A regional approach to assess the impact of living in a chemical world.

In the United States, some 80,000 commercial and industrial chemicals are now in use of which over 30,000 are produced or used in the Great Lakes region. Thus, the environmental quality within the Great Lakes basin has been compromised particularly with respect to persistent toxic substances (PTS). Information derived from wildlife studies, prospective epidemiological and toxicological studies, databases, demographics, and Geographical Information Systems (GIS) demonstrate significant public health implications. Studies of human populations indicate: (a) elevated body burden levels of PTSs, (b) decrease in gestational age, (c) low birth weight (LBW), (d) greater risk of male children with birth defects (OR = 3.01), (e) developmental and neurological deficits, (f) increased risk of infertility, (g) changes in sex ratio, and (h) fluctuations in thyroid hormones. These findings have been identified in vulnerable populations, such as the developing fetus, children, minorities, and men and women of reproductive age who are more susceptible because of their physiologic sensitivity and/or elevated exposure to toxic chemicals. Typically such health effects are assessed on a chemical specific basis; however, most human populations are exposed to hazardous chemicals as mixtures in air, water, soil, and biota. In this article we present an assessment of the potential for joint toxic action of these substances in combinations in which they are typically found. These evaluations represent an integration of all available scientific evidence in accordance with the "NAS paradigm" for risk assessment. In aggregate, our evaluations have demonstrated a need for community-based frameworks and computational techniques to track patterns of environmentally related exposures and associated health effects.

Human health research and policy development: experience in the Great Lakes region.

As a direct outgrowth of industrial and agricultural activities, the quality of the Great Lakes ecosystem has declined significantly because of toxic substances in the water, eutrophication, overfishing, and invasive species that have been introduced into the waterways. Although measures have been adopted to restore the health of the ecosystem, contamination of Great Lakes sport fish continues arising from conditions that still prevail, but on a more limited scale. As a consequence, the Great Lakes states have issued guidelines for the public in the form of health advisories for fish consumption to encourage practices that will minimize exposure to contaminants found in Great Lakes sport fish. Scientific research has strongly influenced many policy decisions, including the development of laws, rules, and guidelines applicable to public health not only in regard to fish advisories but also other issues impacting human health. This paper proposes to outline how policy has been influenced by scientific findings and the far-reaching effect that these decisions have had on the health status of the public in the Great Lakes area and its potential for influencing the nation as a whole and our global neighbors. Within the Great Lakes basin, polychlorinated biphenyls (PCB) and mercury are the subject of the greatest number of fish advisories. Great Lakes-based researchers have studied populations residing in the Great Lakes basin to determine their level of awareness concerning fish consumption health advisories. They found that almost 50% of the residents who consumed Great Lakes sport fish were aware of sport fish consumption advisories. Of those with awareness, almost 60% were males and only about 40% were females. The researchers attributed the greater awareness among males to the health advisory materials that males receive with their fishing licenses and to their contact with fishing-related groups. The lower level of awareness among women regarding fish consumption advisories subsequently prompted the researchers to recommend targeting risk communication programs for female consumers of Great Lakes sport fish, particularly women of reproductive age. The Wisconsin Department of Health and Family Services subsequently followed the recommendation and developed uniform outreach materials for women, minorities, and the general public to be used by the Great Lakes states. The policy change directing educational materials to at-risk groups (e.g., women of reproductive age and minorities) is a direct outgrowth of the finding of low awareness about fish advisories among women who were interviewed.