health environments for the next generation: before, during & after pregnancy collaborative on...
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Health Environments for the Next Generation: Before, During & after
Pregnancy
Collaborative on Health and the Environment
MissionTo work collaboratively with diverse groups
to eliminate harmful environmental exposure effecting children during their most critical development years: pre-
conception to age eight.
JoinWebsite: http://www.chenw.org
Listserve: Northwest Kids Environmental Health Groupwww.ecy.wa.gov/maillist.html
Meeting:Second Thursday of the month, 9:30 – 11:30Location rotatesIn-person or call-in options
Children’s Environmental Health 101
Nicole Thomsen, REHS, HHSPublic Health – Seattle & King CountyEnvironmental Public Health Planner
“Social Justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death.”
WHO Commission on Social Determinants of Health
Source: New England Journal of Medicine, Sept. 2007
Where People Live 60%
Health Care10%
Genetics30%
What We Know About Health
“Children's environmental
health" focuses on
environmental exposures
before, during and after birth,
and the resulting health effects.
Schettler, T., Reproductive Health – NW Children’s Environmental Health Forum. 2013. Available at http://washington.chenw.org/CEHforum2013.html.
Developmental windows of
susceptibilities
Physiological differences
Behavioral differences
Children’s increased vulnerability
Increased speed of….
MyelinationCell divisionDifferentiationSynapse development
TEDX – The Endocrine Disruption Exchange.http://endocrinedisruption.org/prenatal-origins-of-endocrine-disruption/critical-windows-of-development/timeline-test/
Children’s physiology, compared to an adult
Breathing:
Drinking:
Surface Area:
Children’s behavior, compared to an adult
Mouthing:
Time on ground:
Playing:
Chemical Contaminants
Lead
Mercury
Environmental tobacco smoke
Formaldehyde
Polybrominated diphenyl ether
(PBDE)
Bisphenol A (BPA)
Pesticides
Birth defects
Reproductive capacity – age of menarche, semen quality, menstrual irregularities
Infant mortality, pre-term birth
Obesity
Neurological disorders
Endocrine disorders
Cancers
Health Outcomes
Cost to children in King County, per birth cohort
$177 million
172,000 healthy life-years
Live
Learn
Play
Cumulative Exposures
Steve Gilbert, PhD, DABTInstitute of Neurotoxicology and Neurological Disorders
Director & [email protected]
206-527-0926
Global Warming
Burning Coal
Coal Waste
Mercury from Coal to Fish
Nuclear waste
Chemical body burden
Chemical use
Sustainability
Inheriting The Future
Implications for Future Generations
Cumulative exposuresFood, chemical/contaminant, built, social environments; multi-level
Cumulative effectsHealth outcomes: increased risk of various adverse pregnancy outcomes; increased risk of chronic diseases; co-morbidities
From Ted Schettler
Cumulative exposures vs. Cumulative effects
Risk =
Hazard X Exposure
Dose / Response
Individual Sensitivity
78.2% no data
21.4% some data12 or 0.4% good data
U.S. Environmental Protection Agency. TSCA Chemical Substance Inventory. 2012. http://www.epa.gov/oppt/existingchemicals/pubs/tscainventory/index.html
Vogel. S.A. and J.A. Roberts, Why the Toxic Substances Control Act Needs An Overhaul, And How To Strengthen Oversight of Chemicals In The Interim. Health Affairs, 2011. 30(5): 898-905
The Chemical Data Vacuum
Developmental disabilities: one in six, or about 15%, of children aged 3 through 17 years have a one or more developmental
disabilities
Consequences
Learning disabilities: 5-10% of kids in public school
ADHD: 5% of all school kids, maybe higher. Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD
as of 2011.
• Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics. 2011; 27: 1034-1042
• http://www.cdc.gov/ncbddd/adhd/
“Conditions that ensure that all living things have the best
opportunity to reach and maintain
their full genetic potential.”
Steven G. Gilbert, 1999
Gilbert SG. Ethical, legal, and social issues: our children's future. Neurotoxicology. 2005;26:521-30
"A thing is right when it tends to preserve the integrity, stability, and
beauty of the biotic community. It is wrong
when it tends otherwise."
1887 - 1948
Aldo Leopold1949, A Sand County Almanac
Violent Crime and Blood Lead Levels
CDC 1960 CDC 1973 CDC 1975 CDC 1985 WHO 1986 EPA 1986 CDC 1990 CDC 2012 CDC 20??0
10
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52
Agency and Year
Blo
od
Le
ad
(u
g/d
l)
Acceptable Childhood Lead Levels
O
BrxBry
PolyBrominated Diphenyl Ether
Environmental Working Group. In the Dust: Toxic Fire Retardants in American Homes. 2004. http://www.ewg.org/research/pbdes-fire-retardants-dust
PBDE’s in House Dust (ppb)
PBDE’s in Breast Milk (ppb, lipid)
Environmental Working Group. Mother's Milk. 2003. http://www.ewg.org/research/mothers-milk-0
“When an activity raises threats of harm to human health or the
environment, precautionary measures should be take even if some cause
and effect relationships are not fully established scientifically.”
Wingspread Conference, 1998
Precautionary Principle
3 days
32 attendees
1 statement
• Setting goals (Health indicators)
• Taking preventive action in the face of uncertainty
• Shifting the burden of responsibility to the proponents of an activity (Who benefits?)
