Responding to contaminated land issues Keeping everyone unhappy: - - PowerPoint PPT Presentation

Responding to contaminated land issues

Keeping everyone unhappy: the art and science of environmental Public Health Alex G Stewart and a few friends alex.stewart@hpa.org.uk Health Protection Agency

SILC London April 2012

the art and science of environmental Public Health

Syndrome Exposure Cancer Cancer Cancer Birth defects Deaths As Pb PAH Dioxins

Dear Doctor…

Hazard Landfill Industrial sites Commercial sites Deaths Unexplained illness Dioxins

We’re all going to die!

Syndrome Exposure

A familiar approach?

Pathway Receptor Hazard Source

Role of the HPA? Role of the HPA?

Do something about it!

RISK MODEL Hazard analysis

SO: SO:

Exposure analysis Risk assessment Risk communication

Some questions Some questions

The public has a poor understanding of contamination and exposure mechanisms. Do we talk the same language? Authorities response may not meet the public’s expectation. What does the public worry about? Do we really weigh hazards and control measures against the troubles that the community may encounter? How? How should we take into account any bigger picture (e.g. people’s priorities)? Do we have the tools / potential for better communicating risk?

Public Health Public Health

The art and science

• f preventing disease,

promoting health, promoting health, & prolonging life through the organized efforts of society

Acheson D: Independent inquiry into inequalities in health. London: HM Stationery Office 1998.

Science Science

Geochemistry Geochemistry Environmental Sciences Environmental Sciences Risk estimation Risk estimation Toxicology Toxicology Epidemiology Epidemiology Social Sciences Social Sciences

Chemicals Chemicals

> 31,000,000 chemicals assigned CAS numbers

Chemical Abstract Service

~ 640,000 commercially available chemicals

Chemfinder

~ 70,000 chemicals routinely transported in UK ~ 70,000 chemicals routinely transported in UK

NCEC

~ 500 new chemicals introduced to UK market pa

HSE

~ 5,000 chemicals with reliable medical toxicology information for acute and chronic exposure

Baxter, BMJ 1991

What about mixtures?

National & International Environmental conditions Living conditions Social support Personal choices Individual inheritance

The Determinants of Health

Adapted from AG Stewart, E Wilkinson & CV

• Howard. Health: a necessity for sustainable
• development. In L Hens & B Nath [eds]. The

World Summit on Sustainable Development. Springer, Dordrecht, 2005. 151-181.

National & International Individual inheritance - sex, age, genetic makeup Personal choices - diet, smoking, alcohol & illicit drugs, other lifestyle choices Social support - family, friends, colleagues, local community Living conditions – home, water supply, sewerage, employment, health care, peace / war Environmental conditions – working environment, quality of food source and supply, schooling National & international – economy, religion & culture, trade, transport, natural world Note: Some of these may work at several levels

Most disease is multi Most disease is multi-factorial factorial

Morbidity = mortality Morbidity = mortality

\ Morbidity Mortality

Standardsised Rates of Deaths with Renal Codes in Any Cause

Significantly Higher than NW (3) Confidence intervals overlap NW (38) Significantly Low er than NW (2)

Disease pyramid Disease pyramid

Die Hospitalised Presents to GP Symptomatic in community Symptomatic in community Non-symptomatic Biomarker detectable Exposed to causative factor[s]

RISK MODEL Hazard analysis Exposure analysis

Risk calculations: Risk calculations:

Risk assessment Risk communication

Not always easy Large uncertainty Unquantified aspects Numbers might look better than they are

Psychological & Social Effects of Psychological & Social Effects of Living with Environmental Risk Living with Environmental Risk

• Stress, anxiety, worry
• Strained relationships:
• Family
• Family
• Friends
• Colleagues
• Community conflict and division
• Stigmatism “The Village of the Damned”

“The Village of the Damned”

Source : G. Barnes. Social Science & Medicine 2002; 55:2227-2241

Art Art

The art of Public Health

What is art? What is art?

Picasso: Weeping woman (1937) Rembrandt: Self (1630)

What is Art? What is Art?

• A means of indirect

communication between persons (Tolstoy, 1828-1910)

• Imaginative, creative branches of

knowledge (Collins free dictionary)

Imaginative communication? Imaginative communication?

Picasso: Weeping woman (1937) Rembrandt: Self (1630)

RISK MODEL Hazard analysis

SO: SO:

Exposure analysis Risk assessment Risk communication

RISK MODEL

What’s

SITUATION ANALYSIS

What’s

STAKEHOLDER POSITION

Who’s

Hazard Syndrome

Better: Better:

What’s the problem? What do we all need to do? What’s the context? Who’s Involved?

Exposure

Or, simply: Or, simply:

RISK MODEL

Contaminated

SITUATION ANALYSIS

Community

STAKEHOLDER POSITION

Families Neighbours Contaminated Land What do we all need to do? Community Locality History Other? Neighbours Schools MPs LA HPU /CRCE

Or, in general: Or, in general:

Knowledge Experience Relationships Life!

