Giant Mine Remediation Project Team Giant Mine Remed ation Project - PDF document

MV2007L8-0031 Giant Mine Remediation Project Team Giant Mine Remed ation Project Team Outline of scope for asses Outline of scope for assessment of indirect ment of indirect stress ef stress effects of pote fects of potential arsenic exposure ntial arsenic exposure Ketan Shankardass, MHSc, PhD July 7, 2015 Beyond the requirement of a human health risk assessment to be completed, Appendix F of Measure #10 from the “Report of Environmental Assessment and Reasons for Decision, Giant Mine Remediation Project” (Mackenzie Valley Review Board, June 2013) specifies that there must be evaluation of “the indirect effects of potential exposures to arsenic on wellness, including stress effects.” This document shares a working outline for the scope of work. It draws mainly from my own framework of environmental determinants of stress and disease (Shankardass, 2012) and preliminary considerations based some review of the extant literature and facts on the ground. The approach to measurement is also guided by concerns outlined for assessment of direct effects on human health in Measure #10. Future revisions will incorporate the input of the Giant Mine Working Group, Dr. Sue Moodie and the Independent Peer Review Panel. Future revisions are also contingent on a pending contract between myself and the Government of Canada. In that sense, this document is meant to focus and facilitate the on-going discussion that will inform the scope of work. This outline includes: (1) a conceptual framework for understanding how arsenic exposure (as reflected in the built, natural and social environment) can increase harmful manifestations of chronic stress; (2) a literature review of historical and baseline information related to indirect effects of environmental determinants of stress in Yellowknife; and (3) an approach to for the design, measurement and analysis of data to complete the evaluation. Concept Conceptual Framework: al Framework: Environmental determinants of arseni Environmental determinants of arsenic exposure and place-based stress c exposure and place-based stress Stress has been conceptualized and empirically studied in unique ways by psychologists, sociologists, psychoneuroimmunologists and others since Hans Selye first described the ‘General Adapatation Syndrome’ in 1936 (Selye, 1936). I have argued that a unified approach is required in order to more fully understand how social inequalities in health are generated and maintained (in addition to other individual and structural determinants of health) (Shankardass 2012; Shankardass and Dunn 2012). The ‘stress process’ described by Leonard Pearlin and colleagues (Pearlin et al 1981) offers a way to integrate diverse knowledge about stress. In brief, it describes how sources of stress (‘stressors’) can be translated into broad manifestations on human health depending on a series of mediating factors (Table 1). 1

Giant Mine Remed Giant Mine Remediation Project Team ation Project Team Outline of scope for asses Outline of scope for assessment of indirect ment of indirect stress ef stress effects of pote fects of potential arsenic exposure ntial arsenic exposure Ketan Shankardass, MHSc, PhD July 7, 2015 Table 1. Sources So urces Mediators Med ators Ma Mani nifesta festations ns ‐ Potential stressors, Emotional, Perception of stressors Stress process Stress process e.g., meaningful life ‐ behavioural and Assessment of resources stage stage events and daily physiological for coping strains dysfunction ‐ Genetic features I have recently described the stress process in terms of an individual construct embedded in the environment (Figure 1; Shankardass 2012). This approach highlights the deterministic role of both stressors and resources contained in the built, natural and social environment as individual perceive and coping with stress over time. Importantly, environmental factors are potentially static or dynamic (and sometime both where there is some aspect of permanence), and can have a variable effect on the same individual over time. Figure 1. NB. Solid arrows indicate the pathways that relate environmental determinants of stress to chronic diseases via primarily physiologic changes in response to stress hormone dysregulation (1) and in relation to healthy and unhealthy habits related to coping (2); pathways of endogeneity (e); and pathways of confounding (c); while dashed arrows that cross solid arrows indicate effect modification. The notion that individual’s construct a ‘sense of place’ (Jorgensen and Stedman, 2001) is important for understanding how exposure to hazards of the environment (including arsenic trioxide) affect our experience of stress and the manifestation of chronic disease, in particular. Such hazards can interrupt one’s sense of place through cognitive, affective and conative pathways 2

Giant Mine Remed Giant Mine Remediation Project Team ation Project Team Outline of scope for asses Outline of scope for assessment of indirect ment of indirect stress ef stress effects of pote fects of potential arsenic exposure ntial arsenic exposure Ketan Shankardass, MHSc, PhD July 7, 2015 because of ‘place identity’, ‘place attachment’ and ‘place dependence’. Place identity refers to beliefs about the relationship between self and place (i.e., to what extent does one internalize their places as a part of their identity?); place attachment refers to feelings about the place (e.g., how are we positive and negative about our places); and place dependence refers to the behavioral exclusivity of places in relation to alternatives (i.e., to what extent do we rely on these places? would we be just as supported and happy in other places?). The devastating impact of the arsenic hazard in Yellowknife is that “contamination is … invisible… sort of like a ghost… it’s in places that are supposed to be safe. It’s like the monster under your med. And that’s the really devastating impact of things like this is you start to be afraid to live in the place that you are.” - Dr. Erin Freeland Ballantyne in Shadow of A Giant (Johnson and Ferguson 2015) A place-based approach is also enriched by acknowledging the bi-directional relationship between individual and the places that they spend time in living, working and doing other things (so-called ‘third places’). So, arsenic trioxide could be more or less relevant, threatening, culturally damaging, for different individuals. Likewise, specific environmental resources offered to help ameliorate indirect effect on stress may be more or less relevant, appealing, culturally appropriate (or otherwise meaningful), or practically accessible for individuals. Individuals may also be more or less prone to utilize resources in their neighbourhoods according to how they perceive their surroundings over time. Folkman et al (1986) describe stress as individuals “in a dynamic mutually reciprocal, bidirectional relationship” with their context, while Luginaah et al (2002) described how residents living in the shadow of industrial hazards engage in “cognitive reappraisal” of places over time. Literature review: histori Literature review: historical al and base and baseline information line information An initial (read: very brief) review of scholarly and grey literature found some impacts on stress for families of workers involved in the 1992 strike in the Journal of the Canadian Medical Association (Williams, 1992), as well as anecdotal evidence about relevant stressors in the interactive documentary, ‘Shadow of a Giant’ (Johnson and Ferguson, 2015). A more systematic review will be completed in preparing the scope of work. This includes reviewing a paper by Paci and Villebrun (2005) in Pimatisiwin on community health impacts of mining for the Dene nation. I have also been in contact with the Dechinta Centre for Research and Learning, and anticipate contacting other relevant experts and organizations to find more literature. Beyond looking strictly for historical and baseline data about stress effects of arsenic exposure in Yellowknife, this search could be expanded to include stress impacts of arsenic and other environmental toxins on communities (indigenous/non-indigenous) elsewhere. Approach Approach 3