Protecting the Health of Future Generations

The conference was organised by Giz Watson, MLC (Greens WA) and Jane Bremner, Alliance for a Cleaner Environment WA, a community advocacy group.

The aim was to bring together concerned community members, NGOs lobbying for changes to environmental health policy, professionals involved in issues including health and risk assessment, and the Health Department of WA (HDWA). The focus was on providing community members with the opportunity to voice concerns about the current decision-making processes and to provide input for a future environmental health plan. It was acknowledged that community members often have valuable local knowledge to contribute to the assessment of a risk or hazard but are often excluded from environmental health processes. This can lead to a distrust of industry and government agencies that try to reassure communities about risk. The speakers generally discussed broad issues but also some of the concerns specific to WA, which centred around the Bellevue fire (the worst chemical disaster in WA) and the Alcoa Wagerup refinery (community members and employees of Alcoa).

A brief summary of each presentation is provided below.

MARIANN LLOYD-SMITH, PhD, Coordinator, National Toxics Network (Aus, NZ, and S.Pacific).

The National Toxics Network (NTN) www.oztoxics.org.au/ntn is a community based network which aims to reduce the chemical load on the environment and to promote environmentally-responsible technologies and management systems. The Network has over 300 participants from Australia, NZ and the South Pacific. The focus is strongly on community involvement and consultation and lobbying policy makers. It is a part of the International Persistent Organic Pollutants (POPs) Elimination Network (IPEN) www.ipen.ecn.cz. Recently IPEN’s Community Monitoring Working Group, of which Dr Lloyd-Smith is the secretary, produced the ‘Body Burden Community Monitoring Handbook’, a resource for communities to aid them in supporting the implementation of the Stockholm Convention on POPs (2001) and the phase-out and elimination of persistent and bioaccumulative chemicals. Members of the International Society of Doctors for the Environment (ISDE) helped working group members translate into several key languages the ‘Health Professionals can Help’ part of the Handbook. The Handbook is online at www.oztoxics.org/cmwg/index.html. She also praised ISDE’s efforts in collaborating with the WHO on its recent Child Health paper. However, one of Dr Lloyd-Smith’s first points in her talk was that although health professionals commonly see people who are affected by environmental exposure to chemicals, they rarely ask questions about people’s environmental concerns and most are ill informed about conditions such as Multiple Chemical Sensitivity (MCS) or where to refer sufferers for assessment. She discussed vulnerable sub populations in the community - women of child bearing age and children. At a conference in Budapest in 2004, entitled ‘The future of our children’ the top four risks identified to children’s health globally in the future were:

1. Indoor and Outdoor pollution

2. Unsafe water

3. Lead exposure

4. Injuries

The unique vulnerability of children to hazardous chemicals was highlighted with emphasis on the timing of exposures in determining the type of effect, and ‘chemical trespass’ (babies born with a toxic load as measured in meconium). Further information on these issues is available in “Children’s Environmental Health – Intergenerational Equity in Action”, a briefing paper written by NTN, with an examination of specific toxins, Australian experiences and a list of recommendations to ensure the safety of our children. The full paper can be found at www.oztoxics.org/ntn. There also seems to be a percentage of the population (estimated to be up to 10%) who to some degree have a sensitivity to chemicals, ranging from a mild reaction to cleaning products or perfumes through to a severe reaction such as in Multiple Chemical Sensitivity. Dr Lloyd-Smith gave a quick discussion about the precautionary principle and its application to environmental health. ISDE have fully supported the application of this principle in its paper on POPs , currently posted on this website. There is also a briefing paper produced by NTN which discusses the main points and is very informative, found on their website, entitled ‘The Precautionary Principle gets Real’. She then discussed the following groups of toxins:

1. DIOXINS. Australia has a National Dioxins Program and has ratified the Stockholm Convention. Use of dioxins, furans and PCBs has fallen in Australia since this occurred. In the past 3 years, levels of Dioxins in the Australian population have also fallen, according to the findings of the latest community study and generally, levels are lower than in other parts of the world. The study can be found at www.deh.gov.au/industry/chemicals/dioxins.

2. ORGANOPHOSPHATE PESTICIDES. Organophosphate pesticides such as DDT and Dieldrin have been banned in Australia in recognition of their toxicity to animals and humans and their persistence in the environment, although the use of Mirex still continues in the NT (mangoes). These are persistent environmental pollutants and some metabolites of these, such as Chlopryrifos are very toxic. NTN is calling for a ban on the use of these pesticides altogether in Australia.

