1. Slowly poisoned: health consequences of pollution and environmental toxins Martin Donohoe, MD, FACP Portland State University Campaign for Safe Foods, Oregon Physicians for Social Responsibility

2. Overview Public health approach Air pollution Garbage Toxins Education/Corporate Influence Progress and Solutions

3. Some Major Sources of Air Pollution Industry - #1 Agriculture Automobiles Indoor combustion of coal and biomass for cooking, heating and food preservation

4. Air Pollution

6. Top ten most polluted cities in the world are in China and India Most polluted areas in US: –LA, Houston, San Joaquin Valley in Central California

7. Health Effects of Air Pollution Causes approximately 75,000 premature deaths/yr. in U.S. 1.8 million worldwide Linked to autism –Due to higher levels of heavy metals and certain chlorinated solvents

8. Health Effects of Air Pollution Air pollution causes asthma and impairs lung development and function Deaths from cardiopulmonary diseases correlate with air pollution levels in US cities –Both day to day and over time

9. Health Effects of Air Pollution Increased admissions for CHF, asthma, COPD, PVD, and cerebrovascular disease Increased lung cancer mortality Decreased exercise tolerance, increased pulmonary symptoms Impaired sperm production

11. Effects of Ozone Destruction Ozone hole over Antarctic (2½X size of Europe) Increased cataracts (UV damage) Increased lifetime melanoma risk –1/1500 - 1930 –1/68 - today

12. Automobiles

13. Number of autos -US: 1 car/2 people -Mexico: 1/8 -China: 1/100 (increasing; leaded gasoline) Global auto population to double in 25-50 years

14. Automobiles Average miles traveled/car/year in U.S. –1965 - 4,570 mi. –1975 - 6,150 mi. –1985 - 7,460 mi. –1995 - 9,220 mi. –2006 – 12,000 mi.

15. Automobiles 25 lbs. of CO 2 produced for every gallon of gasoline manufactured, distributed, and then burned in a vehicle U.S. energy costs exceed $500 billion/yr. (plus military costs to keep foreign oil flowing)

16. Automobiles Average fuel efficiency of U.S. autos stagnant –Ford Model T – 25 mpg (1908); Avg. Ford vehicle – 22.6 mpg (2003) Relatively low oil prices Growing market for low-efficiency pickups, minivans, and SUVs

17. Automobiles: Alternatives Rapid transit Electric cars –killed by oil companies, automakers, tire manufacturers in early 20th century –Convicted under Sherman Antitrust Act

18. Automobiles: Alternatives Car sharing Pay-as-you-drive auto insurance “ Peak Pricing ” and “ Congestion Fees ” –E.g., London → 30% decrease in traffic, 37% increase in bus ridership, cleaner air Bicycles/walking –30% of all trips by bike in Amsterdam; 2% in Portland, OR

19. Automobiles: Alternatives Busses Trains –15 x more efficient per passenger than autos Natural gas and/or gasohol -generate less CO 2

20. Automobiles: Alternatives Telecommuting Biodiesel –Vegetable oil-based fuel –Problem: Cheapest biodiesel is oil from palm trees; Indonesia, Malaysia deforesting areas to plant palm trees, leading to increase in global CO2

21. Automobiles: Alternatives Solar cars Hydrogen-powered cars –Byproduct = water –Problem: Hydrogen production requires fossil fuels

22. Energy Spending/Research Since 1947, the U.S. has spent $145 billion on nuclear R and D vs. $5 billion on renewables R and D < 5% of the DOE’s budget pays for energy efficiency and renewables BP invests $100 million annually in clean energy = amt. it spends annually to market its new name and environmentally-friendly image of moving “Beyond Petroleum”

23. Garbage 98% of the country’s total refuse is industrial waste; 2% municipal waste American produce 4.4 lbs/d garbage In a lifetime, the average American will throw away 6500 times his/her adult weight in garbage