• Exploring a wide range of alternatives to possibly harmful actions (Is it necessary?)
• Increasing public participation in decision making (transparency of information & environmental justice)
Consensus Statement
Epi, means “upon”, "above", "in addition to"
Epigenetics is the study of changes in gene expression caused by mechanisms other than changes in the genetic (DNA) code
Epigenetics
Epigenetics
Environmental hazards
Epigenetics
Cigarette smoke
Arsenic
Alcohol
Phthalates
Bisphenol A (BPA)
Nutiriton
Mercury
Social and maternal behavior toward
child
• Moving “above” or “beyond” precautionary approach
• Doing good
• Loving & supportive environment
• Doing no Harm is not doing enough
• Ensure children can reach and maintain their full potential
• Biological support epigenetics
Epiprecaution
Holly Davies, PhDWashington State Department of Ecology
Senior [email protected]
360-407-7398
Effective Actions
The American College of Obstetricians and Gynecologists
• Evidence is sufficiently robust linking toxic environmental agents to reproductive and developmental health outcomes.
• Reducing exposures is critical.
• Pre-conception & pre-natal
• Profound and lasting effects
• Healthcare providers should provide guidance
American College of Obstetricians and Gynecologists. Committee of Health Care for Underserved Women Opinion No. 575. Exposures to Toxic Environmental Agents. Obstetrics & Gynecology, 2013. 122(4): 931-5
Susan Buchanan, MD, MPHUniversity of Illinois at Chicago
School of Public Health
http://prhe.ucsf.edu/prhe/pdfs/CREM%20Prenatal%20Environmental%20Exposure%20History.pdf
Lead
Mercury in fish
Pesticide use
Endocrine disruptors
10 4 + =RiskTopicsMinutes
Am J Obstet Gynecol. 2012 Dec;207(6):463-70. doi: 10.1016/j.ajog.2012.02.004. Epub 2012 Feb 14.Environmental exposures: how to counsel preconception and prenatal patients in the clinical setting.Sathyanarayana S1, Focareta J, Dailey T, Buchanan S.
Benign design
Kids & environment
protected
Manufacturers share the
responsibility
Safer Alternatives
Green Chemistry
Phase out PBTs
Averting toxic exposures and avoiding future costs is the smartest, cheapest and healthiest approach.
Identify Chemicals of Concern
Gather dataBans, Limits,
Reporting
>>>BANS
>>> DATA COLLECTION
>>> STAKEHOLDER PROCESSES
Bisphenol A in children’s bottles/cups, sports bottles
Copper in brake pads, boat paint
Toxics in packaging Coal tar sealants
PBDEs, including deca-BDE in certain products
Chemical Action Plans for Persistent, Bioaccumulative Toxics
Children’s Safe Product Act reporting rule
Product testing
Alternatives assessment guidance
Green Chemistry Center
Brake pad law
Lead in wheel weights
Ecology’s Efforts
Flame Retardants
• PBDEs (polybrominated diphenyl ethers) – PBTs– Neurodevelopment and behavior effects,
cancer– Endocrine disruptor (thyroid hormone)– High levels in foam, plastics, textiles– House dust and environmental media
• Advice– Reduce exposure to dust- cleaning– Purchasing– Fish advisory
• PBDEs– Voluntary phase out with EPA (2004-2013)– 2006, PBDE chemical action plan (CAP) recommended ban – In 2007, Washington passed a law (RCW 70.76) banning the
manufacture, distribution, and sale of certain products with PBDEs
• Exemptions • Deca-BDE was prohibited after an alternatives assessment• Good compliance
– Other states also have bans• Other flame retardants
– Sleepwear in the 1970s – California TB117 update (2014)– Current bill in WA legislature– Other state laws (bans, labeling, disclosure) and bills
• Safer alternatives– What are they using instead?
Flame Retardants - Regulation
• Chlorinated Tris– TCEP, TDCPP, TDPP, TCPP, V6
• Firemaster 550
• HBCD
• Tetrabromobisphenol A (TBBPA)
• Polybrominated diphenyl ethanes– Other brominated compounds
• TPP
Alternatives Assessments and Green Chemistry
Flame Retardants - Alternatives
• 1976 Toxics Control Substances Act (TSCA)• Frank R. Laugtenberg Chemical Safety for the
21st Century Act• Senate and House bills• Chemical review by EPA
• High and low• State pre-emption
50
Federal Chemical Reform
– Water Quality rule updating Human Health Criteria
– Budget Package– Toxics Reduction Act
• Expand the use of CAPs for priority chemicals, including emerging contaminants
• Prevention of distributed sources• Alternatives assessments to avoid regrettable
substitutions• State purchasing
Governor’s Toxics Reduction Package
MissionTo work collaboratively with diverse groups
to eliminate harmful environmental exposure effecting children during their most critical development years: pre-
conception to age eight.
JoinWebsite: http://www.chenw.org
Listserve: Northwest Kids Environmental Health Groupwww.ecy.wa.gov/maillist.html
Meeting:Second Thursday of the month, 9:30 – 11:30Location rotatesIn-person or call-in options
Nicole Thomsen, REHS, HHSPublic Health – Seattle & King CountyEnvironmental Public Health Planner
Steve Gilbert, PhD, DABTInstitute of Neurotoxicology and Neurological Disorders
Director & [email protected]
206-527-0926
Holly Davies, PhDWashington State Department of Ecology
Senior [email protected]
360-407-7398