Henry Falk, M.D., M.P.H.
National Center for Environmental Health
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Agency Budgets and Priorities for FY 2011
Committee on Transportation and Infrastructure
Subcommittee on Water Resources and Environment
United States House of Representatives
Thursday March 4, 2010
Chairwoman Johnson and other distinguished members of the Subcommittee, on behalf of the Administrator of the Agency for Toxic Substances and Disease Registry and the Director of the Centers for Disease Control and Prevention, Dr. Thomas R. Frieden, I would like to thank you for the opportunity to present this testimony. I am Dr. Henry Falk, Acting Director of the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention’s (CDC’s) National Center for Environmental Health (NCEH).
As a physician, I’ve spent more than 30 years working to protect Americans from environment-related hazards and diseases. I’ve spent most of that time at CDC as a member of the U.S. Public Health Service, where I was named a Rear Admiral and an Assistant U.S. Surgeon General. I led ATSDR from 1999 until 2005 and am again filling this position until a new agency director is named.
In my dual role with NCEH and ATSDR, I have the opportunity to lead a highly dedicated group of people as they seek to provide answers on a wide variety of issues related to human health and the environment. And, we are working to identify and protect the public from environmental exposures to hazardous substances.
ATSDR is the principal non-regulatory federal public health agency responsible for addressing health effects associated with toxic exposures. The Agency’s mission is to serve the public through responsive public health actions to promote healthy and safe environments and prevent harmful exposures. ATSDR and its basic authorities were established by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 (more commonly known as the Superfund law), as amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986. Through these and other key laws, Congress responded to the public’s demand for a more complete approach to protection from hazardous substances.
While ATSDR collaborates with other federal agencies like the Environmental Protection Agency (EPA), ATSDR distinctly focuses on the human health effects of harmful substances in the environment. Because ATSDR 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 prevent exposures to hazardous substances.
ATSDR’s orientation toward public health is practical, and its responsibilities under CERCLA fall into four functional areas:
• Protecting the public’s health from hazardous and toxic substances
• Building the science base on hazardous and toxic substances
• Providing information on hazardous and toxic substances to health professionals and the public
• Establishing and maintaining health registries
These four functions will continue to define ATSDR’s priorities for FY 2011, 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.
Protecting the Public’s Health from Toxic Substances
A core function of ATSDR is assessing potential health hazards posed by releases of hazardous substances, including releases from hazardous waste sites and making recommendations for protecting public health. This is a mandated function in the case of sites on EPA’s National Priorities List and discretionary in the case of releases from other hazardous waste sites. Most often ATSDR presents the results of its work in one of several products: Public Health Assessments, Public Health Consultations, Exposure Investigations, and Technical Assists. In these assessments, ATSDR reviews environmental and health data, evaluates how people living or working at the site or nearby may be exposed to harmful levels of hazardous substances, and makes appropriate recommendations to protect the public health of the community.
In addition, ATSDR can help protect the public from chemical exposures from releases in settings other than hazardous waste sites. These releases may range from chemical plant explosions to a spill of coal combustion products and can be identified by government agencies or by individuals within the community through the petition process.
ATSDR responds to emergencies involving the release of hazardous substances, most often in collaboration with EPA and other agencies. ATSDR personnel provide real-time public health guidance to emergency responders and to the public following acute releases of hazardous substances (for example, helping determine when people can safely reoccupy their homes and businesses after an evacuation).
ATSDR is highly productive in its work to protect the public’s health. In FY 2009, ATSDR, in cooperation with funded state health agencies, completed evaluations of potential environmental exposures at 211 sites by issuing 322 public health assessments and consultations and providing more than 1400 technical assists. EPA, industry partners, and communities adopted 85% of ATSDR’s recommendations for reducing exposures and collecting additional information.
ATSDR has a strong track record of implementing public health practices and providing recommendations based on the best available science, even in sometimes controversial or highly charged situations. Several examples illustrate this:
- In December 2008, ATSDR provided emergency response support when a containment wall failure resulted in the release of more than 5.4 million cubic tons of coal ash in Tennessee. In the largest fly ash release in the United States to date, coal ash covered approximately 300 acres and required the evacuation of more than 20 residents. As part of the on-site emergency response, ATSDR reviewed large sets of data from water and sediment samples, identified concentrations of concern for metals and other contaminants in water, and coordinated an epidemiological study with EPA. As a result of ATSDR’s work, community members were able to make informed decisions to protect themselves during the cleanup period.
