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 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

Dear Doctor… Cancer Cancer Cancer As Syndrome Exposure Pb Birth defects PAH Deaths Deaths Dioxins Dioxins Unexplained illness Hazard Landfill Industrial sites Commercial sites We’re all going to die!

A familiar approach? Syndrome Pathway Exposure Receptor Hazard Source

Role of the HPA? Role of the HPA? Do something about it!

SO: SO: RISK MODEL Hazard analysis 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 of 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 Toxicology Toxicology Environmental Sciences Environmental Sciences Epidemiology Epidemiology Risk estimation Risk estimation 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?

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 Individual inheritance World Summit on Sustainable Development. Springer, Dordrecht, 2005. 151-181. Personal choices Social support Living conditions Environmental conditions National & International 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 calculations: Risk calculations: RISK MODEL Hazard analysis Exposure analysis Risk assessment Numbers Not always easy Risk communication might look Large uncertainty better than they are Unquantified aspects

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)

SO: SO: RISK MODEL Hazard analysis Exposure analysis Risk assessment Risk communication

Better: Better: STAKEHOLDER SITUATION RISK MODEL POSITION ANALYSIS Hazard Syndrome Who’s Who’s What’s What’s What’s What’s Involved? the context? the problem? Exposure What do we all need to do?

Or, simply: Or, simply: RISK MODEL STAKEHOLDER SITUATION POSITION ANALYSIS Families Contaminated Contaminated Neighbours Neighbours Community Community Land Schools Locality MPs History LA Other? HPU /CRCE What do we all need to do?

Or, in general: Or, in general: Experience Relationships Knowledge Life!

http://www.hpa.org.uk/web/HPAwebFile From Risk to Response From Risk to Response /HPAweb_C/1194947331304 Reid et al. Chemical Hazards and Poisons Report, May 2005; 4: 33-35 STAKEHOLDER SITUATION RISK MODEL POSITION ANALYSIS Hazard analysis Engagement with e.g. Community & Staff Community & Staff Statutory procedures Statutory procedures Local Authority already underway Exposure analysis Councillors & MPs Local environment Environment Agency Local epidemiology Clinicians Local investigations Risk assessment Health agencies being undertaken HSE National pictures et al Litigation Risk communication INTEGRATED HEALTH PROTECTION RESPONSE

What about stress & fear? What about stress & fear? Not rational Do not respond to reason Or numbers Develop trust Bring vision for tomorrow Give sense of security “These three remain, faith, hope, love; St Paul but the greatest is love!” 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: Environmental consultant ��� ���� �� The community: ��������������� ������� ��������� ��������� ���������� ���������� ������������� ����������������� 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 Increased blast cells • radiotherapy in bone marrow • Family history All this is in adults. • Chemotherapy 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?

Initial leaflet Initial leaflet HEALTH & ENVIRONMENTAL INFORMATION 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