depending on the results of the on-going epidemiological investigations.
Mr. Walsh: Another ongoing activity ATSDR has been involved with is the Pediatric Environmental Health Specialty Units established by you on a regional basis to identify and study certain children's environmental health issues.
Dr. Falk: Support to the Pediatric Environmental Health Specialty Units (PEHSUs) has totaled approximately $2.7 million during FYs 1998-2000. ATSDR plans to provide $1.4 million for the PEHSUs in both FY 2001 and FY 2002. ATSDR currently supports ten PEHSUs, one in each federal region, with assistance from EPA. The PEHSUs are a new clinical referral resource for pediatricians (and other primary care providers) whose patients have environmental exposures or suspected triggers of disease. The positive result is that healthcare providers have ready access to reliable information, clinical referrals, and training in this emerging new field. Each facility provides combined expertise in both pediatrics and occupational-environmental medicine; the two sets of specialists work together to help the referring clinicians evaluate and manage their patients. PEHSUs also provide access to other pediatric subspecialists and a certified poison control center. Several thousand children were referred for clinical evaluation or guidance in the first year alone; previously no such referral options existed. The PEHSUs help health professionals obtain relevant training materials. A possible negative result is that if utilization rates continue to rise rapidly, as awareness of the PEHSUs grows, then the demand for specialized pediatric environmental health services could exceed capacity, at current levels of support.
In FY 2002, ATSDR intends to continue funding the PEHSU program at $1.4 million. We only recently selected our 10th program (Denver), and our priority is the successful initiation of the PEHSUs. We are pleased that they have all been established in premier pediatric programs, and all are linked to the successful and well-known Association of Occupational and Environmental Clinic programs. ATSDR is also pleased by the recognition and strong support they are receiving from the public and the broader pediatric community. ATSDR recognizes that any future growth in this program must be done in close coordination with EPA, affected communities, and the leaders of the pediatric community. ATSDR has had recent discussions, e.g., with key representatives of the American Academy of Pediatrics, the Ambulatory Pediatrics Association, and the March of Dimes, to see how the PEHSUs relate to ongoing developments in the emerging fields of pediatric and obstetric environmental medicine. There are potential options for the future, e.g., the PEHSUs would be ideal locations for training future fellows in pediatric/obstetric environmental medicine. For FY 2002, however, the goal is for consolidation, and to have all ten of these PEHSUs on solid footing.
Mr. Walsh: With regard to the Hazardous Substances Emergency Events Surveillance (HSEES) program, you have reported that the use of the system data promotes the prevention of environmental injuries, including changes to municipal emergency plans, and has resulted in a reduction of the number of deaths experienced by HAZMAT first responders. Can you give us more specific information of what ATSDR is doing with this program and provide details in support of this reduction of HAZMAT deaths?
Dr. Falk: Data from the participating states are analyzed and reported for the frequency and types of injuries of responders, and training programs are implemented, or revised response plans are developed, based on the most common types of releases which result in injuries. Sharing information to make responders more aware of their risks encourages them to use their personal protective equipment appropriately and avoid injury. For example, during FY 2000, fact sheets on ammonia and chlorine were distributed to county emergency management agencies, fire departments, police, local HAZMAT teams, and other first responders. Fact sheets were used as training tools to improve safety when dealing with ammonia releases. Another example is data from the MMWR article (November 2000) "Public Health Consequences Among First Responders to Emergency Events Associated with Illicit Methamphetamine Laboratories-Selected States, 1996-1999," were presented at national meetings of public health professionals and used for training first responder managers in a number of states.
Ten states have been in HSEES since 1993. In these 10 states, there have been no deaths in responders (HAZMAT, police, firefighters, EMT, etc) since 1995 (4 deaths reported in 1995). The number of responders injured has decreased each year from 1994 through 1998 and the percentage of events in which responders have been injured decreased from 1993 through 1998. While these downward trends may not be directly attributable to HSEES, the efforts of the program's education and information sharing hopefully contributed to these outcomes.
Mr. Walsh: Does ATSDR coordinate its work on this program with FEMA and other federal agencies, particularly with regard to changing municipal emergency response plans? If so, please define your Agency's relationship with FEMA and any other federal agencies.
