The President′s FY 2008 Budget Request for the Agency for Toxic Substances and Disease Registry (ATSDR)

CDC Congressional Testimony

Committee on Appropriations Subcommittee on Interior, Environment and Related Agencies United States House of Representatives

Statement of:
Julie L. Gerberding, M.D., M.P.H.
Administrator, Agency for Toxic Substances and Disease Registry
U.S. Department of Health and Human Services

Introduction

Mr. Chairman and Members of the Subcommittee, the Agency for Toxic Substances and Disease Registry (ATSDR) is pleased to provide testimony in support of the President′s FY 2008 Budget request of $75,004,000. This funding will maintain ATSDR′s ongoing activities and critical programs as we pursue our common goal of protecting Americans′ health.

ATSDR History and Mission

The mission of the Agency for Toxic Substances and Disease Registry (ATSDR) is to prevent or mitigate harmful exposures and related disease by applying science, taking responsive action, and providing trustworthy health information. The discovery of contamination at Love Canal in New York State during the 1970s first brought the problem of hazardous waste to national attention. Similarly, the health threat from sudden chemical releases came into focus in December 1984, when a cloud of methyl isocyanate gas released from a Union Carbide facility in Bhopal, India, killed or seriously injured thousands of people. Both events represent the kinds of issues at the core of ATSDR′s congressional mandate and public health mission.

ATSDR is at the forefront in protecting people from the health effects of acute and long-term toxic exposures and also applies its expertise in responding to natural and terrorism-related disasters. Since the creation of ATSDR, thousands of hazardous sites have been identified around the country. At the moment, some 1244 appear on the Environmental Protection Agency′s (EPA) National Priorities List (NPL) of Superfund sites, which does not include the many other hazardous sites that ATSDR addresses. In fact, no state in the United States has been completely free of toxic sites. In FY 2006, ATSDR served over 3.2 million people in 346 communities.

ATSDR Authority

ATSDR′s role and authority are outlined in three key laws: the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980, the Superfund Amendments and Reauthorization Act (SARA) of 1986, and the Resource Conservation and Recovery Act (RCRA) of 1976, as amended. Through these and other key laws, Congress responded to the public′s demand for a more complete approach to protection from toxic chemicals.

ATSDR′s Work

ATSDR is a sister agency of the Centers for Disease Control and Prevention (CDC), sharing its focus on health protection goals, including healthy people in every stage of life, healthy places, and protecting people from emerging threats. In collaboration with other federal agencies such as the EPA, the National Institute of Occupational Safety and Health (NIOSH), the Chemical Safety and Hazard Investigation Board (CSB), and the National Institute for Environmental Health Sciences (NIEHS), ATSDR distinctly focuses on the human health effects of hazardous substances in the environment. Although ATSDR works closely with regulatory agencies such as EPA, it is not a regulatory agency. ATSDR achieves much of its impact by providing technical expertise, training, and funding to state public health agencies and by making recommendations to other agencies and communities on how to stop or mitigate exposures to hazardous substances.

ATSDR′s orientation toward public health is practical, and CERCLA frames the Agency′s work into four functional areas:

• Protecting the public from hazardous exposures;
• Increasing knowledge about toxic chemicals;
• Delivering health education about toxic chemicals; and
• Maintaining health registries.

These four functions will continue to define ATSDR′s priorities for FY 2008, with emphasis on achieving public health impact in the most efficient manner possible. The testimony that follows discusses each function and addresses ATSDR′s priorities and vision for the coming year.

The first function is protecting the public from hazardous exposures. ATSDR applies its public health expertise to the task of preventing and responding to exposures at hazardous waste sites; the Agency also leads the public health component of responses to acute or short-term releases of hazardous substances resulting from accidents, natural disasters, and terrorist events. To accomplish this work, ATSDR performs a variety of site-specific activities, including the following services.

