Transcript Slowly poisoned: health consequences of pollution and

Slowly poisoned: health
consequences of pollution and
environmental toxins
Martin Donohoe, MD, FACP
Portland State University
Campaign for Safe Foods, Oregon
Physicians for Social Responsibility
Overview
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Public health approach
Air pollution
Garbage
Toxins
Education/Corporate Influence
Progress and Solutions
Some Major Sources of Air
Pollution
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Industry - #1
Agriculture
Automobiles
Indoor combustion of coal and
biomass for cooking, heating and
food preservation
Air Pollution
Air Pollution
Air Pollution
• Top ten most polluted cities in the
world are in China and India
• Most polluted areas in US:
–LA, Houston, San Joaquin
Valley in Central California
Health Effects of Air Pollution
• Causes approximately 75,000
premature deaths/yr. in U.S.
• 1.8 million worldwide
• Causes asthma and impairs lung
development and function
• Linked to autism
Health Effects of Air Pollution
• Increased admissions for CHF,
asthma, COPD, PVD, and
cerebrovascular disease
• Air pollution Deaths from
cardiopulmonary diseases correlate
with air pollution levels in US cities
–Both day to day and over time
Effects of Ozone Destruction
• Ozone hole over Antarctic (2½X size
of Europe)
• Increased cataracts (UV damage)
• Increased lifetime melanoma risk
–1/1500 - 1930
–1/68 - today
Automobiles
Automobiles
• Number of autos
-US: 1 car/2 people
-Mexico: 1/8
-China: 1/100 (increasing; leaded
gasoline)
• Global auto population to double in
25-50 years
Automobiles
• Average miles traveled/car/year in
U.S.
–1965 - 4,570 mi.
–2006 – 12,000 mi.
Automobiles
• 25 lbs. of CO2 produced for every
gallon of gasoline manufactured,
distributed, and then burned in a
vehicle
• U.S. energy costs exceed $500
billion/yr. (plus military costs to keep
foreign oil flowing)
Automobiles
• Average fuel efficiency of U.S. autos
stagnant
– Ford Model T – 25 mpg (1908); Avg.
Ford vehicle – 22.6 mpg (2003)
• Relatively low oil prices
• Growing market for low-efficiency pickups,
minivans, and SUVs
• Multiple alternatives exist
• Renewables under-funded
Garbage
• 98% of the country’s total refuse is
industrial waste; 2% municipal waste
• In one year, Americans generate 236
million tons of municipal garbage
–30% recycled
–164 million tons thrown away
U.S. Garbage Composition
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Paper and Paperboard - 39%
Yard Waste - 13%
Food Waste - 10%
Plastics - 10%
Metals - 8%
Glass - 6%
Wood - 5%
U.S. Recycling Rates
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Tires - 22%
Plastic containers - 36%
Glass containers - 28%
Yard waste - 41%
Paper and Paperboard - 42%
Aluminum packaging - 54%
Steel cans - 60%
Auto batteries - 93%
Garbage
• Landfills (2300 in US)
• Incinerators
• Garbage exports
Toxins
Annual World Production of
Synthetic Organic Chemicals
• 1930 - 1 million tons
• 1950 - 7 million tons
• 1970 - 63 million tons
• 1990 - 500 million tons
• 2000 - 1 billion tons
Toxins
• 6 trillion tons of over 85,000 chemicals
produced annually
– more than 80% have never been
screened for toxicity
• Chemical manufacturers are not required
to prove safety
– the legal burden is on the government to
prove that a product is dangerous
Toxic Pollutants
• 85,000 known or suspected
hazardous waste sites in the U.S.
–Plus up to 600,000 lightly
contaminated former industrial
sites (“brownfields”)
Toxic Pollutants
• 1 in 4 U.S. citizens lives within 4 mile of a
Superfund site
• Taxpayers paying increasing share of
cleanup costs
– 54% in 2003
– Vast majority presently
– Overall funding decreasing
Toxins
• Body burden of industrial chemicals,
pollutants and pesticides high
–EWG study
• Fetuses and children are most
vulnerable to toxins
• Normal birth sex ratio changing due
to fewer male births
– Cryptorchidism also increasing
Pesticides
• 5.5 billion lbs/yr pesticides
–1.2 billion lbs/yr in US
• EPA estimates U.S. farm workers
suffer up to 300,000 pesticiderelated acute illnesses and
injuries per year
Pesticides
• NAS estimates that pesticides in food
could cause up to 1 million cancers in
the current generation of Americans
• 1,000,000 people killed by pesticides
over the last 6 years (WHO)
• EPA currently allow pesticide testing
in humans, despite strong opposition
Floriculture
• Most commercial flowers grown in sealed
greenhouses in developing countries
• Carry 50 times the amount of pesticides
allowed on food
– 1/5 of chemicals used banned in U.S.
