Making the Link: Protecting Health from Environmental Exposures Vi Waghiyi Sarah Petras (907) phone (907) fax

Our mission: To assure justice by advocating for environmental and community health. We believe everyone has a right to clean air, clean water and toxic-free food. Core Values:  Community right-to-know  Environmental justice  Precautionary principle  Elimination of the production and release of toxics  Rights and sovereignty of Indigenous peoples  Culture of caring and wellness Environmental Health and Justice in Alaska

Addressing Environmental Health Issues in Alaska  Respond to community calls for assistance  Conduct community-based participatory research (CBPR)  Ensure community right-to-know  Advocate for health and justice through prompting of protective, precautionary local, state, national and international policy changes  Field and community health investigations  GIS computer mapping

Toxic Waste Sites in Alaska

 The north has become a hemispheric sink for pesticides and other industrial chemicals  Northern food webs favor the deposition and retention of persistent, bioaccumulative toxics  Contaminants in the north threaten the health of peoples that rely on traditional diets of fish and marine mammals  Global warming enhances the mobilization and transport of contaminants from local and distant sources Contaminants in the North

The North is a Hemispheric Sink

Formerly Used Defense Sites Elder Annie Alowa from Savoonga, Alaska, pictured at Formerly Used Defense Site on St. Lawrence Island

Where is St. Lawrence Island? Located in the Pacific Ocean, between Russia and the U.S.

Disease Patterns Observed on St. Lawrence Island  Cancers  Thyroid disease  Diabetes  Heart disease  Low birth weight babies, premature births, still births, miscarriages  Other reproductive health problems

PCBs in Blood Serum of St. Lawrence Island People  Levels of PCBs in the blood of St. Lawrence Island Yupik people 6-9 times higher than average in lower-48 populations  Evidence of PCBs accumulating in the Arctic via global transport  Military contamination also a significant source Published in the International Journal of Circumpolar Health (Carpenter et al., 2005) Average for populations in the lower-48

Formerly Used Defense Sites in Norton Sound, Alaska

Specific Aims for Environmental Health and Justice for Norton Sound, Alaska Project  Identify sources of contaminants, including those from military and long-range, atmospheric sources  Describe past and current health problems  Increase the capacity of the health care system in Norton Sound to properly diagnose and treat health effects linked with environmental contaminants  Work toward responsible cleanup of contaminated sites and prevent new sources of contaminants  Assist Norton Sound communities in securing training and tools needed to establish independent programs operated by the villages to monitor contaminants

Project partners:  15 Villages in Norton Sound Region  State University of New York  Alaska Community Action on Toxics  Norton Sound Health Corporation  Other researchers at Clarkson University, St. Lawrence University, Environment Canada, Health Canada, University of Alaska, National Marine Fisheries Service, and University of California Environmental Health and Justice Project for Norton Sound, Alaska

(above) Morgan Apatiki, Community Health Researcher from Gambell, AK, collecting food samples for our Traditional Food Study (upper right) Student testing water quality in Nome, AK during 2008 Field Institute (right) Field sampling in Elim, AK, 2007 Environmental Health Programs  Training for community health and field researchers  Field Institute  Quarterly seminars for Village Health Aides & other health care professionals  Environmental Health Care Toolkit  Alaska Collaborative on Health and the Environment

 Independent research informs clean-up decisions  Promoting proper diagnoses and treatment of environmental health effects  Better oversight and holding military accountable for clean up  Influencing public health policy to prevent exposures from this and other formerly used defense sites and long-range transport Community Health Implications of Norton Sound Project

Reproductive Health and the Environment “…exposure to low-level contaminants may be subtly undermining our ability to reproduce.” Environmental Health Perspectives, journal of the National Institute of Environmental Health Sciences 2006

Health of Arctic Children Threatened “Alaska Native infants have a much higher rate of hospitalization for infection than any other group of U.S. infants… Prenatal exposure to contaminants, which are known to affect the developing immune system, could play a role, and that possibility is now being examined.” Dr. Jim Berner, pediatrician, Alaska Native Tribal Health Consortium -Dr. Jim Berner, pediatrician, Alaska Native Tribal Health Consortium

Birth Defects in Alaska Data from the Alaska Birth Defects Registry shows:  Birth prevalence of major congenital anomalies in Alaska is twice as high as in the United States as a whole  Alaska Native infants have twice the risk of MCAs as white infants born in Alaska Recommendations for women include:  Avoid contact with known or suspected environmental teratogens “…even independent of differences in cigarette smoking, alcohol consumption and maternal age—which is a well-known risk factor for birth defects—Alaska Natives still have an increased risk... that we don't really know how to explain." Dr. Bradford Gessner, Maternal and Child Health Epidemiology unit

Adverse Birth Outcomes Associated with Open Dumpsites in Alaska Mothers residing in villages with high hazard ranking were:  43% more likely to have a low birth weight baby  45% more likely to give birth prematurely  More likely to have babies afflicted with intrauterine growth retardation Gilbreath, S. and Philip Kass American Journal of Epidemiology.