24. Garbage In one year, Americans generate 236 million tons of garbage –30% recycled –164 million tons thrown away

25. U.S. Garbage Composition Paper and Paperboard - 39% Yard Waste - 13% Food Waste - 10% Plastics - 10% Metals - 8% Glass - 6% Wood - 5%

26. U.S. Recycling Rates Tires - 22% Plastic containers - 36% Glass containers - 28% Yard waste - 41% Paper and Paperboard - 42% Aluminum packaging - 54% Steel cans - 60% Auto batteries - 93%

27. Garbage Landfills (2300 in US) Incinerators Garbage exports

28. Toxins

29. Annual World Production of Synthetic Organic Chemicals 1930 - 1 million tons 1950 - 7 million tons 1970 - 63 million tons 1990 - 500 million tons 2000 - 1 billion tons

30. Toxins 6 trillion tons of over 85,000 chemicals produced annually –more than 80% have never been screened for toxicity Chemical manufacturers are not required to prove safety –the legal burden is on the government to prove that a product is dangerous –Consequence of 1976 Toxic Substances Control Act

31. Toxic Pollutants 85,000 known or suspected hazardous waste sites in the U.S. –Plus up to 600,000 lightly contaminated former industrial sites (“brownfields”) EPA estimates that there will be 217,000 new hazardous waste sites by 2033 –Will cost hundreds of billions of dollars to mitigate environmental impacts

32. Toxic Pollutants 1 in 4 U.S. citizens lives within 4 mile of a Superfund site (approximately 1,305 sites listed; another 2,500 sites eligible) Taxpayers paying increasing share of cleanup costs –54% in 2003 –Vast majority presently –Overall funding decreasing

33. Toxins Body burden of industrial chemicals, pollutants and pesticides high –Environmental Working Group (2004)found 287 pesticides, consumer product ingredients, and wastes from burning coal, gasoline, and garbage in umbilical cord blood Many other compounds not even tested; numbers undoubtedly higher

34. Fetuses and Children are Most Vulnerable to Toxins Greater pound-for-pound exposure Immature, porous blood brain barrier Lower levels of chemical binding proteins, allowing more chemicals to reach “target” organs

35. Fetuses and Children are Most Vulnerable to Toxins Organs/organ systems rapidly developing, thus more vulnerable to damage Systems that detoxify and excrete industrial chemicals are not fully developed Longer future life span allows more time for adverse effects to arise

36. Toxins in breast milk Human babies at the top of the food chain Fat soluble toxins concentrated in breast milk –Benefits of breast feeding still exceed risks Birth defects, learning disabilities increasing –Toxins play important role

37. Toxins and gender Sex ratio changing: –Normal = 105 boys/girls born (skewed by early male mortality) –Fewer boys being born in industrialized countries Other causes include obesity, older parental age, stress, fertility aides

38. Pesticides 5.5 billion lbs/yr pesticides –1.2 billion lbs/yr in US EPA estimates U.S. farm workers suffer up to 300,000 pesticide-related acute illnesses and injuries per year –Possibly linked to higher rates of sarcoidosis in agricultural workers –Pesticide-exposed men have impaired semen quality, which is associated with reduced fertility and testicular cancer

39. Pesticides NAS estimates that pesticides in food could cause up to 1 million cancers in the current generation of Americans Children living on or near farms score 5 points lower on IQ tests and other mental and verbal tests –May be due to pesticide exposure

40. Pesticides 1,000,000 people killed by pesticides over the last 6 years (WHO) CA and NY are the only states currently tracking pesticide sales and use EPA currently allows pesticide testing in humans, despite strong opposition

41. Pesticides

43. $2.4 billion worth of insecticides and fungicides sold to American farmers each year –Pesticides inhibit nitrogen fixation, decrease crop yields –Evidence suggests pesticides actually promote pests (vs. natural pesticides) 30% of medieval crop harvests were destroyed by pests vs. 35-42% of current crop harvests –Implies organic farming more cost-effective