• Workers underpaid, 50-60% suffer from
pesticide poisoning
Pesticides
Pesticides
• Pesticides inhibit nitrogen fixation,
decrease crop yields
• Evidence suggests pesticides actually
promote pests (vs. natural pesticides)
• 30% of medieval crop harvests were
destroyed by pests vs. 35-42% of current
crop harvests
• Implies organic farming more costeffective
Pesticides and Other Toxins Linked
to Neurological Disease
• Parkinson’s Disease
• Autism
• Others
Lead
• 2 million US children with
elevated levels
• 120 million people with level >
10mcg/dL worldwide
• #s affected dropping
Lead
• Affects brain development, associated with
lower IQ
– No safe level for neurological development
• Levels between 4 and 10 significantly
increase risk of cardio- and
cerebrovascular disease
• Elevated levels associated with crime and
violent behavior
Lead
• Poor, African-Americans,
Hispanics more commonly
exposed
• Developing world at risk
Lead Poisoning: S/S, DX, and RX
• S/S: AP, CP, arthralgias, myalgias, HA,
anorexia, ↓libido, ↓memory, anemia,
nephropathy, HTN, cataracts, CV dz,
cancer, ↓sperm count, lead line on teeth,
basophilic stipling
• Dx: lead level, FEP (free erythrocyte
protoporphyrin)
• Rx: ↓exposure, CaEDTA, DMSA
Toxic Pollutants – Economic
Costs
• Americans pay more than $55 billion
annually for direct medical expenses plus
special schooling and long-term care for
pediatric diseases caused by lead
• This excludes the greatest toxic pollutant tobacco
Mercury
• Released into air by coal combustion,
industrial processes, mining, and waste
disposal
– 4500 tons/yr
• Travels throughout atmosphere and settles
in oceans and waterways
• Bacteria convert it to toxic methyl-mercury
• Travels up food chain via fish
Mercury
16% of women of childbearing
age exceed the EPA’s “safe”
mercury level
Mercury: S/S, Dx, and Rx
• S/S: neuropsychiatric symptoms,
inflammation of gums with excessive
salivation, rash, nephropathy
• Dx: mercury levels in air, blood, urine
(>100 mcg/l in blood and/or urine = toxic)
• Rx: chelation with BAL, penicillamine,
DMPS, DMSA
Toxic Pollutants
• Dioxin - from manufacturing, medical
incinerators, defoliants (“Agent Orange”)
-Love Canal
-cancers
• Nitrates/nitrites, trichloroethylene, vinyl
chloride, ozone
• Diacetyl – popcorn lung
Hazardous Waste and
Fertilizer
• Legal to dispose of hazardous waste
by turning it into fertilizer
• e.g. uranium, arsenic, cadmium, and
dioxins
• Unclear if a health hazard
• No requirement that toxins be listed on
ingredient labels
Persistent Organic Pollutants
• Toxic, remain in environment longterm, resist degradation, can travel
long distances
• Bioaccumulate - higher
concentrations as you move up
the food chain
Persistent Organic Pollutants
• 10 of the these are endocrine disrupters
– e.g.s - DDT, chlordane, heptachlor, dioxins,
PCBs
– possible cause of decreasing male sperm
counts (100 million/ejaculate in 1950, 50
million in 1990), increasing male infertility
(0.5% in 1938 vs. 10% in 2006), increasing
cases of hypospadias, early puberty, and
breast cancer
Phthalates
• Found in construction materials, clothing,
toys, cosmetics, pills, added to PVCs in IV
tubing/other plastics
• 5 million metric tons consumed by industry
per year (13% in the U.S.)
