Transcript The economic costs of failing to protect children from

The economic case for protecting
children from chemical hazards
Leonardo Trasande, MD, MPP
Associate Professor of Pediatrics,
Environmental Medicine and Health Policy
New York University
Why are children are uniquely
vulnerable?
• Pound for pound, drink more water, eat more
food and breathe in more air
• Less well able to detoxify or eliminate chemicals
from their bodies
• Developing organ systems are more susceptible
• Greater years of life in which chronic conditions
can occur as a result of early life exposures
National Academy of Sciences 1993
Evidence confirming child vulnerability
• Epidemic increases in chronic disease in US
and other industrialized nations (asthma,
childhood cancers, certain birth defects,
learning/developmental disabilities)
– Contemporaneous with widespread increase in
use of chemicals
Trasande et al Dec 2011 Health Affairs
Evidence confirming child vulnerability
• Population studies quantify strong and consistent
associations with chemical exposures
– US National Academy of Sciences: 28% of
developmental disabilities at least in part due to
environment
– Benzene and 1,3-butadiene associated with childhood
cancer
– Outdoor air pollutants are well documented to
worsen and may increase risk of development of
asthma
Trasande et al Dec 2011 Health Affairs
Why have we been slow to protect
children?
• Toxic Substances Control Act of 1976 does not
require premarket testing of chemicals
– Fewer than ½ of most produced chemicals in US have
any toxicity testing data; fewer than 1/5 have data
with respect to impacts on development
•
•
•
•
Epidemiologic studies post hoc take years
Outcomes have many potential confounders
Criteria of reproducibility, consistency
Uncertainty about dose-response relationships
(also linear pedagogy), thresholds
Why have we been slow to protect
children?
• Strong vested (economic) interests with
powerful political forces
• Subclinical effects are not as powerful as the
Minamata or Bhopal disasters
• Cost-benefit analyses are complicated by one
group enduring costs (industry) with another
group enduring benefits (children)
– How do you estimate the cost to industry of
environmental intervention? (Incentive to inflate)
Case study 1: Lead in gasoline
The Success and Near-Failure of Lead
in Gasoline
• Lead phased-out from gasoline (catalytic
converters or kids?) beginning 1975
• Fix discovered for catalytic converters: does
lead get back in?
• Only when data on lock-step decrease of
blood lead levels and lead use presented is
effort to phase back in blocked
Retrospectively, a Wise Economic
Decision
Grosse et al
Environ Health Perspect 110:563-569 (2002)
Global Benefits of Phasing Out Lead
From Gasoline
• Range from $1-$6 trillion/year, with a best estimate
of $2.45 trillion/year. These benefits may also be
expressed as 4% of global GDP.
Tsai and Hatfield 2011 J Environ Health
Case study 2: Mercury emissions from
coal-fired power plants
How can economic analyses drive
policy?
• Bush EPA proposes relaxation on mercury
emissions requirements for coal-fired power
plants
– Technical analyses in support of "Clear Skies"
failed to incorporate or quantify consideration of
the health impacts resulting from increased
mercury emissions
What are the Economic Consequences
of Mercury Pollution?
Trasande et al Environ Health Perspect 113:590-596 (2005)
Also identified 1566 additional cases of mental retardation associated with IQ loss
from methylmercury toxicity, at a cost of $2.0 billion. (Trasande et al Am. J. Ind.
Med. 49:153–158, 2006)
What happened?
• Arguably influenced US Senate debate
• Administration bill fails
• EPA enacts Clean Air Mercury Rule (CAMR;
essentially = Clear Skies)
• Multiple states enact more aggressive
regulations (PA, GA, MI and others)
• Multi-state lawsuit overturns CAMR
The global case for reducing mercury
emissions
• Global health costs from loss of productivity due to
mercury pollution could amount to as much as $29.4
billion in 2020.
•
Pacyna et al 2008
• Reductions in emissions could contribute $1.8–2.2
billion in global economic benefits in 2020, with
similar benefits for subsequent cohorts of children
born with lower levels of exposure from their
mothers who ingest less contaminated fish.
•
Sundseth et al 2010
15
Case study 3: Policy failures from
2000-8 in the US to protect children
In addition to mercury…
• US policy action to limit children’s exposure to known chemical
hazards has also been extremely limited. Funding for lead-hazard
control programs did not meet levels projected to be necessary
for eliminating childhood lead poisoning by 2010.
• US National Ambient Air Quality Standards still do not
adequately protect children from the respiratory effects of
outdoor air pollutants.
Economic costs, 2008
Trasande and Liu May 2011 Health Affairs
How does this compare?
Trasande and Liu May 2011 Health Affairs
Case study 4: Regulating Bisphenol A
in food uses
Bisphenol A (BPA)
CH3
OH
HO
CH3
• Used to manufacture polycarbonate resin
• Recently banned from baby bottles and sippy cups by US Food and Drug
Administration
• Breakdown product of coatings intended to prevent metal corrosion in
food and beverage containers
• Comprehensive, cross-sectional study of dust, indoor and outdoor air,
and solid and liquid food in preschool age children suggested that dietary
sources constitute 99% of BPA exposure
• Dietary interventions have reduced geometric BPA 66% in children and
adults
• Crossover trial of canned food consumption increased BPA 1221%
(suggesting 92% reduction if BPA was removed from aluminum cans)
Schecter et al. Environ Sci Technol. 2010;44(24):9425-9430
Wilson et al.Environ Res. Jan 2007;103(1):9-20.