44. Lead 2 million US children with elevated levels 120 million people with level > 10mcg/dL worldwide #s affected dropping

45. Lead Affects brain development, associated with lower IQ –No safe level for neurological development Levels between 4 and 10 significantly increase risk of cardio- and cerebrovascular disease Elevated levels associated with crime and violent behavior Poor, African-Americans more commonly exposed

46. Lead Poisoning: S/S, DX, and RX S/S: AP, CP, arthralgias, myalgias, HA, anorexia, ↓libido, ↓memory, anemia, nephropathy, HTN, cataracts, CV dz, cancer, ↓sperm count, lead line on teeth, basophilic stipling Dx: lead level, FEP (free erythrocyte protoporphyrin) Rx: ↓exposure, CsEDTA, DMSA

47. Toxic Pollutants – Economic Costs Birth defects, learning disabilities increasing –Toxins play important role Americans pay more than $55 billion annually for direct medical expenses plus special schooling and long-term care for pediatric diseases caused by lead This excludes the greatest toxic pollutant - tobacco

48. Mercury Released into air by coal combustion, industrial processes, mining, and waste disposal –4500 tons/yr Travels throughout atmosphere and settles in oceans and waterways Bacteria convert it to toxic methyl-mercury Travels up food chain via fish

49. Mercury 16% of women of childbearing age exceed the EPA’s “safe” mercury level Freshwater fish mercury levels too high for pregnant women to eat in 43 states

50. Mercury ↓ coal burning New EPA ruling ineffective: –allows cap-and-trade of power plant emissions –Removes power plants from list of pollution sources subject to federal Clean Air Act

51. Mercury: S/S, Dx, and Rx S/S: neuropsychiatric symptoms, inflammation of gums with excessive salivation, rash, nephropathy Dx: mercury levels in air, blood, urine (>100 mcg/l in blood and/or urine = toxic) Rx: chelation with BAL, penicillamine, DMPS, DMSA

52. Toxic Pollutants Dioxin - from manufacturing, medical incinerators, defoliants (“Agent Orange”) -Love Canal -cancers Nitrates/nitrites, trichloroethylene, vinyl chloride, ozone PFOA (Teflon): multiple health effects; being phased out by Dupont

53. Hazardous Waste and Fertilizer Legal to dispose of hazardous waste by turning it into fertilizer e.g. Uranium-laced fertilizer in Oklahoma, lead-laced fertilizer in SW Wash., other mixtures containing arsenic, cadmium and dioxins Unclear if a health hazard No requirement that toxins be listed on ingredient labels

54. Persistent Organic Pollutants Toxic, remain in environment long- term, resist degradation, can travel long distances Bioaccumulate - higher concentrations as you move up the food chain

55. Persistent Organic Pollutants 10 of the these are endocrine disrupters –egs. - DDT, chlordane, heptachlor, dioxins, PCBs –possible cause of decreasing male sperm counts (100 million/ejaculate in 1950, 50 million in 1990) and increasing cases of hypospadias. early puberty, and breast cancer

56. Toxic Pollutants and DNA Toxins can damage DNA New evidence from rats of epigenetic transgenerational effects of endocrine disruptors on male fertility in rats In 1938, 0.5% of men were functionally sterile –8-12% in 2006

57. Pesticides and Other Toxins Linked to Neurological Disease Parkinson’s Disease Autism Others

58. Phthalates Found in construction materials, clothing, toys, cosmetics, pills, added to PVCs in IV tubing/other plastics 5 million metric tons consumed by industry per year (13% in the U.S.) Exxon Mobil and BASF dominate the market

59. Phthalates Associated with: –demasculinization and alterations in genitalia in male infants –lower testosterone levels –lower sperm counts in adults

60. Phthalates/PVCs and Medical Devices EPA regulations weak, based on 50- year old study FDA has advised healthcare providers to use alternatives to DEHP-containing PVC medical devices, esp. in neonatal units