From Risk to Response From Risk to Response

RISK MODEL Hazard analysis SITUATION ANALYSIS e.g. Statutory procedures STAKEHOLDER POSITION Engagement with Community & Staff http://www.hpa.org.uk/web/HPAwebFile /HPAweb_C/1194947331304 Reid et al. Chemical Hazards and Poisons Report, May 2005; 4: 33-35 Exposure analysis Risk assessment Risk communication

INTEGRATED HEALTH PROTECTION RESPONSE

Statutory procedures already underway Local environment Local epidemiology Local investigations being undertaken National pictures Litigation Community & Staff Local Authority Councillors & MPs Environment Agency Clinicians Health agencies HSE et al

What about stress & fear? What about stress & fear?

Not rational Do not respond to reason Or numbers “These three remain, faith, hope, love; but the greatest is love!”

St Paul

Develop trust Bring vision for tomorrow Give sense of security Keeping everyone unhappy?

Story

What happened? What happened?

Syndrome Syndrome

Two deaths from rare Acute Megakaryoblastic Leukaemia Lived back to back Nov 2003 – Feb 2004 Died one year apart

Who were involved? Who were involved?

Health Advisory Team:

• The community:

Who were involved? Who were involved?

Health Advisory Team:

• The community:
• The media:

Who were involved? Who were involved?

Health Advisory Team:

• The community:
• Environmental consultant
• The media:
• Community’s

Environmental Consultant

Possible causes of Possible causes of Acute Acute Megakaryoblastic Megakaryoblastic Leukaemia Leukaemia

• Organic solvents
• Benzene
• Pesticides
• Ionising radiation
• Ionising radiation
• radon
• xrays
• radiotherapy
• Family history
• Chemotherapy

Increased blast cells in bone marrow All this is in adults. What about children?

2006

1985

Oh no! old landfill! Oh no! old landfill!

1972

Local anxiety was high: Local anxiety was high: what should they be told? what should they be told?

Local anxiety was high: Local anxiety was high: what should they be told? what should they be told?

HEALTH & ENVIRONMENTAL INFORMATION

Initial leaflet Initial leaflet

For people who live in: The Muir Housing Properties, Leftwich, Northwich, Cheshire.

Ownership and Trust Ownership and Trust

The community:

• Community meetings

Residents Chaired meetings Selected environmental consultant Helped inform investigation design Commented on draft press releases Participated in remediation options

Intrusive investigations 14 boreholes Soil Soil gas Ground water 12 months

Unacceptable levels [SPOSH] Observed level SGV The community:

• ! " #

Landfill Landfill

• Methane in potentially explosive levels
• CO2 in potentially lethal levels
• Gas tight membrane failure

Non-threshold toxins Threshold toxins

• Non-threshold toxins

Threshold toxins

– Benzene (>SGV, SSV, AQ) Mercury – B[a]P Nickel – DB[ah]A – Fluoroanthene – Arsenic

The community: " ! #

Meanwhile Meanwhile - Water supply Water supply

• 4 houses
• 9 dates 4/11/05 – 20/3/06
• 26 samples
• 26 samples
• 256 analyses

The community: $% $ # $&'(

1,2 Di chloro ethane none Benzene none Benzo [a] pyrene 2 Muirfield x1 Tri tetra chloro ethene none

Water: Water: Excess in houses over supply? Excess in houses over supply?

Tri tetra chloro ethene none Tetra chloro methane 9 Greenlaw x1 Tri halo methanes all 4 houses PAHs [DWI4] 2Muirfield x1

All tests were far below standards

What What did we look did we look for? for?

• Area

– Small area: postcodes CW8 & CW9 – SOA population area: 1500 residents

Health Advisory Team:

• Cases of

– All cancers – Leukaemia – Acute megakaryoblastic leukaemia (AML) (definition included related disorders)

Cancer Cancer

• No evidence of a change in incidence of

all leukaemias or all cancers

10 15 bers

• [Analysis limited by low numbers of cases]

5 J a n u a r y M a r c h M a y J u l y S e p t e m b e r N

• v

e m b e r months numb

NHS Direct calls NHS Direct calls

• RECORDS: time, date of call, complaint
• CW8 & CW9 vs Manchester centre

vs National data

• Cough, cold/flu, diarrhoea, difficulty

breathing, eye problems, fever, lumps, rash, vomiting

NHS Direct: No unusual patterns of symptoms NHS Direct: No unusual patterns of symptoms

Calls to NHS Direct for Fever and Cough by Area and Month July 2002 - Mar 2005

6.00% 7.00% 8.00% 9.00% 10.00%

• n of Calls

neighbours

e.g.

0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 2002 2003 2004 2005 Month Proportion Fever CW8 - CW9 Fever Manchester

Existing membrane

Key Considerations Key Considerations

Raw or interpreted?

Internet! Standards vs levels observed

• Selected journalist – press unhappy
• Personal contacts, letters, leaflets
• Community or agencies?
• Differential remediation
• Sensitivity, privacy
• Rehousing issues

Costs (measurable) Costs (measurable)

• Physical health

No new illness

• Mental health

No new illness

• Time

3 years part time

• Time

3 years part time

• Staff

10% time

• Whole Investigation

£10k / household = 1 month child cancer in-patient

• Remediation

£25K per house

Worth it? Worth it?

The houses were agreed to be safe to live in by:

• The incident team
• The environmental consultants
• The environmental consultants
• The environmental consultants to the residents
• The housing society
• Most of the residents
• New residents moving in

Acknowledgements Acknowledgements Apologies Apologies

Contaminated Land Officers I have known Public Health colleagues Environmental Scientists Epidemiologists Social Scientists ……..