Dr. Falk: ATSDR and Federal Emergency Management Agency (FEMA) plan to meet during May of this year to discuss coordination and data sharing matters. ATSDR works with FEMA within the National Oil and Hazardous Substances Response Team. Both agencies are represented on this team, which coordinates federal responses to hazardous substances emergencies. The National Response Team (NRT) holds its regular meetings monthly and conducts joint exercises at an annual meeting. Further, ATSDR works with FEMA as part of Regional Hazardous Substance Response Teams and represents DHHS on the NRT. ATSDR is engaged in extensive emergency preparedness, prevention and response activities in coordination with the EPA, the Chemical Safety and Hazard Investigation Board (CSB), the Coast Guard, and State and local emergency preparedness activities. ATSDR also has a memorandum of understanding with the CSB to provide technical expertise and advice regarding the health effects of chemical exposures, training in environmental public health, and health and safety programs to the CSB.
Mr. Walsh: In addition to its appropriated dollars, the ATSDR expects to receive approximately $26 million in reimbursements for work performed on behalf of other governmental agencies. Please provide for the Record a list of the entities from whom you expect to receive such reimbursements, the dollar amount you expect to receive, and a brief description of the work you will perform for these entities.
Dr. Falk: Exhibit E1 - E2 on page 5 of ATSDR's FY 2002 Congressional Justification (CJ) reflects projected reimbursements of $25 million for FY's 2001 and 2002. The reimbursable dollar estimates by agency were based on cost projections that would allow ATSDR to complete the various tasks identified either in the statements of work (SOW) or annual plans of work (APOW) by agency. The following is a breakout of the projected reimbursable funding by agency with a brief description of the activities being performed:
| Agency | Projected Amount | Description |
|---|---|---|
| Department of Energy | $13,585,382 | Assessing the presence and nature of health haards at specific DOE sites. |
| Department of Defense | $9,500,000 | Assessing the presence and nature of health hazards at specific DOD sites. |
| Department of Interior Bureau of Indian Affairs | $250,000 | Assessing the presence and nature of health hazards as specific DOI/BIA sites. |
| U.S. Agency for International Development | $308,328 | Assessing the presence and nature of health hazards at specific USAID sites. |
| Peace Corps | $27,000 | Provides funds for the salary and benefits of an ATSDR employee who will serve as a consultant for Peace Corps health care providers. |
| National Institutes of Health | $45,000 | To fund the salary and benefits of an ATSDR employee who will participate in the presidential special oversight board for The Department of Investigations of Gulf War Chemical and Biological Agents. |
| EPA (5 agreements) | $1,284,290 | To partially fund the Pediatric Environmental Health Specialty Units and several childhood lead screening projects. |
| Total | $25,000,000 |
| Object Class | FY 1999 Appropriation | FY 2000 Appropriation |
|---|---|---|
| Personnel Compensation: | ||
| Full-Time Permanent (11.1) | $18,924,512 | $20,295,867 |
| Other than Full-Time Permanent (11.3) | $657,995 | $766,545 |
| Other Personnel Compensation (11.5/11.8) | $719,174 | $815,286 |
| Total Personnel Compensation | $20,301,681 | $21,877,698 |
| Civilian Personnel Benefits (12.1) | $5,467,325 | $5,951,924 |
| Subtotal Pay Costs | $25,769,006 | $27,829,622 |
| Travel (21.0) | $1,617,461 | $1,479,833 |
| Transportation of Things (22.0) | $147,205 | $178,859 |
| Rental Payments to GSA (23.1) | $2,694 | $811 |
| Rental Payments to Others (23.2) | $23,423 | $29,241 |
| Communications, Utilities, and Misc. Charges (23.3) | $684,934 | $753,363 |
| Printing and Reproduction (24.0) | $366,953 | $277,573 |
| Other Contractual Services: | ||
| Advisory and Assistance Services (25.1) | $1,464,943 | $3,777,885 |
| Other Services (25.2) | $1,562,804 | $1,786,197 |
| Purchases from Government Accounts (25.3) | $9,448,760 | $7,740,120 |
| Operation and Maintenance of Facilities (25.4) | $69,052 | $16,339 |
| Research and Development Contracts (25.5) | $7,252,532 | $5,249,583 |
| Medical Services (25.6) | $20,243 | $18,490 |
| Operation and Maintenance of Equipment (25.7) | $3,820,307 | $369,083 |
| Subtotal Other Contractual Services | $23,638,641 | $18,957,697 |
| Supplies and Materials (26.0) | $402,214 | $285,351 |
| Equipment (31.0) | $2,099,488 | $2,429,287 |
| Grants, Subsidies, and Contributions (41.0) | $21,247,955 | $17,761,895 |
| Subtotal Non-Pay Costs | $26,592,327 | $23,196,213 |
| Total Budget Authority by Object Class | $75,999,974 | $69,983,532 |
Mr. Walsh: On pages 18 and 19 of your budget justification, you have provided a so-called "Output Table." My review of the table indicates that, despite an increase of resources in 2002 as compared to 2000 and 2001, your output levels for the coming fiscal year will essentially stay flat. Why aren't outputs going up in relation to funding?
