Protecting health by eliminating hazards: New APHA policy statements take proactive approach to preventing illness and injury

by Elizabeth Grossman

At this year's American Public Health Association (APHA) annual meeting that took place in Denver November 7-11, the APHA's Environmental and Occupational Health and Safety sections proposed new policy statements that recommend proactive strategies for preventing illness and injury by reducing exposure to hazardous chemicals and through design that promotes workplace safety. All five policy statements presented at public hearings on November 7 have now been approved. Two additional policy proposals - one that addresses the public health impact of U.S immigration policy and another that endorsed the World Health Organization's code of practice on the international recruitment of health personnel - will serve as interim APHA policies pending full review at next year's annual meeting.

Reducing Exposures to Endocrine-Disrupting Chemicals and Pesticides
One of the new policy statements advocates a precautionary approach to reducing Americans' exposure to endocrine-disrupting chemicals, a group that includes brominated flame retardants, pesticides, plasticizers, and other compounds that make up plastics, water, stain and grease repellents, and non-stick surfaces, among many other products. US residents are widely exposed to endocrine-disrupting chemicals, as documented by the testing done for Centers for Disease Control and Prevention's National Health and Nutrition Evaluation Survey (NHANES), among other studies.

With its approval of this endocrine-disrupting chemicals policy, the APHA joins a growing number of national health and medical organizations that have made this recommendation. The list includes the American Medical Association (AMA), the Endocrine Society, Society for Occupational and Environmental Health, and the American College of Obstetricians and Gynecologists. Modeled on the policies adopted the AMA and Endocrine Society in 2009, the APHA recommends reducing exposure to endocrine disrupting chemicals (particularly for children, infants, and other vulnerable individuals) based on existing evidence of adverse health effects and despite current research gaps.

Another new APHA policy statement that aims to prevent illness by reducing chemical exposure is one that asks the Environmental Protection Agency (EPA) to require both biomonitoring of pesticide exposure and development of clinical diagnostic tools to detect and evaluate health effects of such exposures as part of any new pesticide registration. This policy statement is designed to improve health protections for farm and other agricultural workers and their families. Amy Liebman, director of environmental and occupational health at the Migrant Clinicians Network, presented the policy and explained that the Federal Insecticide, Fungicide, and Rodenticide Act of 1972 (FIFRA) makes the EPA - rather than OSHA - responsible for setting chemical safety standards for agricultural workers. Unlike comparable provisions under OSHA, the EPA currently lacks requirements for medical surveillance of workers' chemical exposures. The new APHA policy aims to close that gap.

Addressing Risks from Nuclear Waste
Two additional policy statements that aim to reduce toxic chemical exposures focus on radioactive chemicals. One recommends that to protect public health, the federal government make clean-up of the Hanford Nuclear Reservation a national priority. Located on the banks of the Columbia River in Washington State near agricultural and tribal communities, Hanford is considered to be the United States' largest Superfund site. Hanford has become a repository for nuclear waste generated on site and elsewhere. Some of this waste is poorly contained and threatens the Columbia River (a vital Pacific Northwest salmon migratory corridor and source of irrigation water), groundwater, and deep soil.

The other policy statement aimed at reducing risk of exposure to nuclear waste states that APHA considers intrastate and interstate transportation of spent nuclear fuel to be a public health risk and promotes measures to reduce this risk - for those directly engaged in this transport and for communities through which this waste would travel. The Hanford clean-up and spent nuclear waste policy statements were both formulated and presented at the APHA meeting by students at the University of Washington's School of Public Health.

Built-in Prevention
Also taking a proactive strategy to protecting occupational health and safety is the new APHA policy statement that recommends structural design improvements to prevent occupational injuries, illnesses, and fatalities. As Walter Jones, associate director of the Laborers Health and Safety Fund of North America, who presented this policy statement, explained it to me, the idea is to build physical safety into architectural design and construction. Examples include using beams that enable maintenance workers to clip in (rather than using free-standing scaffolding) or building fall protection into green or solar-paneled roofs to facilitate safe maintenance. This policy statement, which mirrors the fundamentals principle of green chemistry, supports the simple but radical idea of eliminating hazards at the design and engineering stage rather than trying to cope with resulting dangers after they present themselves. It dovetails with NIOSH's Prevention through Design Program and OSHA's green jobs programs, and with many of the "making green jobs safe jobs" discussions that took place at this year's APHA meeting and the National Council for Occupational Safety and Health meeting immediately preceding it.

What struck me about the new APHA Environmental and Occupational Health policy statements is their proactive strategy - their focus on protecting occupational and public health by eliminating hazards rather than by concentrating on risk reduction. This approach was the subject of many presentations and conversations at the APHA and COSH meetings in Denver, during which many speakers highlighted recent occupational disasters: Massey Upper Big Branch mine, BP/Deepwater Horizon, Tesoro, Kleen Energy, and the many less headline grabbing but no less devastating individual workplace injuries and fatalities. Overall, there was wide agreement that prevention and hazard elimination through improved workplace and process design is the most effective way of protecting both workers and the environment.

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.