ATSDR conducts Public Health Assessments that review information about hazardous substances found at a toxic site. The assessments evaluate whether people living or working at or near a site may be exposed to harmful levels of these substances. They may also recommend that EPA or other agencies take certain actions to protect public health. ATSDR conducts an assessment or other appropriate activity for NPL sites and in response to petitions from communities at other sites. In 2006, the Agency and the New Jersey Department of Health and Senior Services completed such an assessment for a landfill site in Ringwood, New Jersey, and determined that lead exposure from paint sludge and soil posed a public health hazard, particularly for children. This work led to the state issuing a public health advisory cautioning local residents to avoid certain wild food sources. The Agency also conducts Health Consultations, which are more limited in scope than public health assessments, and answer specific, health-related questions about hazardous substances in communities. ATSDR and the New York State Department of Health recently released a report assessing elevations in certain cancers and adverse reproductive outcomes in Endicott, New York.

ATSDR performs Exposure Investigations to collect and analyze site information, perform biological tests and determine whether people have been exposed to hazardous substances. For example, the Agency examined individuals in the Spring Valley neighborhood of Washington, D.C. for possible exposure to arsenic contamination in their yards. The investigation found that the levels of arsenic were not expected to cause health problems. ATSDR also protects public health by providing technical assistance, resources, and staff across the United States. ATSDR responded to more than10,000 requests from local, state and federal agencies, communities, health professionals and first responders in FY 2006. For example, at the request of the health department for the City of Alexandria, Virginia, ATSDR reviewed air quality and other environmental modeling data regarding the Mirant Potomac River Generating Station site. ATSDR found that sulfur dioxide levels at the site present a public health hazard for children with asthma and exercising asthmatics. The Agency recommended that additional data be collected and that the City initiate health education efforts for vulnerable populations.

The ATSDR Cooperative Agreement Program helps the Agency accomplish its mission in communities nationwide. As ATSDR′s largest extramural grant, the program funds 30 states and one tribal government to build their ability to assess and respond to site-specific issues involving human exposure to hazardous substances in the environment. The Agency′s partners use these funds to support approximately 100 environmental public health professionals who serve as front-line responders in site assessments, emergency spills, and community concerns. In addition, ATSDR maintains regional staff who are located in EPA regional offices around the country. This arrangement enables ATSDR to respond quickly to emergencies. For instance, when a train crash in Kentucky in January 2007 led to a fire and chemical release, ATSDR regional staff members were able to arrive on the scene within six hours to provide technical assistance.

These services are just some of the ways ATSDR helps protect Americans from hazardous exposures. In FY 2006 alone, ATSDR responded to 742 releases of hazardous substances and released 527 public health assessments and consultations. ATSDR′s work frequently involves helping people in community settings such as schools. In New Jersey, ATSDR and its state partner helped protect the health of preschool children who attended daycare in a building once occupied by a mercury thermometer manufacturer. Following ATSDR and state guidance, all children and staff were evacuated, and the day-care operator immediately closed the center. We also arranged for mercury testing and education in conjunction with the ATSDR-funded Mt. Sinai Hospital Pediatric Environmental Health Specialty Unit. ATSDR and its partners offered repeat testing to all affected families and staff until all had mercury levels considered to be in an acceptable range. ATSDR′s work also contributed to efforts to prevent this problem in the future. New Jersey recently enacted a law preventing schools and daycare centers in the state from opening on contaminated land.

ATSDR′s efforts to protect people from hazardous substances during FY 2006 also included work with EPA, CDC, and others to respond to Hurricanes Katrina and Rita. Our work in Louisiana and Mississippi following both storms enabled thousands to return home more safely. We provided returning residents with critical health guidance on carbon monoxide, water sanitation, electrical hazards, and other topics. In addition, we helped assess and reopen approximately 200 schools in Jefferson Parish, Louisiana, and helped evaluate NPL sites in the area. ATSDR staff also helped identify and remediate potential hazardsincluding removing 55-gallon chemical drums that floated during the storms from barges to front lawns.

