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Public Health Implications of Contaminated Land

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  • Describe natural levels, soil guideline values, toxicity, health effects and public health implications of the most current land contaminants found in Wales. Provide guidance on how to communicate risk to the population affected by land contamination. Inform population about basic precautions that can be taken to minimise risk posed by contamination. Establish best practice for managing land contamination in Wales through direct collaboration between agencies involved in land contamination issues in Wales To strength channels of communication between the agencies involved in land contamination in Wales.
  • The Environment Protection Act defines contaminated land as: “ Any land which appears to the local authority in whose authority it is situated to be in such a condition, by reason of substances in, or under land that significant harm is being caused or there is significant possibility of such harm being caused” The EA estimates between 5,000 and 20,000 contaminated land sites in England and Wales Wales, with his rich industrial heritage, has a significant number of such sites
  • Risks to humans posed by contaminants on land: Despite fact that biomarkers have shown exposure to soil contaminants does occur in many cases, increased levels of illness have not been observed in people living on contaminated land. This does not rule out the possibility of ill effects, which may be undetectable using current epidemiological and analytical methods Impact from contaminated soil can be difficult to separate from other types of pollution or contaminants that we are exposed to in our daily lives, this makes extremely difficult to demonstrate a cause-effect relationship Possible health effects of the contaminants are difficult to establish because there are many confounding factors (pre-existing health of people being studied, wealth or poverty of the people, availability of health or social care services, etc)
  • Soil Guideline Values (SGVs): Published by the DEFRA and the EA SGVs aimed to help deciding when land poses a “significant possibility of significant harm” (SPOSH) Values above the SGV do not imply necessarily that the risk to human health is significant; however, it does indicate that where limit is exceeded more detailed risk evaluation or site specific risk assessment is needed to assess the potential to harm The SGVs have been derived for long term exposure to contaminants in the soil. No guidelines for acute exposure
  • There are thousands of possible soil contaminants, but we decided to include de most common in Wales
  • For each of the contaminants we have described: Uses and sources of pollution Natural levels Soil guideline values Toxicity Health effects Biological sampling Public Health Implications
  • As an example Cadmium can be found in cigarettes, fertilisers used in agriculture and in low levels in all foods but in highest levels in shellfish, liver, and kidney meats In the guidelines you will find the mean and median contaminant content in soil in England and Wales and the Soil Guideline values depending on the use of the land: residential, allotments and commercial use. Sometimes both values can be very close.
  • Also the Tolerable daily intake and the index dose and some of the possible health effects attributable to chronic exposure to the contaminant
  • Also information about biological sampling and biomarkers and the public health implications In the case of cadmium there has been several studies on the effect of high cadmium concentrations in soil on human health and none of them has demonstrated adverse effects It is important to explain that people is much likely to be exposed to Cadmium through cigarettes that from soil in their gardens
  • Some basic precautions are described, particularly regarding Contaminated gardens and children It is well known that children are especially vulnerable to contaminants, in part because their bodies cannot tolerate as much contaminants and partially because of increased exposure when playing in the garden
  • Because the uncertainty surrounding the effects of contaminated land, the guidelines has an special attention for risk communication Risk communication has been described an interactive process of exchange of information People’s fears should be taken seriously and steps should be taken to address them even if they are not necessary from a technical perspective
  • Contaminated land management requires more than technical expertise. Social issues such as house prices, house ownership or stigma of the neighbourhood are also important and should be considered from day one Risk Comparisons are useful but can be dangerous. Often, an involuntary risk is compared with a voluntary one (e.g. the risk from nearby incinerator is compared with smoking or dietary habits). If such a comparison is done in the spirit of minimising the importance of the involuntary risk, it will generate anger Several types of risk comparisons are generally more useful , for example: Comparisons to natural background levels: How does the level of a substance in a suspected contaminated area compare with natural background levels-such as the level of lead in someone's backyard compared with the average natural lead levels in soils. Or Comparisons of risks with benefits
  • It is know that there are certain characteristics that make risks to be perceived as more worrying
  • Well, all apply to contaminated land: The risk is: Involuntary Inequitably distributed Inescapable Arise from an unfamiliar or novel source Result from man-made, rather than natural sources Cause hidden and irreversible damage with onset many years later Pose particular danger to small children or pregnant women May cause CANCER The damage is identifiable rather than anonymous Is poorly understood by science Is subject to contradictory statements from responsible sources Is invisible or undetectable, catastrophic, memorable, uncertain