61. Environmental Racism and Toxic Imperialism Environmental Racism –waste dumps/incinerators more common in lower SES neighborhoods –“Cancer Belt” (Baton Rogue to New Orleans) –“White residential neighborhoods” - 1.7 acres parkland/1000 residents –“African-American neighborhoods” - 0.3 Toxic Imperialism

62. Mining and Pollution: Gold Cyanide “heap leach” gold mining –cyanide dripped over crushed rock to extract gold –taxpayers often stuck with cleanup costs

63. Mining and Pollution: Gold International gold mining linked to human rights abuses 84% of gold becomes jewelry –To save the environment, consider not buying gold jewelry

64. Should I Send Flowers? Most commercial flowers grown in sealed greenhouses in developing countries (e.g., Colombia, India China, Mexico) Carry 50 times the amount of pesticides allowed on food –One fifth of chemicals used banned in U.S. Workers underpaid, 50-60% suffer from pesticide poisoning

65. Electronic Waste Only 5-10% of computers recycled Most sent overseas, children disassemble EU now requires electronics firms to recycle and to eliminate lead, cadmium and mercury from their products Dell, www.computertakeback.comwww.computertakeback.com

66. Electronic Waste European laws re extended producer responsibility and product liability –Similar San Francisco resolution Maine passed first law requiring elctronic manufacturers to pay for recycling their discarded products

67. Medical Waste The 6,000 US hospitals generate 2 million tons of waste per year; clinics and doctors’ offices an additional 700,000 tons –850,000 tons incinerated 15% infectious waste

68. Medical Waste Incinerated pollutants include dioxin, mercury, cadmium and lead EPA regulations weak Segregation and alternatives to incineration would cost 93 cents/patient/day

69. Medical Waste One hospital bed generates between 16 and 23 lbs/day of waste Solutions: –80% of thermometers no longer contain mercury –Remove PVCs from medical supplies (e.g., IV tubing)

70. Water Pollution 40% of U.S. waters are unfit for fishing or swimming –beach closings The Jordan River (believed to be the gateway to the Garden of Eden and the place where Jesus was baptized) is now more than 50% raw sewage and agricultural runoff

71. Willamette River One of the most polluted rivers in the American West –Arsenic, lead, mercury, DDT 5.5 mile stretch Superfund site Current law allows polluters to calculate discharges using “toxic mixing zones” to get around limits on discharges

72. Water In developing countries, 90-95% of sewage and 70% of industrial wastes are dumped untreated into the local water supply 13,000-15,000 deaths per day worldwide from water-related diseases

73. Water Pollution: Bathtub=Toilet=Source of Drinking Water

74. Infamous Industrial Disasters Minimata, Japan, 1920s-1970s (Chisso Corporation) - methylmercury poisoning -400 dead; 10,000 injured Bhopal, India, 1984 (Union Carbide) - methyl isocyanate gas –7000-10,000 dead within 3 days, 15,000- 20,000 more over next 10 years; tens of thousands injured –persistent water and soil contamination

75. Minimata Disease W Eugene Smith

76. Infamous Industrial Disasters Chernobyl, USSR, 1986 - nuclear power plant explosion -25-100 dead, up to 1,000 injured acutely, NCI estimates 10-75K thyroid cancers Alaska, Exxon Valdez, 1989 - oil spill -wildlife devastated, $5 billion damage 2006 BP Alaskan pipeline ruptures

77. Since Exxon Valdez At least 1.1 million tons of oil have spilled from tankers worldwide –Equivalent to 30 Valdez incidents

78. Oil Pollution is Expensive to Clean Up

79. Oil Slicks Kill Marine Life

80. The Military and Pollution World’s single largest polluter 6-10% of global air pollution 2-11% of world raw material use 97% of all high level and 78% of all low level nuclear waste Pentagon generates 500,000 tons toxic waste/year