• Exxon Mobil and BASF dominate the
market
Phthalates
• Associated with:
–demasculinization and alterations in
genitalia in male infants
–lower testosterone levels
–lower sperm counts in adults
Phthalates/PVCs and Medical
Devices
FDA has advised healthcare
providers to use alternatives to
DEHP-containing PVC medical
devices, esp. in neonatal units
Environmental Racism
and Toxic Imperialism
• Environmental Racism
–waste dumps/incinerators more
common in lower SES
neighborhoods
–“Cancer Belt” (Baton Rogue to New
Orleans)
• Toxic Imperialism
Mining and Pollution: Gold
• Cyanide “heap leach” gold mining
– cyanide dripped over crushed rock to
extract gold
– Mercury used to concentrate gold
– taxpayers often stuck with cleanup
costs
Electronic Waste
• Only 5-10% of computers recycled
• Most sent overseas, children disassemble
• EU now requires electronics firms to
recycle and to eliminate lead, cadmium
and mercury from their products
• Dell: www.computertakeback.com
Electronic Waste
• European laws re extended producer
responsibility and product liability
–Similar San Francisco resolution
• Maine passed first law requiring
electronic manufacturers to pay for
recycling their discarded products
Medical Waste
• The 6,000 US hospitals
generate 2 million tons of
waste per year; clinics and
doctors’ offices an additional
700,000 tons
–850,000 tons incinerated
• 15% infectious waste
Medical Waste
• Incinerated pollutants include dioxin,
mercury, cadmium and lead
• EPA regulations weak
• Segregation and alternatives to
incineration would cost 93
cents/patient/day
Medical Waste
• One hospital bed generates between 16
and 23 lbs/day of waste
• Solutions:
– 80% of thermometers no longer contain
mercury
– Remove PVCs from medical supplies
(e.g., IV tubing)
Water Pollution
• 40% of U.S. waters are unfit for fishing or
swimming
– beach closings
• Willamette River: one of the most polluted
rivers in the American West
– Arsenic, lead, mercury, DDT
– 5.5 mile stretch Superfund site
Water
• In developing countries, 90-95% of
sewage and 70% of industrial wastes
are dumped untreated into the local
water supply
• 13,000-15,000 deaths per day
worldwide from water-related
diseases
Water Pollution:
Bathtub=Toilet=Source of Drinking Water
Infamous Industrial Disasters
• Minimata, Japan, 1920s-1970s (Chisso
Corporation) - methylmercury poisoning
-400 dead; 10,000 injured
• Bhopal, India, 1984 (Union Carbide) methyl isocyanate gas
–7000-10,000 dead within 3 days, 15,00020,000 more over next 10 years; tens of
thousands injured
–persistent water and soil contamination
Minimata Disease
W Eugene Smith
The Military and Pollution
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World’s single largest polluter
6-10% of global air pollution
2-11% of world raw material use
97% of all high level and 78% of all low
level nuclear waste
• Pentagon generates 500,000 tons toxic
waste/year
The Military and Pollution
• “The more birds that the [Department of
Defense] kill[s], the more enjoyment
[people] will get from seeing the ones that
remain: ‘Bird watchers get more
enjoyment spotting a rare bird than they
do spotting a common one.’”
– 2002 court summary of the U.S. Defense
Department’s argument for exemption from
the Migratory Bird Treaty Act of 1918
The Military
• Small arms and rocket propelled
grenades
• Land mines
• Nuclear, chemical and biological
weapons
Military Waste
• More than 27,000 toxic hot spots at the
pentagon’s 8,500 properties
– less than 400 toxic waste dumps have
been cleaned up
– costs to clean - immense: likely never to
be completed
• Military exempt from most environmental
regulations
Worrisome Trends
• Trade agreements:
– GATT
– NAFTA
– CAFTA
• SLAPP suits
Politics: Bush Administration
• Key administrators/committee
members/regulators former industry
representatives and/or lobbyists
• Corporate profit before public good
• Unsound/distorted/suppressed science
• Eco-harassment
– Criminalizing activists
Bush Administration
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Rollbacks of key environmental laws
Lax enforcement of existing laws
Huge tax cuts primarily benefit wealthy
Federal and state government deficits
astronomical
– Program and funding cuts
Would You Sign a Petition to
Ban Dihydrogen Monoxide?
1. It can cause excessive sweating and vomiting
2. It is a major component in acid rain
3. It can cause severe burns in its gaseous state
4. It can kill you if accidentally inhaled
5. It contributes to erosion
6. It decreases effectiveness of automobile brakes
7. It has been found in tumors of terminal cancer
patients
Environmental Ignorance
• A majority of Americans believe that electricity in
the U.S. is produced in nonpolluting ways
– 25% knew that majority (70%) comes from oil,
coal and wood
• 1/3 assumed that spent nuclear fuel (from our
104 plants) is stored “in a deep underground
facility in the West”
– Only 17% were aware that it is mostly stored
on-site at powerplants pending a long-term
solution (30,000/tons)
Greenwash
• Public relations / ad campaigns
-Chevron’s “People Do” Campaign,
butterflies/refinery
-Dupont Freon Campaign in 1970’s
-Grants to a few scientists who
challenge environmental warnings
-tobacco ads in 1950’s
Astroturf and Corporate Front
Groups
• Artificially-created grassroots
coalitions
• Corporate front groups
– The American Council on Science and Health
– National Wilderness Institute
– The Foundation for Clean Air Progress
Corporate PR tactics
• Invoke poor people as beneficiaries
• Characterize opposition as
“technophobic,” anti-science,” and
“against progress”
• Portray their products as
environmentally beneficial in the
absence of (or despite the) evidence
Sponsored Environmental
Educational Materials
• Corporate-sponsored and
supported by a loose
coalition of antiregulatory
zealots, corporate polluters,
lapdog scientists and
misguided parents
Sponsored Environmental
Education Materials (Examples)
• Exxon’s “Energy Cube”
-“Gasoline is simply solar power hidden in
decayed matter”
-“Offshore drilling creates reefs for fish”
• Pacific Lumber Company
-“The Great American Forest is. . .