  • The guidelines will have a protocol about how to manage an specific case on land contamination. This will be available in November The protocol will cover the initial response, key individuals and organisation that need to be involved, a communication strategy and public health actions and implications
  • Although the situation is changing, you may encounter some problems when dealing with a case of land contamination The main one is the fact that usually the NPHS knows about the case at a late state and people has unrealistic expectations about what we can do The initial lack of consultation is dangerous because it can lead to inaccurate health messages, unrealistic expectations and the worst of all, unnecessary community concerns
  • This are some of the solutions: Openness and transparency is vital when managing a case Trust should be based on mutual respect Communication should be open and honest An open communication process with the public and the media can be achieved by organising public meetings, issuing press reports, sending letters to residents, fact sheets, setting up internet sites, etc The language used should be understandable for the general public And the most important aspect: Engage early with partners from LHBs, LAs and HPA
  • Comprehensive references

Transcript

  • 1. Public Health Implications of Contaminated Land Dr Josep Vidal-Alaball Specialist Registrar in Public Health Medicine Swansea NPHS Staff Conference, October 2006 GUIDELINES
  • 2. OVERVIEW
    • Guideline Objectives
    • Target users covered by the Guideline
    • Basic concepts
    • Most common contaminants
    • Precautions
    • Communication (risk communication)
    • How to manage a case of land contamination
    • Appendixes
    • Glossary and acronyms
    • References
  • 3. Guideline Objectives
    • Describe natural levels, soil guideline values, toxicity, health effects and public health implications of the most current land contaminants
    • Guidance on risk communication
    • Inform population about basic precautions
    • Establish best practice for managing land contamination through direct collaboration between agencies involved in land contamination issues
    • To strength channels of communication between the agencies involved in land contamination
  • 4. Target users
    • Local Authorities
    • National Public Health Service for Wales
    • Local Health Boards
    • Chemical Hazards and Poisons Division (Health Protection Agency)
  • 5. Basic concepts
    • Contaminated land defined as “Any land which appears to the local authority in whose authority it is situated to be in such a condition, by reason of substances in, or under land that significant harm is being caused or there is significant possibility of such harm being caused” (Part IIA of the Environment Protection Act (1990, Section 78(A))
    • The EA estimates between 5,000 and 20,000 contaminated land sites in England and Wales (Wales, has a significant number of such sites)
  • 6.
    • Land contamination may impact on health or the environment
    • Contamination may effect people’s perceptions of their local environment and it may affect the use of land
    • Contamination may also affect people’s personal finances
  • 7.
    • Risks to humans posed by contaminants on land:
    • Increased levels of illness have not been observed in people living on contaminated land
    • However ill effects, which may be undetectable using current epidemiological and analytical methods, may occur
    • Impact from contaminated soil can be difficult to separate from other types of pollution
    • Possible health effects of the contaminants are difficult to establish because there are many confounding factors
  • 8. Basic concepts
    • Source-pathway-receptor model:
    • A contaminated parcel of land will only pose a risk to human health if there is a route of exposure between the site and a given population, in accordance with the source–pathway-receptor model
  • 9.
    • source (contaminated land) receptor (humans)
    Pathway : route needed by the chemical substances to enter the human body: inhalation of volatile compounds, ingestion of soil (particularly in children), consumption of contaminated food or water or direct dermal contact with polluted sources.
  • 10. Basic concepts
    • Soil Guideline Values (SGVs):
    • Published by the DEFRA and the EA
    • SGVs aimed to help deciding when land poses a “significant possibility of significant harm” (SPOSH)
    • Values above the SGV do not imply necessarily that the risk to human health is significant
    • The SGVs have been derived for long term exposure to contaminants in the soil. No guidelines for acute exposure
  • 11. Most common contaminants
  • 12. Most common contaminants
    • Uses and sources of pollution
    • Natural levels
    • Soil guideline values
    • Toxicity
    • Health effects
    • Biological sampling
    • Public Health Implications
  • 13. CADMIUM Cadmium can be found in cigarettes, fertilisers used in agriculture and in low levels in all foods (highest in shellfish, liver, and kidney meats) Mean cadmium content in soil 1.2 mg/Kg. Median 0.9 mg/Kg (England and Wales)
  • 14. TDSI: Tolerable daily soil intake
    • Breathing or eating air or food contaminated with cadmium over a long period of time can cause health effects including:
      • Renal dysfunction (characterised by proteinuria)
      • Growth disturbances
      • Lung disturbances (bronchitis, obstructive lung disease)
      • Skeletal damage (osteomalacia and osteoporosis – Itai-itai disease)
      • Reproductive disturbances
      • Anaemia
  • 15. Tests are available to measure cadmium in blood, urine, hair, or nails
  • 16. Precautions
    • Contaminated gardens
    • E.g. Vegetables can be grown in raised beds with clean soil
    • Special precautions with children
    • Children are especially vulnerable to contaminants, because of increased exposure when playing in the garden
  • 17. Risk communication
    • Uncertainty is an important factor that complicates risk communication in contaminated land issues
    • Is an interactive process of exchange of information
    • People’s fears should be taken seriously
  • 18.
