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rTlhis guide was developed through a collaboration between the
JL Agency for Toxic Substances and Disease Registry; the U.S.
Environmental Protection Agency, Region 4; interested stakeholders;
and the environmental and community involvement staff for Alabama,
Florida, Georgia, and South Carolina. It is not intended to replace
existing policy or guidelines. Additional resources on community
involvement, risk assessment, public health assessments, risk
communication, and the Superfimd process are cited in the Sources
of Information section, Risk Assessment Guidance for Superfund:
Volume 1. Human Health Evaluation Manual Supplement to Part
A: Community Involvement in Superfund Risk Assessments.
Washington, DC: U.S. Environmental Protection Agency;
1999 March.
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U*S. Environmental
•,?••," •. '
Protection Agency %
: (EPAty National
Priorities List (NPL).
ATSDR, EPA, and state health organizations work
to protect the public from harmful exposure to
environmental contaminants.
What are contaminated sites?
Contaminated sites may include federally
identified Comprehensive Environmental
Response, Compensation, and Liability Act
(CERCLA or Superfund) sites and Resource
Conservation and Recovery Act (RCRA) sites
managed under state environmental programs,
state Superfund sites, NPL sites, emergency
response sites, and removal action sites.
The Agency for Toxic Substances and Disease
Registry (ATSDR) is a federal public health
agency charged with protecting people from
hazardous substances in the environment.
ATSDR works at both CERCLA and RCRA
sites, as well as other sites at which citizens
are concerned about contamination. ATSDR
is responsible for evaluating the public health
impact (i.e., diseases or illnesses) of past,
current, or future site contamination. ATSDR
and state public health offices use the public
health assessment process to evaluate the
health impact of sites and to develop appropri-
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ate recommendations to ensure that people
will not be exposed to harmful levels of
chemicals released from contaminated sites.
A complete guide to how ATSDR becomes
involved in working on contaminated sites
and to the public health assessment pro-
cess can be accessed at ATSDR's Web site,
www. ats dr. cdc. gov.
What does it mean to be a
Superfund site?
The Comprehensive Environmental Response,
Compensation, and Liability Act as amended
in 1986 (CERCLAor Superfund) established
procedures for identifying and correcting
uncontrolled releases of hazardous materials
from abandoned and other hazardous waste
sites. Among other things, the Superfund
program was designed to characterize, or help
define and understand, the nature and extent
of risks posed by hazardous waste sites. The
information would enable a thorough evalu-
ation of the hazards, and appropriate cleanup
remedies could be conducted at the site.
EPA must, by law, consider a number of factors
when considering an appropriate remedy for a
site. Under Superfund, EPA is responsible for
the protection of human health from the effects
of hazardous substances in the environment, as
well as the selection of cleanup remedies that
best meet current and possible future uses for
the contaminated site. EPA uses risk assess-
ment procedures to (a) determine the need
for remedial actions and (b) define how the
cleanup strategies should occur. A guide to the
Superfund risk assessment process is available
on EPA's Web site at www.epa.gov.
| What does it mean to be a
I RCRA site?
| RCRA, enacted in 1976, gives EPA the author-
| ity to control and regulate all facets of haz-
| ardous waste in the environment. The 1984
I amendments to RCRA enabled EPA to address
I environmental problems that could result from
I underground storage tanks and other hazard-
1 ous substances. RCRA focuses only on haz-
j ards at active facilities—it does not address
| abandoned or historic sites. Abandoned sites
i are managed under CERCLA (Superfund). It
i is possible for a Superfund site to be located at
| an active RCRA facility and, in such cases, the
i site would be managed under RCRA because it
i is an active facility.
I What is a risk assessment?
i A risk assessment is an analysis that uses
I information about toxic substances at a site to
i estimate a theoretical level of risk for people
I who might be exposed to these substances. The
i information comes from scientific studies and
I environmental data from a site. A risk assess-
i ment provides a comprehensive scientific esti-
! mate of risk to persons who could be exposed
i to hazardous materials present at a site.
i Risk assessments, prepared by EPA and other
! agencies, are used to determine if levels of
i toxic substances at hazardous waste sites pose
I an unacceptable risk as defined by regulatory
j standards and requirements. The risk assess-
| ment helps regulatory officials determine haz-
I ardous site cleanup strategies that will ensure
; overall protection of human health and the
i environment.
i A risk assessment does not measure the actual
i health effects that hazardous substances at a
j site have on people. Risk assessments often are
i conducted without considering actual or pos-
I sible exposure. Conservative safety margins are
i built into a risk assessment analysis to ensure
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protection of the public. Therefore, people will
not necessarily become sick even if they are
exposed to materials at higher dose levels than
those estimated by the risk assessment. In other
words, during the risk assessment analysis, the
most vulnerable people (e.g., children and the
elderly) are carefully considered to make sure
all members of the public will be protected.