The Agency′s second functional area is increasing knowledge about toxic chemicals. ATSDR expands the scientific knowledge base on the health effects of toxic exposures by regularly reviewing existing science and summarizing this work in a variety of state-of-the art scientific publications. ATSDR also identifies information gaps, and takes steps to fill these data gaps, by encouraging research by others, conducting research or sponsoring partners. When it comes to protecting health, filling data gaps is research with real-world results.

ATSDR′s Toxicological Profiles are an important part of our work in filling data gaps. ToxProfiles summarize, interpret, and evaluate available data and possible health effects of 275 priority hazardous substances found at NPL sites. As their citations in numerous scientific and medical journal articles and books every year attest, ToxProfiles are a valuable resource for health professionals, scientists, emergency response personnel, and researchers worldwide. ATSDR also conducts original toxicologic research, especially in computational toxicology, which uses computer models to apply knowledge about chemicals with known health impacts to chemicals with similar structures. This technology provides the Agency with rapid, cost-effective information on the health effects of chemicals and is especially useful in assessing poorly characterized chemical wastes and emergency releases.

ATSDR′s studies determine whether exposures to hazardous substances can lead to increased risk for various health problems, such as cancer, birth defects, auto-immune or neurological disorders, respiratory diseases, and other illnesses. The Agency conducts its own health studies and supports others through agreements with state health departments, universities, and other partners. This year ATSDR continued work on 45 health studies, including a study in New York that found a link between asthma emergency department visits and exposures to pollutants in that area.

Partners play a key role in ATSDR′s research efforts. For instance, the Agency collaborates with EPA, NIOSH, and NIEHS to establish and coordinate research priorities. ATSDR also collaborates with industry to fill data gaps through a program in which corporate partners volunteer to help answer research questions on hazardous substances. For instance, Halogenated Solvents Industry Alliance, Incorporated, recently helped ATSDR fill two data needs. Another highly valuable relationship is the one we share with the Minority Health Professions Foundation. ATSDR offers funds for toxicologic research and training to the Foundation′s 12 member institutions. The arrangement is mutually beneficial: to date, the institutions have filled 14 specific priority data needs for priority hazardous substances; at the same time, ATSDR supports the development of environmental health scientists and students at minority institutions. This work has been carried out at schools of medicine, pharmacy, and veterinary science at several historically black institutions, including Charles R. Drew University, Morehouse School of Medicine, Texas Southern University, Florida A&M University, Xavier University of Louisiana, Meharry Medical College, and Tuskegee University.

Our work in filling data gaps has a strong applied component as well. ATSDR′s Hazardous Substances Emergency Events Surveillance (HSEES) system tracks and reports hazardous substances releases, enabling ATSDR and its partners to identify patterns of releases, plan for response, and prevent future releases. HSEES, maintained with 14 states and the National Response Center, collects, analyzes, and interprets real-time information about acute releases of hazardous substances and associated injuries. Every year, HSEES records approximately 8,000 events involving 1,800 injured persons. States, universities, research organizations, and industry use data from HSEES for emergency planning and response.

A good example of ATSDR′s applied research is our continued work at the Marine Corps Base Camp Lejeune in North Carolina. Two decades have passed since contaminated drinking water wells were closed at the Base. For an uncertain period before that, some personnel and their families who resided at the Base and personnel were exposed to volatile organic compounds in the water. Analyzing the extent of exposures has posed a formidable challenge. To compensate for the lack of information about the Camp′s water distribution system operations for that period, ATSDR used an innovative computer model to reconstruct likely past exposures. In part, the model involves measuring flow rates and pressures at different locations along the water distribution system. The model will help identify the likely route, timeframe, and extent of exposure, filling a knowledge gap with significant data that will help answer some long-standing health questions at the Base.