3. BROMINATED FLAME RETARDANTS. Brominated flame retardants are now causing great concern globally. Many have been banned in the EU however there is no such ban in Australia. Levels are highest in children under 4. They have been shown to cause disruption of thyroid hormones, mimic oestrogen and are linked to cancer and reproductive damage. Studies from the US have found high levels in dust inside homes. NTN would like to see the precautionary principle applied in this instance in Australia. No monitoring of this group of chemicals is occurring in Australia despite the emerging risks. They are used in a wide range of finished products including plastics, white goods, furniture, bedding and carpets. NTN’s briefing paper on brominated flame retardants is available at www.oztoxics.org/ntn/bulletins.

4. PERFLUOROCHEMICALS AND PHTHALATES. Perfluorochemicals are used widely in cosmetics and clothing. Teflon is also in this category and there is emerging evidence about its toxicity. Globally, alternatives are being sought for these chemicals in a plan to phase them out. Phthalates are another group. In Australia, NTN are calling on industry to regulate this group and divulge information on types of phthalates, levels and what they are being used in. This information is apparently not public at this time so that potential risks to the population cannot be determined.

In her summary, Dr Lloyd-Smith called for greater accountability by industry in Australia, greater transparency and the formation of a database of chemicals used in everyday household goods and items. She recommended community education and vigilance with respect to making consumer choices, and for the community to support products which do not contain the toxins listed above, and the companies that make them. The Community Monitoring Handbook is a resource for communities to assist them to achieve this goal.

Mr LEE BELL (Campaigner for Environmental health in WA)

Background: Lee Bell has been involved in campaigning against industry pollution in WA, especially the Alcoa Alumina plant in Wagerup south of Perth. Residents living nearby and workers at the plant were affected, particularly after Alcoa increased the scale of its operations in 2001. Complaints included those of odour and noise and varied health effects. Alcoa reassured the community that safe levels were not being exceeded as determined by its monitoring program and a risk assessment of the hazards. An inquiry by the Environment and Public Affairs Committee (Legislative Council) into the Alcoa Wagerup plant and possible public health effects started in November 2001 and received 71 written submissions and conducted over 20 hearings. It released its report in October 2004 with 20 public health recommendations. It acknowledged that there were some serious concerns with emissions from the plant, and with Alcoa’s response to community concerns. It called for Alcoa to rehabilitate chemically injured workers, and the creation of a long term health surveillance program of residents and employees backdated to 1996. The Inquiry also recommended the creation of, and long term funding for, an Environmental Health Foundation by the Government, which is to be independent, but is to report to the Minister for Health and the Minister for the Environment, and that this Foundation to include community representation. A full report of the Inquiry, including the recommendations made can be found at www.parliament.wa.gov.au click onto Legislative Council, Committees, Environmental and Public Health Affairs, Past Inquiries.

Lee presented an overview of the risk assessment process as commonly used by industry and regulatory bodies. As well as pointing out that many risk assessment processes may use questionable scientific method, there are many opportunities for subjective intervention in the process. He discussed controversies in risk assessment, including how empirical toxicological evidence can disempower communities and how local knowledge can be ignored in this process. (ie by testing in the wrong place, in the wrong weather conditions and so on.) On many occasions industry has been able to reassure regulatory bodies that there have been no risks on the basis of flawed information producing a flawed result. This leads to distrust within the community. He called for the inclusion of independent advice and testing, and community representation in such controversies. He felt that reliance on the risk assessment process should be reduced, with an increase in clinician input and medical evidence (often ignored if the risk assessment decides there is ‘no problem’) as well as epidemiological reports. It was his view, that as a community, we need to push for an end to chemical exposure, rather than deciding on a tolerable level, considering that for some vulnerable sub populations, this level is still too high. He also called on the medical profession to increase its recognition of adverse chemical impacts and for training to occur in standardized diagnostic protocols for chemical injury. He also gave a summary of how current scientific thinking in toxicology, differs from views held in the recent past. Previously, single toxins were considered in isolation with a focus on cancer risk. However, complex combinations of toxin exposure are now the norm, with evidence that endocrine disruption is the health effect most likely to occur. There has also been recognition that effects can occur at low doses and that the dose does not necessarily make the poison, with effects possibly occurring in some people at ‘background or accepted levels’. Instead of a focus on acute toxic effects, there is concern that long latency periods, with health effects occurring later in life, may result in not just cancer, but a wide range of endpoints, including immune system dysfunction, neurological deficits, cognitive and behavioural deficits, reproductive disorders and chronic disease. The same toxin, with exposure occurring at a different stage of development in a human (ie infant vs older person) may have different effects and cause different end points.

DR ANDREW HARPER, (Occupational Health Physician).