81. The Military and Pollution “The more birds that the [Department of Defense] kill[s], the more enjoyment [people] will get from seeing the ones that remain: ‘Bird watchers get more enjoyment spotting a rare bird than they do spotting a common one.’” –2002 court summary of the U.S. Defense Department’s argument for exemption from the Migratory Bird Treaty Act of 1918

82. The Military Small arms and rocket propelled grenades Land mines Nuclear, chemical and biological weapons

83. Military Waste More than 27,000 toxic hot spots at the pentagon’s 8,500 properties –less than 400 toxic waste dumps have been cleaned up –costs to clean - immense: likely never to be completed Military exempt from most environmental regulations

84. Worrisome Trends GATT NAFTA CAFTA Other trade agreements

85. SLAPP/SLAPP-Back Strategic Lawsuits Against Private Parties/ Countersuits SLAPPs- designed to harass environmental groups, deplete their financial resources through threatened or actual litigation

86. Politics: Bush Administration Key administrators/committee members/regulators former industry representatives and/or lobbyists Corporate profit before public good Unsound/distorted/suppressed science Eco-harassment –Criminalizing activists

87. Bush Administration Rollbacks of key environmental laws Lax enforcement of existing laws Huge tax cuts primarily benefit wealthy Federal and state government deficits astronomical –Program and funding cuts

89. Would You Sign a Petition to Ban Dihydrogen Monoxide? 1. It can cause excessive sweating and vomiting 2. It is a major component in acid rain 3. It can cause severe burns in its gaseous state 4. It can kill you if accidentally inhaled 5. It contributes to erosion 6. It decreases effectiveness of automobile brakes 7. It has been found in tumors of terminal cancer patients

90. Environmental Ignorance A majority of Americans believe that electricity in the U.S. is produced in nonpolluting ways –25% knew that majority (70%) comes from oil, coal and wood 1/3 assumed that spent nuclear fuel (from our 104 plants) is stored “in a deep underground facility in the West” –Only 17% were aware that it is mostly stored on-site at powerplants pending a long-term solution (30,000/tons)

91. Pseudoscientific Beliefs Percentage of Americans who believe “at least to some degree” in these “phenomena” 19971976 Astrology37% 17% UFOs30% 24% Reincarnation25% 9% Fortune-Telling14%4%

93. Greenwash Public relations / ad campaigns -Chevron’s “People Do” Campaign, butterflies/refinery -Dupont Freon Campaign in 1970’s -Grants to a few scientists who challenge environmental warnings -tobacco ads in 1950’s

94. Astroturf and Corporate Front Groups Artificially-created grassroots coalitions Corporate front groups –The American Council on Science and Health –The Oregon Lands Coalition –National Wilderness Institute –The Foundation for Clean Air Progress

95. Corporate PR tactics Invoke poor people as beneficiaries Characterize opposition as “technophobic,” anti-science,” and “against progress” Portray their products as environmentally beneficial in the absence of (or despite the) evidence

96. Sponsored Environmental Educational Materials Corporate-sponsored and supported by a loose coalition of antiregulatory zealots, corporate polluters, lapdog scientists and misguided parents

97. Sponsored Environmental Education Materials (Examples) Exxon’s “Energy Cube” -“Gasoline is simply solar power hidden in decayed matter” -“Offshore drilling creates reefs for fish” Pacific Lumber Company -“The Great American Forest is... renewable forever”

98. Sponsored Environmental Education Materials (Examples) International Paper -“Clearcutting promotes growth of trees that require full sunlight and allows efficient site preparation for the next crop” American Nuclear Society’s “Activities with the Atoms Family” Dow’s “Chemipalooza”

99. “Doubt is our product” Brown and Williamson Tobacco Company Memo, 1960s

100. Progress and Solutions

101. The “Benefits” of Sterility-Causing Chemicals in the Workplace? 12 September 1977 Dr. Eula Bingham, Assistant Secretary for Occupational Safety and Health [Regarding] worker exposure to DBCP. While involuntary sterility caused by a manufactured chemical may be bad, it is not necessarily so. After all, there are many people who are now paying to have themselves sterilized to assure they will no longer be able to become parents... If possible sterility is the main problem, couldn’t workers who were old enough that they no longer wanted to have children accept such positions voluntarily? Or…some [workers] might volunteer for such workposts as an alternative to planned surgery for a vasectomy or tubal ligation, or as a means of getting around religious bans on birth control when they want no more children? Sincerely, Robert K. Phillips, National Peach Council