renewable forever”
Sponsored Environmental
Education Materials (Examples)
• International Paper
-“Clearcutting promotes growth of trees
that require full sunlight and allows
efficient site preparation for the next
crop”
• American Nuclear Society’s “Activities
with the Atoms Family”
• Dow’s “Chemipalooza”
Progress and Solutions
The “Benefits” of Sterility-Causing
Chemicals in the Workplace?
12 September 1977
Dr. Eula Bingham, Assistant Secretary for Occupational Safety and Health
[Regarding] worker exposure to DBCP.
While involuntary sterility caused by a manufactured chemical may be
bad, it is not necessarily so. After all, there are many people who are now
paying to have themselves sterilized to assure they will no longer be able to
become parents...
If possible sterility is the main problem, couldn’t workers who were old
enough that they no longer wanted to have children accept such positions
voluntarily? Or…some [workers] might volunteer for such workposts as an
alternative to planned surgery for a vasectomy or tubal ligation, or as a
means of getting around religious bans on birth control when they want no
more children?
Sincerely,
Robert K. Phillips, National Peach Council
The Montreal Protocol (1987)
• Phase-out of chlorofluorocarbons
(CFCs, which destroy the
protective ozone layer in the
upper atmosphere) by 1996
–Bush administration has
withdrawn from Treaty
Toxic Pollutants:
The Basel Convention
• The Basel Convention on the Control of
Transboundary Movements of Hazardous
Wastes (designed to control dumping of
hazardous wastes from the industrialized
world in developing countries)
• Despite being the largest producer of toxic
pollutants in the world, the U.S. has signed
but not ratified this agreement
Persistent Organic Pollutants
(POPS) Convention
• UN Environmental Program
organizing worldwide phase-out of top
12 through the Stockholm Convention
on POPS
– Including DDT, PCBs, and dioxins
–US has signed, but not ratified
Lead
• American Assn. of Pediatrics now recommends
toxic lead be removed from all housing and that
all children be tested once during their first two
years
• 25% of U.S. homes still contain significant
amounts of lead-based paint
– Cost of removing lead from 4 million seriously
affected homes: $28 billion
• Cost savings each year thereafter: $43 billion
(higher IQs, increased earning power, increased
tax revenue, lower health care costs, less crime)
Leaded Gasoline
• Banned in Canada in 1990, US in 1996
(after 25-year phaseout period), EU in
2002, Africa in 2006
– Ban fought by industry for decades
– Scientists harassed
• Many countries still sell leaded gasoline:
– Indonesia, Venezuela, North Korea, Iraq,
Afghanistan, Jordan, Syria, Yemen
Medical Waste
• Organizations:
– Health Care Without Harm
– Green Health Center Movement
• Hospitals built and operated on more
environmentally sound principles save money
(NAS):
– Costs recovered more quickly, patients get better
sooner, patients’ families happier, medical errors
reduced, staff turnover/absenteeism/workers’ comp
claims drop
REACH
• Registration, Evaluation, and Authorization
of Chemicals
• European Treaty requiring companies to
test chemicals already on the market by a
set timetable and test new products before
putting them on the market
REACH
• Cost of evaluations < 1% of chemical
industry’s total sales
• Economic analyses show REACH could
bring environmental benefits worth €95
billion over the next 25 years and result in
health cost savings of €50 billion over the
next 30 years
Solutions
Based on the Precautionary
Principle
“When evidence points toward the
potential of an activity to cause
significant, widespread or irreparable
harm to public health or the
environment, options for avoiding that
harm should be examined and
pursued, even though the harm is not
yet fully understood or proven”
The Precautionary Principle:
Practical Essentials
• Give human and environmental health the
benefit of doubt
• Include appropriate public participation in
the discussion
• Gather unbiased, scientific, technological
and socioeconomic information
• Consider less risky alternatives
The Precautionary Principle
• Endorsed by APHA, ANA, others
• Puerto Rico, San Francisco have
adopted, among others
• Big business, US Chamber of
Commerce oppose
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
[email protected]