How should the
community use the
information about risk?
The risk assessment helps answer these three
questions for people who might be exposed to
hazards at a site:
» Under what circumstances might I and my
family and neighbors be exposed to hazard-
ous substances at this site?
M Is it possible that we might be exposed to
hazardous substances at levels higher than
those determined to be safe?
B If the levels of hazardous substances are
higher than regulatory standards, how low
do the levels have to be for the risk to fall
within regulatory standards?
Communities can participate in EPA risk
assessments by helping to identify areas of
environmental concern and by identifying local
behavior patterns that might put people at risk.
An example might be to identify areas where
children often play, or a pond or stream where
people swim or fish.
A comprehensive guide and video explain-
ing the Superfund risk assessment process is
available from EPA Region 4 at www.epa.gov/
superfund/programs/risk/tooltrad.htm#gp.
What is a public health
assessment?
A public health assessment is similar in many
ways to a risk assessment. The health assessor
reviews site-related environmental data and
general information about toxic substances
at the site. The assessor derives an estimated
dose of the substance to which people in the
community might be exposed; then this dose is
During a public health assessment, scientists sometimes
gather data used for computer models that suggest past
exposure levels.
compared with regulatory standards. However,
unlike a risk assessment, the public health
assessment also factors in information from
citizens about actual exposures, including any
health data that might be available.
A public health assessment functions like
a clinical evaluation of a community. The
process involves examining the relationship
between actual exposures to contaminants and
subsequent signs of disease and illness. The
assessor then evaluates cases of those diseases
and injuries with regard to potential site-spe-
cific exposure situations in the community.
The conclusions of the assessment, which are
based on the professional knowledge and judg-
ment of the health assessment team, address
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the likelihood that persons living near a site
were exposed, are being exposed, or might
be exposed at some future time to harmful
levels of hazardous substances from the site.
The public health assessment can be prepared
by either a state public health department or
ATSDR.
ATSDR staff frequently meet and work with
local community members to collect informa-
tion on the past use of the site, community
health concerns, and evidence of community
health problems. ATSDR community-related
activities can include
H collecting and analyzing information on
health concerns expressed by community
members;
H gathering information on how people in the
community actually interact with the site
(for example, whether children play there or
people picnic or fish nearby);
» conducting (or working with others to con-
duct) blood, hair, urine, tissue, or environ-
mental sampling;
a and, if available, collecting and evaluating
information from county or state health
departments about certain types of illnesses
in the community.
What does 3 public health
assessment report tell you?
First, it tells you if people have been or are
likely to be exposed to a toxic substance and,
usually, how and when they were exposed.
Second, it tells you whether the exposures are
likely to lead to illness. Third, it recommends
ways to protect public health. For example,
recommendations might be made for the elimi-
nation or reduction of harmful exposures, or
that some critical but missing data be obtained
to assist the evaluation. It could also recom-
mend a more rigorous health investigation—
such as a health study—be conducted.
What a public health
assessment is not
The public health assessment is neither a medi-
cal evaluation of individuals nor a rigorous
health study of populations. It is not a state-
ment about establishing or meeting regulatory
standards. The assessor does not determine
cleanup levels or the best methods for cleanup
or treatment Unlike a risk assessment, a public
health assessment does not investigate and
evaluate the effects of hazardous waste on the
environment itself.
A public health
assessment
is not :
a physical examination
* a doorAto-dbor medical
survey, \ \
a cancer duster assess-
meat * *
,a health study
medical care
How does EPA contribute to
public health assessments?
EPA often assists ATSDR in filling critical data
gaps identified during the public health assess-
ment process. For example, if important health
issues are identified during the public health
assessment, EPA will often work with ATSDR
to help investigate site conditions that ATSDR
has identified as possibly posing a health
hazard. EPA may also make special efforts to
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Specific environmental information may be derived from
soil sampling.
obtain specific environmental information or
modify their original plans for studying site
contaminants.
How might the community
use health assessment
information?
The results of the public health assessment
process can tell the community what to expect
in terms of their health as a result of site-spe-
cific conditions. The community can see what
steps others need to take and what steps the
community needs to take to ensure that harm-
ful exposures are eliminated. The public health
assessment provides important information
to government entities responsible for public
health protection and to residents, parents,
teachers, community leaders, and health care
professionals.
What do EPA and ATSDR
do with the results of their
assessments?
In the risk management process, EPA uses risk
assessment information to decide what actions
need to be taken to protect human health. Such
actions can include deciding how much of a
substance a company may discharge into a
river; deciding which substances may be stored
at a hazardous waste disposal facility; deciding
to what extent a hazardous waste site must be
cleaned up; setting permissible discharge, stor-
age, and transport levels for hazardous wastes;
establishing levels for air emissions; and deter-
mining allowable levels of contamination in
drinking water.