102. Environmental Success Story The Montreal Protocol (1987) Phaseout of chlorofluorocarbons (CFCs) by 1996 Developed in 1920s; the chief working fluid in refrigerators, aerosol spray cans, insulating foams, and industrial solvents and cleaning agents -1 million tons/year manufactured in 1970s -major cause of Antarctic and Arctic ozone holes -current substitute, HCFCs, much less damaging to ozone layer, also to be phased out

103. The Montreal Protocol 1980 - 880,000 tons CFC’s produced worldwide 1996 - 141,000 tons 1996 - all industrialized nations stopped producing CFC’s Today: Illegal CFC trade, once quite large, starting to taper off 2010 - rest of world expected to stop

104. The Montreal Protocol However, the Bush administration has withdrawn from the Treaty, under pressure from agribusiness and chemical lobbyists, who favor increased spraying of the pesticide methyl bromide (the most dangerous ozone-destroying chemical still in use)…..

105. Toxic Pollutants: The Basel Convention The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes (designed to control dumping of hazardous wastes from the industrialized world in developing countries) Despite being the largest producer of toxic pollutants in the world, the U.S. has signed but not ratified this agreement

106. Persistent Organic Pollutants UN Environmental Program organizing worldwide phaseout of top 12 through the Stockholm Convention on Persistent Organic Pollutants –Including DDT, PCBs, and dioxins –US has signed, but not ratified

107. Lead American Assn. of Pediatrics now recommends toxic lead be removed from all housing and that all children be tested once during their first two years 25% of U.S. homes still contain significant amounts of lead-based paint –Cost of removing lead from 4 million seriously affected homes: $28 billion Cost savings each year thereafter: $43 billion (higher IQs, increased earning power, increased tax revenue, lower health care costs, less crime)

108. Leaded Gasoline Banned in Canada in 1990, US in 1996 (after 25-year phaseout period), EU in 2002, Africa in 2006 –Ban fought by industry for decades –Scientists harassed Many countries still sell leaded gasoline: –Indonesia, Venezuela, North Korea, Iraq, Afghanistan, Jordan, Syria, Yemen

109. REACH Registration, Evaluation, and Authorization of Chemicals European Treaty requiring companies to test chemicals already on the market by a set timetable and test new products before putting them on the market

110. REACH Cost of evaluations < 1% of chemical industry’s total sales Economic analyses show REACH could bring environmental benefits worth €95 billion over the next 25 years and result in health cost savings of €50 billion over the next 30 years

111. Medical Waste Organizations: –Health Care Without Harm –Green Health Center Movement Hospitals built and operated on more environmentally sosund principles save money (NAS): –Costs recovered more quickly, patients get better sooner, patients’ families happier, medical errors reduced, steaf turnover/absenteeism/workers’ comp claims drop

112. Solutions Based on the Precautionary Principle “When evidence points toward the potential of an activity to cause significant, widespread or irreparable harm to public health or the environment, options for avoiding that harm should be examined and pursued, even though the harm is not yet fully understood or proven”

113. The Precautionary Principle: Practical Essentials Give human and environmental health the benefit of doubt Include appropriate public participation in the discussion Gather unbiased, scientific, technological and socioeconomic information Consider less risky alternatives

114. The Precautionary Principle Endorsed by APHA, ANA, others Puerto Rico, San Francisco have adopted, among others Big business, US Chamber of Commerce oppose

115. The Precautionary Principle "All scientific work is incomplete - whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action it appears to demand at a given time." (Bradford Hill, 1965)

116. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org