Tavernise S. New York Times, 17 July 2012 edition.
BPA, obesity and cardiovascular risk
• Experimental studies suggest that BPA
disrupts multiple metabolic mechanisms, at
levels commonly seen in US population
– Increases fat cell size
– Disrupt adiponectin function
– Low-grade synthetic estrogen
• Estrogen-testosterone balance may have sex-specific
differences in influence on body mass
Masuno et al. J Lipid Res. 2002;43(5):676-684; Sakurai K et
al. Br J Pharmacol. 2004;141(2):209-214;
BPA, obesity and cardiovascular risk
• Urinary BPA concentration has been
associated with:
– Adult and childhood obesity
– Adult diabetes, cardiovascular diagnoses and
abnormalities in liver function
– Increased frequency of later coronary artery
disease in later life
– Poorer executive function and behavior in children
Carwile JL, Michels KB. Environ Res. 2011;111(6):825-830; Lang al. JAMA.
2008;300(11):1303-1310;Melzer et al. PLoS One. 2010;5(1):e8673; Melzer
et al. Circulation. 2012;125(12):1482-1490; Braun JM et al. Pediatrics.
2011;128(5):873-882.; Trasande et al JAMA 2012;11:1113-1121.
Childhood obesity costs
Adult cardiovascular cost
Benefits and costs of replacing BPA
• Alternatives to BPA include polyester coatings and
oleoresin linings in cans as well as polyethylene
plastic, glass and aluminum containers.
• If oleoresin linings cost 2.2 cents more than those
derived using BPA, and 100 billion aluminum cans are
produced annually, then the incremental cost of
replacing BPA would be $2.2 billion.
BPS replacing BPA?
• Emerging evidence
suggests replacement
of BPA and BPS
Bisphenol A
• Similar, weak estrogen
like BPA
• Disrupts signaling of
estrogen in animal
studies
Bisphenol S
• Does not degrade as
Liao et al Environ Sci Technol. 2012 Jun 19;46(12):6860-6.
easily in seawater
Liao et al Environ Sci Technol. 2012 Jun 19;46(12):6515-22.
Grignard et al Toxicol In Vitro. 2012 Aug;26(5):727-31.
Vinas and Watson EHP doi:10.1289/ehp.1205826
Danzl et al Int J Environ Res Public Health. 2009 Apr;6(4):1472-84
What do we learn from these case
studies?
Take away messages 1-3
• While not always decisive, economic cost
estimates can be influential and document the
consequences of failures
• US/global experience with economic benefits of
removal of lead from gasoline should be applied
to continuing efforts to remove it from paint
globally
• Economic estimates of mercury pollution costs
and potential benefits of abatement should be
prominent part of global mercury treaty
negotiations
The increasingly global chemical
picture
• OECD estimates in 2020: industrializing
nations will account for 33% of global
chemical demand and 31% of production
– compared with 23 percent and 21 percent,
respectively, in 1995
– industrializing nations are expected to lead in the
manufacture of high production volume chemicals
– occurs against a backdrop of insufficient
infrastructure to protect public health and the
environment
Take away message 4
• Sound chemicals management must be
implemented in industrializing nations to
avoid repeating the experience with chronic
disease epidemics in the industrialized nations
– Need not interfere with economic development
Context to take away message 4
• Early warning signs of similarly disturbing trends
in industrializing countries have recently emerged
– Sustained increase between 1982 and 2002 in the
incidence of acute lymphocytic leukemia in children in
Mexico.
– Increases over the past five to ten years in childhood
asthma prevalence in many developing countries.
– WHO estimates that 5.8% of life-years lost because of
disabilities in children living in low- and middleincome countries are attributable to lead exposure
and air pollution
Cites in Trasande et al Dec 2011 Health Affairs
Costs are being felt globally
• World Bank 2010: direct and indirect costs of
childhood disease associated with air and
water pollution were 9.3 percent in Ghana
and 8.8 percent in Pakistan, respectively, of
these two countries' gross domestic products.
• 2007 cost in China of pediatric and adult
health costs associated with air and water
pollution: 4.3% of China's GDP
Cites in Trasande et al Dec 2011 Health Affairs
Principles of sound chemicals
management
• Precaution, or the use of cost-effective measures to prevent
potentially hazardous exposures before scientific understanding is
complete;
• Right to know, or informing the public—especially vulnerable
groups—in a timely fashion about the safe use of chemicals and any
releases of chemicals into the environment;
• Focus on preventing the use of hazardous chemicals and the
production of pollutants, rather than focusing on managing wastes;
• Internalization of environmental and health costs, or ensuring that
the consequences of exposures are reflected in the price of
chemicals through such approaches as “polluter pays”; and
• Use of best available scientific information, in making decisions
such as what chemicals to allow into the market.
Trasande et al Dec 2011 Health Affairs
Context for the costs of sound
chemicals management
• The global chemical industry has annual
revenues of more than $3 trillion dollars per
year.
• If mechanisms were created so that the
industry itself effectively financed chemicals
management, at a cost of just 0.1 percent of
the industry’s annual revenues, more than $3
billion would be available for that purpose.
Trasande et al Dec 2011 Health Affairs