Dr. Falk: Of the total $3.4 million increase, $1.4 million is to cover mandatory federal pay raises for federal government employees in FY 2002 and will not result in increased outputs. A $2.5 million increase relates to a new initiative, " The National Environmental Surveillance Program at Superfund Sites " which is reflected on page 18 of the Congressional Justification. Additionally, the FY 2002 budget request reflects a reduction of $500,000 for a one-time FY 2001 Alaska Native Subsistence and Dietary Contaminants Program. Other programs remain at level funding and thus result in level outputs.
Mr. Walsh: For the Record, please provide the specific pay scale for grades 1 through 8 for your Commissioned Corp.
Dr. Falk: The table follows:
| Pay Grade | 2 or Less | Over 2 | Over 3 | Over 4 | Over 6 | Over 8 | Over 10 | Over 12 |
|---|---|---|---|---|---|---|---|---|
| O-8 | 6,838.20 | 7,062.30 | 7,210.50 | 7,252.20 | 7,437.30 | 7,747.80 | 7,819.80 | 8,114.10 |
| O-7 | 5,682.30 | 6,068.40 | 6,068.40 | 6,112.50 | 6,340.80 | 6,514.50 | 6,715.50 | 6,915.90 |
| O-6 | 4,211.40 | 4,626.60 | 4,930.20 | 4,930.20 | 4,949.10 | 5,160.90 | 5,189.10 | 5,189.10 |
| 0-5 | 3,368.70 | 3,954.90 | 4,228.80 | 4,280.40 | 4,450.50 | 4,450.50 | 4,584.30 | 4,831.80 |
| O-4 | 2,839.20 | 3,457.20 | 3,687.90 | 3,739.50 | 3,953.40 | 4,127.70 | 4,409.70 | 4,629.30 |
| O-3 | 2,638.20 | 2,991.00 | 3,228.00 | 3,489.30 | 3,656.40 | 3,839.70 | 3,992.70 | 4,189.80 |
| O-2 | 2,301.00 | 2,620.80 | 3,018.60 | 3,120.30 | 3,184.80 | 3,184.80 | 3,184.80 | 3,184.80 |
| O-1 | 1,997.70 | 2,079.00 | 2,512.80 | 2,512.80 | 2,512.80 | 2,512.80 | 2,512.80 | 2,512.80 |
Note: The Commissioned Corps average on page 21 of the Congressional Justification for FY 2000 was based on basic pay and special pays only. FY 2001 and FY 2002 estimates include basic allowance for housing and other subsistence allowances in addition to basic pay and special pays.
Mr. Knollenberg: As a member from the State of Michigan, I am interested in the Great Lakes Human Health Effects Research Program, which studies the human health effects of consuming contaminated Great Lakes fish. In last year's FY 2001 conference report, H. Rept. 106-988, the language states: "Within the appropriated level [$75 million], ATSDR is to use up to $2,000,000 to continue the Great Lakes fish consumption study..." I'm concerned that the words "up to" leaves uncertainty in the program funding level of the Great Lakes fish consumption study. These long term studies still need all the funding they receive from Congress to continue the research.
Can you assure me that ATSDR will fully fund the Study at $2 million, and not use the conference report language as a justification to fund less than $2 million, in order to cover any Agency shortfalls?
Dr. Falk: In accordance with the conference language report and based on the Agency's resources, needs, and priorities, ATSDR intends to fund the Great Lakes Human Health Effects Research program at $1.0 million in FY 2001. In addition, the program has $179,165 in carryover funds available for use during the current fiscal year.
Mr. Knollenberg: Within the FY 2002 request of $78 million, how much is allocated for the Great Lakes Human Health Effects Research Program?
Dr.Falk: At the President's Budget level of $78 million, ATSDR plans to provide approximately $1.2 million to fund the Great Lakes Human Health Effects Research Program.
Mr. Mollohan: In the justification, it says that state health agencies are important partners in helping ATSDR -- and that staff from funded states actively coordinate with federal, state, and local health and environmental officials to provide public health expertise.
In those states where you are not a partner, how does environmental public health work get accomplished?
Dr. Falk: ATSDR has the primary responsibility for carrying out the public health mandates under the Superfund program whether through its partners or through direct activity. Unlike the states where we have partnerships and build capacity to carry out these mandates, ATSDR staff must play a more direct role in evaluating the Superfund sites within the states that are not cooperative agreement partners and in conducting needed public health activities. ATSDR staff strive to work with state and local officials and community members in accomplishing the needed Superfund public health mandates.