- After ATSDR’s found elevated levels of lead in synthetic turf products, the Consumer Product Safety Commission has requested the elimination of non-essential uses of lead in synthetic turf products. The synthetic turf industry has responded through public statement that they plan to reduce voluntarily the lead content in synthetic turf products in U.S. markets.
- At one Arizona high school, students found a large amount of elemental mercury in a school storage room, spilled it on school buses, and took it home—exposing their families and community to this harmful substance. ATSDR’s funded partner, the Arizona Department of Health Services, collaborated with the Maricopa County Department of Public Health to alert and educate the families of exposed students about mercury poisoning and to ensure that all mercury was removed from school storage rooms. Also in 2009, ATSDR and EPA worked together on a 30-second television spot targeting middle-school aged children with the message “Don’t mess with mercury!”
Building the science base on toxic substances
ATSDR’s applied research includes toxicological and epidemiological research. In some cases, ATSDR conducts this research in-house; for example, ATSDR scientists have developed innovative techniques using computational toxicology to help rapidly assess hazards of chemical releases. In other cases, ATSDR identifies critical toxicological data needs and works with other federal agencies, as well as state agencies, universities, and volunteer organizations, to fill those needs.
A key feature of ATSDR's scientific research is that it often grows out of site-specific public health activities. In the last year ATSDR investigated a cluster of cases of a rare blood disease called polycythemia vera in Pennsylvania, the cardiovascular effects of exposure to PCBs in Alabama, and the nervous system effects of exposure to airborne manganese in the Ohio River Valley. In 2010 ATSDR will begin to study the links between uranium exposure and pregnancy and neonatal complications of Navajo mothers, and also to provide educational outreach to increase prenatal care and to mitigate exposure to uranium on the Navajo Reservation.
An example of scientific research that has grown out of site-related activities is the work at the Camp Lejeune military base in North Carolina. ATSDR has worked at Camp Lejeune since the early 1990s, conducting public health assessments, epidemiological studies, and modeling to reconstruct exposures to volatile organic compounds from drinking water systems. In 2010, ATSDR is moving forward with a mortality study (causes of death among former residents) and a congressionally mandated health survey (presence of certain diseases and conditions), both of which the Navy will fund. If the health survey findings meet appropriate criteria, it may serve as the foundation for additional analyses (for example, medical records review) that could begin in 2011.
In addition to original research, ATSDR assembles existing data on hazardous and toxic substances. ATSDR’s Toxicological Profiles are thorough reviews of available toxicological and epidemiological information on specific substances that ATSDR health assessors and other responders use to identify contaminants and potential health effects that may be of concern at hazardous waste sites. They are widely used by scientists and members of the public.
ATSDR’s Hazardous Substances Emergency Events Surveillance (HSEES) program has been the only national public health-based surveillance system to coordinate the collection, analysis, and distribution of hazardous substances emergency release data to public health practitioners. In FY 2009, the National Toxic Substances Incidents Program (NTSIP) replaced HSEES, resulting in a more comprehensive system. ATSDR developed the NTSIP following an HSEES program peer review and several years of information gathering with key stakeholders.
With its new capabilities, NTSIP will reduce duplication of government efforts, collect nationwide data not limited to the states ATSDR funds, promote green chemistry principles as a proactive approach to prevention, and develop tools and knowledge to support emergency response efforts.
Providing Information on Toxic Substances to Health Professionals and the Public
A third function of ATSDR is to provide health professional and community education through direct service at the community level and through broader distribution of materials by the internet and other mechanisms. For example, ATSDR’s ToxFAQs is a series of summaries of information about hazardous substances. These are user-friendly documents excerpted from Toxicological Profiles that provide plain language information about hazardous and toxic substances. ATSDR also develops and provides medical education to assist health professionals in diagnosing and treating conditions related to hazardous exposures.