The third functional area for ATSDR is its leading role in delivering health education about toxic chemicals. ATSDR provides training and continuing education on environmental health issues for physicians, nurses, and other health professionals. During FY 2006, ATSDR trained over 60,000 health practitioners. A key tool in this effort is ATSDR′s Case Studies in Environmental Medicine, a well-developed and well-known series of self-paced, self-study programs for health professionals. These modules, delivered in a variety of media, teach medical personnel ways to assess, control, or prevent exposure to hazardous substances in the environment. Two other ATSDR education resources are our Toxicological Profiles and greatly condensed versions of the Profiles, ATSDR′s ToxFAQs. These products also help educate professionals and the public about issues in environmental health.

ATSDR funds Pediatric Environmental Health Specialty Units (PEHSU) in each region. The PEHSUs work with major medical centers to provide education and consultation for health care professionals, the public, and others on the topic of children′s environmental health. For example in Region IV, the Southeast PEHSU at Emory University recently published Safe and Healthy School Environments, the first book to apply the principles of environmental health to the school setting. This resource provides technical assistance and information for school officials and parents on how to maximize the health of their schools.

ATSDR delivers health education to communities as well. These efforts complement the Agency′s other activities, in which we interact principally with other agencies and industry on behalf of the public. Through health education, we help community members protect themselves. Last year we conducted health education in affected communities around the country for over 142,000 people. Accurate information about hazardous substances and potential health effects can be vital to a community. In some cases, having evidence-based health information can help reassure people who may have unwarranted fears rooted in rumors or unsubstantiated claims. In others, correct information may prompt people to take action to safeguard their own health.

The towns of New Castle and Ellwood, Pennsylvania, provide a good example. Both communities once had plants that processed asbestos-contaminated vermiculite ore originating in Libby, Montana. As in many such communities around the country over the past few years, ATSDR assisted in educating former plant workers and their families about their potential exposure. The Agency also provided guidance about coping with asbestos-related disease.

ATSDR′s fourth and final functional area is maintaining health registries. Exposure registries enroll people with defined exposures, track them over time to document health outcomes, and provide health information to registrants as appropriate. ATSDR once maintained a number of exposure registries for chemicals such as trichloroethylene, trichloroethane, benzene, and dioxin. More recently, however, ATSDR has re-focused its approach to registries. Today, we are concentrating on a small number of specific, tightly defined exposure situations.

The best-known of these efforts is the World Trade Center Health Registry. In collaboration with the New York City Department of Health and Mental Hygiene (NYCDOHMH), ATSDR established this registry to track long-term health effects among workers, residents, and school children who were the most directly exposed to smoke, dust, and debris resulting from the World Trade Center disaster. The largest health registry of its kind in the United States, the registry enrolled over 71,000 people. This past year ATSDR started the first round of follow-up interviews in partnership with NYCDOHMH. The registry will track participants over 20 years to determine the extent to which people′s exposures to smoke, dust, and airborne substances from the towers′ collapse have long-term effects on their physical and mental health.

Another major registry activity is our Tremolite Asbestos Registry. The medical screening program ATSDR conducted in Libby, Montana, revealed an unusually high rate of asbestos-related disease among participants. These findings led us to develop the Tremolite Asbestos Registry to trace, locate, and track exposed individuals. To date, 83 percent of former Libby mine workers, their household contacts, and a defined set of other local residentsover 4,000 individuals in allhave registered. Follow-up interviews and medical screenings will occur on a regular basis. Studies of household contacts and community members may be of particular interest because most asbestos studies to date concentrate on workers. As new information about asbestos-related disease and potential therapies develops, ATSDR will communicate that information to registrants.

FY 2008: Budget and Performance Objectives

ATSDR will continue to protect Americans from toxic exposures in FY 2008. We will execute our mandate and stay focused on protecting public health. The four functional areas outlined earlier will continue to frame and guide our work. Looking ahead to FY 2008, we are undertaking the following key improvements:

Protecting the Public from Hazardous Exposures

• Strengthening our ties with EPA, the Federal Emergency Management Agency, and other federal and state agencies to improve in such areas as terrorism preparedness and prioritizing sites that pose the greatest threat to human health.
• Addressing more sites and delivering products to our customers more promptly by producing fewer full-scale Health Assessments and more targeted Health Consultations and Exposure Investigations.
• Requiring our State Cooperative Agreement partners to focus on delivering health impacts directly linked to ATSDR′s goals.