Mr. Mollohan: ATSDR will shortly release a toxicological profile update on DDT and it will be used by the United Nations in the development of treaty negotiations on worldwide banned substances.
What other studies, research, or profiles has ATSDR undertaken that have been used by the United Nations? (Please provide a comprehensive list for the record).
Dr. Falk: In response to a request from the Department of Health and Human Services (DHHS), of which ATSDR is a part, ATSDR provided background information and technical assistance on DDT including information from the soon to be released toxicological profile on DDT and also helped to assemble information on DDT for the prevention of malaria to the Office of International and Refugee Health/DHHS. DHHS used this information to provide assistance to other U.S. Government Agencies involved in treaty negotiations. The treaty negotiations are now concluded. The agency's toxicological profile on DDT when released should be of value to parties evaluating the uses of DDT. Although the studies, research, and profiles undertaken by ATSDR are directed to the domestic health interests of the Superfund program, as public documents they are freely available to anyone with an interest. While ATSDR may not be aware of how and by whom all of its work is used, the Agency is aware of interest shown by the World Health Organization and the Pan American Health Organization (PAHO), both of which are constituencies of the United Nations. The World Health Organization/International Program on Chemical Safety (WHO/IPCS) utilizes ATSDR's toxicological profiles as a primary source document in the development of its Concise International Chemical Assessment Documents (CICAD) and has requested technical assistance from ATSDR in its development of the CICADs. ATSDR has assisted on CICAD documents on Manganese, Mercury, PCBs, and Hydrogen Sulfide. ATSDR has also provided copies of Spanish translated documents, including Chemical Fact Sheets and Public Health Statements developed for use in Hispanic communities around Superfund sites, to PAHO.
Mr. Mollohan: Has the Environmental Protection Agency (EPA) used studies, research, or profiles produced by the ATSDR in the promulgation of any of its regulations? (Please provide a comprehensive list for the record).
Dr. Falk: ATSDR works closely with the EPA Superfund program. The work of ATSDR is directed to the domestic health interests of the Superfund program, and are not developed to support the promulgation of regulations. Studies, research, and profiles developed by ATSDR are public documents available to all and are routinely shared with EPA. ATSDR documents and profiles are rarely, if ever, the central focus of EPA regulations, but may be referenced or cited as part of literature compilation or comprehensive reviews of subjects.
Mr. Mollohan: ATSDR uses the Geographic Information System (GIS) for environmental public health activities and research.
Could you please explain in more detail how ATSDR uses the GIS?
Dr. Falk: The Geographic Information System (GIS) enables ATSDR to visually consolidate health data, environmental data, demographic data, and census data. ATSDR has developed a state-of-the art GIS to characterize environmental conditions and community characteristics (demographics) near Superfund hazardous waste sites to assist in the assessment of the potential for exposure to toxic substances and mitigate any adverse health outcomes from those exposures. ATSDR's GIS program is on the forefront of the use of spatial analysis tools for public health applications. The methodologies for identifying the demographic profile of populations living within 1 mile of a site were conceived by ATSDR and have been used at over 1600 hazardous waste sites across the United States. Analyses of populations that surround sites are now conducted for every site that ATSDR evaluates to identify the number of the very young, the elderly, and women of childbearing age who live in close proximity. GIS based analyses permit investigations of health outcome and survey data overlaid on location data that identify contaminant concentrations. As noted by Congressman Hobson during the hearing, GIS methodologies have been utilized at the Kelly Air Force Base, located in San Antonio, Texas. ATSDR effectively used GIS to integrate data sets necessary to establish possible associations between past exposures to hazardous substances and excess cancer rates in the surrounding community. GIS provided a graphical correlation of the modeled risks, population density, and cancer mortality data. The estimation of risks was based on the results of an air dispersion model that estimated the transport and fate of past and present emissions from the base, and GIS was used to incorporate the results of air modeling performed by ATSDR to provide an estimate of exposure to contaminants. This information was combined with cancer incidence information provided by the Texas Department of Health. Based on its evaluation, ATSDR determined that it is unlikely that exposure to the low level of current emissions from the base would result in a meaningful increase in cancer. As a leader in the use of GIS technology, ATSDR is collaborating with the Centers for Disease Control and Prevention to develop a Geographic Analysis Tool for Health and Environmental Research which is an interface for the display of health data in a mapping environment. Additionally, ATSDR has provided a satellite broadcast training program on the use of GIS in public health, sponsored several national conferences on GIS and public health, and established an Internet site on the use of GIS to address public health concerns.
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