Establishing and Maintaining Registries
The fourth function assigned to ATSDR is to establish and maintain registries—confidential databases designed to collect, analyze, and track information about groups of people who share defined exposures or illnesses. ATSDR also provides information to registrants about health services and other services available to them through other sources. Current registry activities include tracking people exposed to tremolite asbestos from Libby, Montana, and establishing a disease registry which follows people with Amyotrophic Lateral Sclerosis (ALS). In addition, with funds from the Federal Emergency Management Agency (FEMA), ATSDR has begun a pilot registry of persons displaced by Hurricanes Katrina and Rita who were potentially exposed to formaldehyde in FEMA-provided temporary housing units. The pilot registry will be used to address the health concerns of people living in FEMA-provided housing units and to evaluate research and registry priorities for the future.
Advancing ATSDR’s activities to protect the public’s health
The FY 2011 President’s Budget requests $76,337,000 for ATSDR to continue its work in the four functional areas, which includes $608,000 in contract and travel savings from FY 2010 levels. ATSDR will continue to strive to meet its mission through increased efficiencies and productivity and the efforts of a dedicated staff. The contract and travel reduction is not expected to reduce programmatic activities.
When ATSDR was established, the primary focus was on responding to health concerns from exposures related to hazardous waste sites being addressed under CERCLA. Through work with these sites, ATSDR’s scientists have developed unique skills. In recent years, ATSDR has found an increasing demand for those skills in other areas related to hazardous exposures. For example, local health departments often lack the staff and resources to engage in land reuse and redevelopment decision making. ATSDR has developed two technical tools that help local health departments provide timely feedback to developers and policy makers on potential health issues associated with reuse of a property that may have chemical contamination. The first tool allows health departments to provide developers with timely information on health hazards that may affect the future use of the property. The second tool is a dose calculator that helps health department staff to identify quickly whether levels of contaminants at sites could pose a public health risk.
ATSDR receives a wide variety of requests from federal, state, and local agencies and individuals for assistance in responding to health concerns related to many kinds of hazardous exposures. We find that community interest in our work is increasing rather than decreasing. In response to this changing landscape, we are taking a fresh look at how ATSDR can serve communities that have concerns about toxic exposures.
As part of an enhanced community engagement model, ATSDR will continue to work with communities to use available resources to address their health concerns. Community assessments identify social determinants of health and specific community and individual behaviors that can be adopted to help improve and maintain a safe and healthy community. Community assessments are formal, integrated assessments of a community’s human and economic resources, health status, capacity, readiness, behavior, educational needs, and social capital. These assessments can help to reduce the health disparities experienced at many sites, including designated Environmental Justice sites, in minority or low-resourced communities.
Taking into consideration the many changes that have occurred in chemical science and technology during the quarter century of ATSDR’s existence, ATSDR is undertaking major efforts to improve the abilities to meet those needs and to meet new challenges in the future through a review of the overall approach to carrying out its mission. ATSDR is working to implement and apply the latest scientific advancements and tools to our work, including advances in analytic chemistry and biomonitoring (tools that better measure the chemicals present in people’s bodies and the environment), computational toxicology (tools that provide rapid, low cost insight into the interaction of chemicals), and green chemistry (the design and production of environmentally safe chemicals).
The responsibility of protecting the public from hazardous and toxic substances does not rest with ATSDR alone. Several other agencies share in this responsibility, and many other stakeholders—industry, environmental groups, community groups, professional associations—play essential roles. To further the collaboration between these entities, ATSDR, with its companion organization—the National Center for Environmental Health—continues to sponsor the National Conversation on Public Health and Chemical Exposures. The National Conversation is engaging stakeholders in government, public health, academia, and in communities to develop recommendations on cross-cutting public health and chemical exposure issues.
As ATSDR’s work has expanded beyond the traditional focus on hazardous waste sites, ATSDR has begun to collaborate actively with the Department of Transportation (DOT) and the Department of Housing and Urban Development (HUD). For example, ATSDR is working closely with DOT through an interagency agreement to use data from our National Toxic Substances Incident Program (NTSIP) surveillance system to map, model, and assess national trends in chemical incidents and to provide recommendations for improving the public’s safety through prevention of chemicals spills.
ATSDR is an agency with a relatively short history, but a history that spans much of our nation’s response to health concerns resulting from hazardous environmental exposures. ATSDR has worked diligently to address the needs and concerns of communities. ATSDR has assembled a strong record of accomplishment—protecting health near hazardous waste sites, advancing science, and educating health professionals and the public.
Last revised: April 19, 2011