Chemicals Associated with Reproductive Health Effects  Commonly-used pesticides  Polychlorinated biphenyls (PCBs)  Chemical additives (used in production of plastics, e.g., bisphenol A)  Perfluorinated compounds (used in production of stain-resistant, water- repellant, or non-stick surfaces)  Chemical additives to beauty and self- care products (e.g. phthalates)  Polybrominated diphenyl ethers (PBDEs) (used as flame retardants in household upholstery and electronics)

Health Concerns associated with Metals Mining  Blasting, crushing operations mobilize toxic air emissions  Leaching of heavy metals into streams and rivers can harm fish and drinking water sources  Cyanide used in leaching process is lethal at very small doses  Negative effects on quality of life, social, cultural and emotional impacts Lone Tree and Marigold Mines in NV—photo by Peter Essick

Toxics Release Inventory—Mines are Among Largest Industrial Polluters of Toxic Chemicals  Red Dog Mine 533,421,591 lbs of toxic chemicals released in 2007 with increasing trend  Largest polluter in the nation, 4 times that of any other facility in the U.S. Red Dog Mine-Ikalukrok Creek Junction

Environmental Health Care Toolkit  Designed for Village Health Aides in Alaska for use in clinics  Purpose: To promote proper diagnosis, treatment, and prevention of health problems linked to environmental contaminants in Alaska  A work in progress… We welcome your feedback! With about 1,000 pounds of dental equipment, a Dental Health Aide Therapist awaits a ride after traveling to Point Hope, AK by airplane.

Collaborative Effort  Village Health Aides provide village-specific information on prevalent exposures and diseases to cover in toolkit materials  EHC Toolkit Advisory Group (comprised of Community Health Aides, local physicians, and community field researchers) contributes to and reviews all toolkit materials  Annual Community Health Aide Program (CHAP) Forum  Annual Alaska Tribal Conference on Environmental Management (ATCEM)

Toolkit Contents  Foreword  Introduction  Environmental Health History and Assessment  Resources for More Information  Environmental Health Care Fact Sheets  Household Toxics  Hazardous Waste  Reference Cards on prevention of exposure for patients  Map of Villages and Federal Defense Facilities  Protecting Our Health in Alaska: a poster for clinics and homes

 Symptoms of environmental exposures can be misdiagnosed as common symptoms of other diseases  Exposures can occur in the home, at work, from food and water, from hobbies, and from outdoor activities  Taking an environmental health history is important in determining if patients had an environmental exposure and making a correct diagnosis Environmental Health History & Assessment Form

Environmental Health Care Fact Sheets  Fact sheets contain information about:  what the contaminant is  how exposure occurs  symptoms of exposure  what to do for patients showing exposure symptoms  how to prevent or reduce exposure  Toolkit will contain fact sheets on chemicals of concern in the Norton Sound region, including chemicals associated with household toxics, hazardous waste, mining, and FUDS

Reference Cards  Tips on how to prevent or reduce exposure  Handouts for patients  Example: REDUCING YOUR EXPOSURE You can minimize your exposure to bisphenol-A in the following ways: Use glass, stainless steel, or polyethylene bottles (PETE, PET, or #1; HDPE or #2; LDPE or #4) instead of polycarbonate (PC or #7) bottles. Avoid heating foods in polycarbonate containers, as bisphenol-A tends to leach faster with higher temperatures. Use glass or ceramic containers instead. Cut back on consumption of canned foods to reduce exposure to bisphenol-A contamination from the interior coating of the container. Also, avoid canned foods with higher fat content, which may have higher levels of bisphenol-A. Before getting dental sealants, check with your dentist about the ingredients in the products they use, as some formulations may leach bisphenol-A.

Poster  Provides information on potential exposures  Tips on how to reduce exposures  Designed for clinics, waiting rooms, community buildings, and homes  Now available!

Maps  Contains the Map of Villages and Federal Defense Facilities in the Norton Sound Region  Other statewide and regional maps of toxic waste in Alaska are available on ACAT website: Mapping.htm

Resources Listings  Non-governmental organizations (NGOs)  Government agencies  Publications and other materials (books, websites, online databases, etc.)  Scientific journal articles and ACAT Health Bulletins For Example: Alaska Community Action on Toxics (ACAT): Collaborative on Health & the Environment (CHE):  Access the CHE Toxicant and Disease Database: database.healthandenvironment.org Agency for Toxic Substances and Disease Registry (ATSDR): Pediatric Environmental Health  Editor Ruth A. Etzel, MD and Associate Editor Sophie J. Balk, MD Skin Deep Cosmetics Safety Database: For more information, see full resources listings in toolkit

Additional Resources  Journal Articles  Polychlorinated Biphenyls in Serum of the Siberian Yupik People from St. Lawrence Island, Alaska (Journal of Circumpolar Health)  Adverse Birth Outcomes Associated with Open Dumpsites in Alaska Native Villages (American Journal of Epidemiology)  Health & the Environment Bulletins  Body of Evidence: Reproductive Health and the Environment  Diabetes: The Role of Persistent Toxic Chemicals in this Complex Disease

Any Questions? Thank you!