Increasing Knowledge about Toxic Chemicals

• Conducting and supporting research to fill data gaps on 275 priority substances found at NPL sites, including assessing the effects of interactions between these substances.
• Maintaining and updating our catalog of Toxicological Profiles and other products to ensure that these resources remain state-of-the art. ATSDR will finalize profiles on acrolein, heptachlor, and xylenes.

Delivering Health Education about Toxic Chemicals

• Supporting our highest impact educational activities, such as the Pediatric Environmental Health Specialty Units and programs with the Minority Health Professions Foundation.
• Delivering technical support and health information to states, local health officials, private industry, and communities to address public health hazards.

Maintaining Registries

• Conducting follow-up interviews with the 71,000 registrants in the World Trade Center Health Registry regarding long-term physical and mental health effects of exposures resulting from the disaster.
• Continuing to enroll people in the Tremolite Asbestos Registry and conducting related activities in areas receiving asbestos-contaminated vermiculite ore from Libby, Montana, including sites in California, Ohio, Minnesota, New Jersey, New York, and Wisconsin.

ATSDR is also improving its effectiveness by improving our accountability to the public. ATSDR recognizes and affirms that results matter most. Toward this end, we continue to measure our success in terms of impact on the public′s health. In accordance with the Government Performance and Results Act of 1993, we established performance goals rooted in health impact and tied our annual budget to the achievement of those goals.

As part of ATSDR′s commitment to achieving meaningful impact, the Agency actively tracks and follows up on its public health recommendations to EPA, other federal agencies, and state and local partners. As a non-regulatory agency, ATSDR cannot simply direct responsible parties to clean up sites or make other changes it thinks are necessary. It must rely on other agencies. Therefore, following up to ensure that recommendations get implemented is important to ensuring the Agency′s effectiveness in protecting public health. ATSDR ensures its effectiveness by remaining vigilant in anticipating emerging health threatssuch as those posed by climate change and the continuing threat of terror attacks. Climate change may produce severe storms and flooding, which may cause chemical spills and other problems. The Murphy Oil site in Louisiana illustrates the kind of challenge we might expect: the storm surge from Hurricane Katrina lifted and dislodged a 250,000-barrel above-ground storage tank, spilling over one million gallons of mixed crude oil into the surrounding neighborhood, affecting over 1,800 homes. Threats of chemical attacks are also of concern, as demonstrated by the 1995 sarin releases in the Tokyo subway. ATSDR must continue to build its readiness to respond to such emergencies and to emerging threats of all kinds.

We recognize and pursue methods to improve environmental health in a positive, proactive way. Researching and encouraging the design and building of healthy communities is a CDC health protection goal fully consistent with ATSDR′s commitment to protecting the public from hazardous exposures. ATSDR is working with EPA on ways to remediate and redevelop contaminated sites into healthy communities. Our expertise in and experience with toxic substances have made ATSDR a valuable resource in this field, resulting in more frequent requests for assistance. These sites, known as “brownfields,” have been regarded primarily as potential sources of hazardous exposures which also possess a tremendous opportunity. Remediating such sites is not just a chance to remove a health hazardit is an opportunity to create communities that are “healthy” by design.

Conclusion

ATSDR continues to play a unique and vital role in protecting Americans by fulfilling our four key mandatesprotecting the public from hazardous exposures, increasing knowledge about toxic chemicals, delivering health education about toxic chemicals, and maintaining registries. As we apply this framework to existing and emerging threats, we embrace our role as the nation′s public health agency for chemical safety. Thank you again for the opportunity to provide this testimony and for your continued support of ATSDR′s essential public health work.