ENVIRONMENTAL POLLUTION
AND
CANCER AND HEART AND LUNG DISEASES
SECOND ANNUAL REPORT TO CONGRESS
August 7,1979
TASK FORCE ON
ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
Environmental Protection Agency National Cancer Institute
National Heart, Lung and Blood Institute National Institute for Occupational Safety and Health
National Institute of Environmental Health Sciences National Center for Health Statistics
Center for Disease Control Food and Drug Administration
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ENVIRONMENTAL POLLUTION
AND
CANCER AND HEART AND LUNG DISEASES
Second Annual Report to Congress
August 7, 1979
TASK FORCE ON ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
Environmental Protection Agency
National Cancer Institute
National Heart, Lung and Blood Institute
National Institute for Occupational Safety and Health
National Institute of Environmental Health Sciences
National Center for Health Statistics
Center for Disease Control
Food and Drug Administration
Prepared with the assistance of GEOMET, Incorporated, under EPA Contract Number 68-01-5773,
George R. Simon, Project Officer,
Office of Research and Development, Environmental Protection Agency, Washington, D. C. 20460
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PREFACE
The Task Force on Environmental Cancer and Heart and Lung Disease
was established in accordance with Section 402 of Public Law 95-95, enacted
August 7, 1977, for the purpose of recommending and coordinating Federal pro-
grams concerned with the reduction of such diseases. The Task Force initially
included representatives from the Environmental Protection Agency, the
National Cancer Institute, the National Heart, Lung and Blood Institute, the
National Institute for Occupational Safety and Health, and the National Insti-
tute of Environmental Health Sciences. The Administrator of the Environmental
Protection Agency (or his delegate) was designated as Chairman by this law.
Subsequent legislation, Section 9 of Public Law 95-623 enacted November 9,
1978, added the Director of the National Center for Health Statistics and the
head of the Center for Disease Control to the membership of the Task Force.*
The Task Force is required to report annually to Congress on its progress and
problems.
This report describes the work of the Task Force in its second year
(August 1978 to August 1979) and outlines plans for the future. Chapter 1 is
an introduction that delineates the responsibilities of the Task Force and
summarizes its first annual report. Status summaries of the Task Force's
activities are presented in Chapter 2. Chapter 3 describes future plans of
the Task Force.
* In September 1978, the Food and Drug Administration was invited to participate in Task Force activities.
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Abbreviations of Agencies and Organizations
ACDA - Arms Control and Disarmament Agency
ADAMHA - Alcohol, Drag Abuse, and Mental Health Administratipn
CDC - Center for Disease Control
CEQ - Council on Environmental Quality
CPSC - Consumer Product Safety Commission
DHEW - Department of Health, Education, and Welfare
DOC - Department of Commerce
DOD - Department of Defense
DOE - Department of Energy
DOT - Department of Interior
DDL - Department of Labor
DOS - Department of State
DOT - Department of Transportation
EOF - Executive Office of the President
EPA - Environmental Protection Agency
FAA - Federal Aviation Administration
FDA - Food and Drug A dministration
FSOS - Food Safety and Quality Service
HCFA - Health Care Financing Administration
HRA - Health Resources Administration
HSA - Health Services Administration
HUD - Department of Housing and Urban Development
ITC - International Trade Commission
LOG - Library of Congress
MSHA - Mine Safety and Health Administration
NAS - National Academy of Sciences
NASA - National Aeronautics and Space Administration
NCHS - National Center for Health Statistics
NCI " - National Cancer Institute
NCTR - National Center for Toxicological Research
NHLBI - National Heart, Lung, and Blood Institute
NIA " - National Institute on Aging
NIAID - National Institute of Allergy and Infectious Diseases
NIAMDD - National Institute of Arthritis, Metabolism and Digestive Diseases
NICHHD - National Institute of Child Health and Human Development
NIDA - National Institute of Drug Abuse
NIEHS - National Institute of Environmental Health Sciences
NIGMS - National Institute of General Medical Services
NIH - National Institutes of Health
NIMH - National Institute of Mental Health
NINCDS - National Institute of Neurological and Communicative Disorders and Strokes
NIOSH - National Institute for Occupational Safety and Health
NLM . - National Library of Medicine
NOAA - National Oceanic and Atmospheric Administration
NRC - Nuclear Regulatory Commission
NSF - National Science Foundation
OASH - Office of Assistant Secretary for Health
OSHA - Occupational Safety and Health Administration
OSTP - Office of Science and Technology
SI - Smithsonian Institution
SSA - Social Security A dministration
USDA - U.S. Department of Agriculture
VA - Veterans Administration
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TABLE OF CONTENTS
EXECUTIVE SUMMARY
Page
vii
Chapter 1. INTRODUCTION
The Task Force Responsibility
The First Year
1
2
Chapter 2. STATUS SUMMARY
Standardization of Measurements and Tests
Education of the Public and of Health Professionals
Exposure and Metabolic Mechanisms
Information Exchange
Risk Assessment
Funding of Federal Efforts
13
15
22
23
Chapter 3. TASK FORCE PLANS
The Approach to Strategy Development
Actions for Next Year
27
27
31
Appendix A.
Appendix B.
Appendix C.
Appendix D.
Appendix E.
Appendix F.