    • Contaminated land management requires more than technical expertise. Social issues such as house prices, house ownership or stigma of the neighbourhood are also important
    • Risk Comparisons. Often, an involuntary risk is compared with a voluntary one (e.g. the risk from nearby incinerator is compared with smoking or dietary habits). If such a comparison is done in the spirit of minimising the importance of the involuntary risk, it will generate anger
  • 19.
    • Risks are generally more worrying if perceived:
      • To be involuntary
      • As inequitably distributed, some benefit while others suffer
      • As inescapable by taking personal precautions
      • To arise from an unfamiliar or novel source
      • To result from man-made, rather than natural sources
      • To cause hidden and irreversible damage with onset many years later
      • To pose particular danger to small children or pregnant women or more generally future generations
      • To threaten a form of death (or illness/injury) arousing particular dread
      • To damage identifiable rather than anonymous victims
      • To be poorly understood by science
      • As subject to contradictory statements from responsible sources (or even worse, from the same source), or from untrustworthy source.
      • Invisible or undetectable, catastrophic, memorable, uncertain, uncontrollable or unethical risk.
  • 20.
    • All apply to contaminated Land !
      • Involuntary
      • Inequitably distributed
      • Inescapable
      • Arise from an unfamiliar or novel source
      • Result from man-made, rather than natural sources
      • Cause hidden and irreversible damage with onset many years later
      • Pose particular danger to small children or pregnant women
      • Threaten a form of death arousing particular dread: CANCER
      • Damage identifiable rather than anonymous
      • Poorly understood by science
      • Is subject to contradictory statements from responsible sources
      • Invisible or undetectable, catastrophic, memorable, uncertain
  • 21. How to manage a case
    • Protocol under review (end November)
    • Will cover:
    • Initial response
    • Key individuals and organisations
    • Communication strategy
    • Public Health implications/actions
  • 22. Some problems….
    • LHBs, HPA, NPHS: Very late engagement with unrealistic expectation to respond
    • Lack of consultation can result in
      • inaccurate health messages
      • raised expectation
      • unnecessary community concern
  • 23. Some solutions ….
    • Openness and transparency
      • Trust should be based on mutual respect
      • Communication should be open and honest
      • The language used should be understandable for the general public
    • Engage early with LHBs, LAs, HPA!
  • 24. Appendixes
    • Example of Press release: allotments contaminated with arsenic
    • Example of letter of information to residents (NEED TO BE ADAPTED TO LOCAL CIRCUMSTANCES)
    • Do’s & Don’ts for Residents
    • Questions & Answers at Notification of Results
    • Contact details for key individuals
    • Health Information leaflet for residents ( separate document )
  • 25. Glossary and acronyms References
    • Scientific articles
    • EA, DEFRA, HPA
    • WHO
    • Agency for Toxic Substances and Disease Registry (US)
  • 26. Acknowledgements
    • Dr David Russell Chemical Hazards and Poisons Division, Cardiff
    • Mr Andrew Jones National Public Health Service for Wales, Bangor
    • Dr Sandra Payne National Public Health Service for Wales, Mold
    • Mr Peter Davies Chemical Hazards and Poisons Division, Cardiff
  • 27.
    • Dr Josep Vidal-Alaball
    • Specialist Registrar in Public Health Medicine
    • National Public Health Service Wales
    • Mid and West Wales Region
    • 36 Orchard Street
    • Swansea
    • SA1 5AQ
    • Wales, U.K.
    • Tel. + 44 (0) 1792 607411
    • Fax. + 44 (0) 1792 470743
    • [email_address]