Dr Harper has been pivotal in assisting workers in WA to gain recognition of chemical-induced injury, particular those affected by emissions at the Alcoa Wagerup plant. A plume from a liquor burning plant frequently enveloped an area where workers were exposed to fumes on a regular but intermittent basis, depending on weather conditions. Many of these men became progressively more ill after each episode of emission exposure and gradually over time, many did not recover between episodes. Their symptoms were varied and systemic and 9 fulfilled the criteria for Multiple Chemical Sensitivity (MCS), as proposed by Dr Mark Cullen in 1996, an American Occupational Health Physician, a consultant for Alcoa who also gave evidence at the Inquiry. The Inquiry accepted that these workers had been severely debilitated by the emissions exposure which had seemed to cause their symptoms. Although scientific and diagnostic evidence for their condition was lacking, the inquiry felt that their stories, as presented to different doctors, were consistent with a common causality and called on Alcoa to accept liability and rehabilitate them.

MCS is a controversial condition, which can occur in all occupations, not just those typically thought to be associated with chemical exposure. The generalised nature of symptoms make it difficult to define a set of precise clinical criteria for diagnosis - these symptoms include mucous membrane symptoms (eyes, nose, mouth, pharynx), respiratory symptoms, palpitations, skin rashes, joint pains, urinary symptoms particularly frequency, generalised fatigue and sensitivity to usually-quite-innocuous chemicals such as chlorine, perfumes, smoke etc. The obvious controversy is why some people get sick and others don’t. It appears that there are vulnerable sub populations in the community (perhaps relating to genetic variability); but that the total numbers of people being affected by MCS is on the whole increasing. As MCS does not yet have a code in the International Classification of Disease codes (ICD), it is difficult to collect epidemiological data on it’s incidence and prevalence, which some authors put at 10% of the population to varying degrees.

Dr Harper pointed out that science is lagging behind the condition, as sometimes occurs in medicine, where understanding can follow the event. There is however mounting evidence of the biological effects of many organic compounds, as they can be measured in blood via markers of cellular damage. For example, the frequency of chromosomal aberrations in peripheral blood lymphocytes (as a bio-marker of genotoxic damage) of non smoking bus drivers was much greater than that of a group of postal workers, in a study from Copenhagen in 1999. Recently, elevations of nitric oxide/perioxynitrite and neural sensitisation have been proposed as a central mechanism for the exquisite sensitivity to organic solvents apparently induced by previous chemical exposure. (See a paper by Dr Martin Pall from the School of Molecular Biosciences, Washington State University at www.ehp.niehs.nih.gov/members/2003/5935/5935.html#intro.)This is thought to provide answers to the puzzling aspects of MCS including fatigue, neural symptoms and biochemical effects. He feels that further research will result in science ‘catching up’ and the dilemma of MCS will become a syndrome that can be confirmed by diagnostic tests. He emphasized that factors such as unprecedented population growth, energy intensive technology, unregulated synthetic chemical production with an emphasis on short term gains rather than long term costs has led to a situation where the rate of change is outstripping the rate of scientific development in this area. Dr Harper emphasized that we cannot defer social action in the face of mounting although incomplete evidence; standing by and waiting could result in great and potentially irreversible health consequences. He reiterated that the precautionary principle must apply where possible and that community members and NGOs need to remain vigilant for the emergence of future public health concerns.

MR MICHAEL JACKSON (Executive Director of Population Health Division of the Health Dept of WA)

Mr Jackson acknowledged that there are several challenges currently facing communities in Australia. One is the presence of residential communities close to industry where hazardous chemical and waste are presenting a risk of exposure. The Bellevue fire in Perth was an example where toxic material entered ground water and toxic plumes enveloped residential areas. He felt that health concerns such as MCS are a challenge that needs to be met with greater resources, research, facilities for testing and upgrading of toxicological services independent of industry. Greater planning needs to occur before new industrial facilities are built, including buffer zones. He admitted that the HDWA needed to do a better job with regard to responding to community concerns about these issues and hoped that with the establishment of the new Environmental Health Foundation, this could occur.

Some of the recommendations or tasks for the new Foundation included liaising with Divisions of General Practice, community telephone hotlines, public meetings and open days, health surveys, a medical register for ongoing evaluation, cancer studies, community health nurses with links to clinical toxicologists and improved and more comprehensive diagnostic testing. The Environmental Health Foundation would comprise a core group of independent medical professionals and academics who would be able to consult with and respond to community members and their concerns.

Further suggestions such as the development of an environmental health assessment unit located at one of Perth’s public hospitals, and the introduction of ‘right to know’ legislation (re potential hazards in products, or for people living close to industry etc) were enthusiastically received by community members at the forum.