In the public health assessment report, ATSDR
presents conclusions about the actual existence
and level of health threat, if any, posed by a
site, and recommends ways to stop or reduce
exposures. The public health assessment report
usually identifies the appropriate actions to
be taken by EPA, the state government, or the
responsible parties: Recommendations may be
made to conduct health education activities,
pilot studies of health effects, epidemiologic
investigations, disease surveillance studies, or
research on specific hazardous substances.
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—^—^^^K^^^^^^^^HOBBQa^^^M
information from community members about past or
> current activities at hazardous waste sites is valuable.
How might a community
toe involved with risk
assessments and public
health assessments?
Many persons who live and work near
Superfund sites want a greater role in help-
ing to make decisions about environmental
work being done at the site. In the past, com-
munity members have expressed the belief
that current public involvement practices are
often inadequate and that more meaningful
and effective ways to participate are needed.
Both risk assessments and public health assess-
ments benefit greatly from early community
involvement, ATSDR and EPA are committed
to promoting early participation in the deci-
sion-making process by people whose lives
are affected by Superfund sites located in their
neighborhoods.
t
Why is community input
important?
Persons living and working near a Superfund
site deserve to be informed and involved, and
they are likely to have unique knowledge and
insights about the site's history, uses, and activ-
ities—knowledge that can improve the accu-
racy of the risk assessment and public health
assessment processes. While assessors consult
state and local agencies and use population
surveys, databases, and appropriate assessment
guidance, the community can contribute vital
and unique information that cannot be located
elsewhere.
The timing and amount of community involve-
ment at Superfund sites will differ, because of
scheduling requirements and because many
Superfund sites are already being cleaned up.
The degree of community input during the
assessment process will differ according to the
complexity of the issues, available resources,
and the level of community interest.
Community Input Can Help
* * Community members may have useful
information about the site's Mstory;
chemical usage; human activities; and
past, current and tutors lantfuses
Community input
-" can augment and improve estimates of
exposure, risks, and health threats
Streamline efforts
a Community members may have special
issues'or concerns that, if factored into
the assessment platming, will reduce -
the likelihood that ttoe risk assessment,
public healiij assessment, and eleaaup'
plans will have to be redone,"
Gain acceptance
• Coininunify members who contribute 10
planning assessments will have a better
, mderstanding of the process aiid will
more likely give Ihew support to &e
, effort
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Additional Source information
You can contact any of the people listed below
to get more information about this guide, the
assessment process, and ways you can become
involved.
AbenaAjanaku
Community Involvement Coordinator
Georgia Environmental Protection Department
Floyd Towers East
205 Butler Street, SB, Suite 1162
Atlanta, GA 30334
Phone: (404) 657-8688
Fax: (404) 651-9425
email: abena_ajanaku@mail.dnr.state.ga.us
Michelle Cook
U.S. Environmental Protection Agency
Region 4
61 Forsyth Street
Atlanta, GA 30303
Phone: (404) 562-8805
Fax: (404) 562-8842
email: cook.michelle@epa.gov
Cheryl Browder
Health Educator
Division of Epidemiology, Suite 1450
Alabama Department of Public Health
PO Box 303017
Montgomery, AL 36130
Phone: (334) 206-5948
Fax: (334) 206-2012
email: cbrowder@adph.state.al.us
Beth Copeland, Community Involvement/
Education Consultant
Superfund Health Assessment and Education
Bureau of Environmental Epidemiology
Florida Department of Health
4052 Bald Cyprus Way (Bin AO8)
Tallahassee, FL 32399-1712
Phone: (850) 245-4299
Fax: (850) 922-8473
email: Beth_Copeland@doh.state.fl.us
Ligia Mora-Applegate
Environmental Scientist
FDEP Bureau of Waste Cleanup
2600 Blair Stone Road, MS 4535
Tallahassee, FL 32399-2400
Phone: (850) 488-0783
Fax: (850) 922-4368
email: ligia.mora-applegate@dep.state.fl.us
Neil Sass
State Toxicology and
Counterterrorism Coordinator
Alabama Department of Public Health
The RSA Tower
201 Monroe Street, Suite 1450
Montgomery, AL 36104
Phone: (334) 206-5973
Fax: (334) 206-2012
email: nsass@adph.state.al.us
Allan S. Susten
Assistant Director for Science
Division of Health Assessment and Consultation
Agency for Toxic Substances and
Disease Registry
1600 Clifton Road, NE (MS E-32)
Atlanta, GA 30333
Phone: (404) 498-0007
Fax: (404) 498-0073
email: ASusten@cdc.gov
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