PERTINENT SECTIONS OF PUBLIC LAWS 95-95 AND 95-623
MEMBERS OF THE TASK FORCE, WORKING GROUP AND
PROJECT GROUPS
MEETING DATES
A RESPONSE TO THE FIRST ANNUAL REPORT FROM
CONGRESSMAN PAUL G. ROGERS
SUMMARY OF RECOMMENDED RESEARCH IN EXPOSURE AND
METABOLIC MECHANISMS OF FOUR TOXIC CHEMICALS
CATEGORIZATION AND FUNDING OF FEDERAL PROGRAMS
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EXECUTIVE SUMMARY
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EXECUTIVE SUMMARY
This is the second annual report to Congress by the Task Force
on Environmental Cancer and Heart and Lung Disease.
INTRODUCTION
The Task Force was established in the Clean Air Act Amendments of
1977 to focus efforts by the Environmental Protection Agency and the various
branches of the Department of Health, Education, and Welfare on the develop-
ment of coordinated, comprehensive Federal research programs and strategies
for the reduction of the risks of environmentally related cancer and heart and
lung diseases.
During its first year, the Task Force defined the problem of environ-
mentally related cancer and heart and lung diseases and developed objectives
and an organizational capability to address the problem. It also identified
Federal resources available and began the exchange of information among its
members. The Task Force identified six areas of special concern which war-
ranted early action:
Standardization of Measurements and Tests
Exposure and Metabolic Mechanisms
t Early Indicators of Disease
Risk Assessment
Education of the Public and of Health Professionals
t Strategies to Protect Public Health.
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WORK OF THE SECOND YEAR
During the second year, Project Groups were formed to deal with
three of these areas.
A Project Group on Standardization of Measurements and Tests
examined ways to improve comparability of experimental results, and sub-
sequently concentrated on formulating suggested Federal guidelines on the
standardization of measurements and tests.
A Project Group on Education of the Public and of Health Profes-
sionals concentrated on identifying available educational programs of envi-
ronmentally related disease. In October 1979, this group will conduct a
workshop to explore how health professionals perceive their needs in envi-
ronmental education and to consider ways in which the Government can promote
educational initiatives to meet these needs and thereby aid in the reduction
of environmental disease.
The Task Force requested a feasibility report on the utility of
interagency study of exposure and metabolic mechanisms. A report was pre-
pared by the National Institute of Environmental Health Sciences which
addressed the problem in terms of four representative chemicals. A Project
Group on Exposure and Metabolic Mechanisms was then established to work in
this field.
Separate Project Groups were not established for Early Indicators
of Disease, Risk Assessment, or Strategies to Protect Public Health. The
question of Early Indicators of Disease may be considered by the Project
Group on Exposure and Metabolic Mechanisms. The Task Force as a whole
reviewed the work done by the Interagency Regulatory Liaison Group in the
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area of risk assessment and decided to coordinate activities of other
groups in this area rather than establish a separate Project Group.
The Task Force views information exchange among it members as the
primary basis for establishing coordination and development of interagency
programs. Activities this year included creation of a directory of inter-
agency groups working in environmental health, publishing a monthly calendar
of events, listing data bases for Federal research programs, and assisting the
National Center for Health Statistics in its efforts under Section 8 of Public
Law 95-623 to develop plans for the collection of environmental health data.
As it did last year, the Task Force identified and classified relevant funding
in each of its member agencies. Approximately $270 million were spent in 1978
by the seven agencies on research and strategy planning addressed to Task
Force objectives.
TASK FORCE PLANS
In the coming year the Task Force will continue its information
exchange activities and will strengthen ties with such groups as the Inter-
agency Regulatory Liaison Group and the National Toxicology Program. In
addition, it will move forward in the Project Group areas of Standardization
of Measurements and Tests, Education of the Public and of Health Professionals,
and Exposure and Metabolic Mechanisms. Each group will identify and recom-
mend specific actions appropriate for meeting the objectives of reduction of
environmental diseases.
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The Task Force will continue and expand its review of the role of
risk assessment. An inventory of relevant current and planned programs will
be assembled by member agencies as a basis for analyzing emphases and new
initiatives. Activities during the year will be directed toward the develop'
ment of recommendations to Congress and to the member agencies.
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Chapter 1
INTRODUCTION
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Chapter 1
INTRODUCTION
THE TASK FORCE RESPONSIBILITY
The Task Force on Environmental Cancer and Heart and Lung Disease
is composed of representatives from:
Environmental Protection Agency (EPA)
National Cancer Institute (NCI)
National Heart, Lung and Blood Institute (NHLBI)
National Institute for Occupational Safety and Health (NIOSH)
National Institute of Environmental Health Sciences (NIEHS)
National Center for Health Statistics (NCHS)
Center for Disease Control (CDC)
Food and Drug Administration (FDA) (observer).
The Task Force was established to provide a focus for a concerted attack upon
the national problem of environmentally related cancer and heart and lung dis-
eases.* Congress directed the Task Force to recommend comprehensive programs
for quantifying the relationships between environmental pollution and asso-
ciated disease and for reducing the risk and incidence of such disease. It
also was directed to coordinate relevant research, stimulate cooperation
among Federal agencies, and report to Congress annually on its progress and
difficulties in reaching these objectives. The Task Force was identified in
Appendix A includes relevant sections from Public Laws 95-95 and 95-623.
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Section 8 of Public Law 95-623 which requires that the Secretary of the
Department of Health, Education, and Welfare, acting through NCHS, consult
with and take into consideration recommendations of the Task Force with
respect to collection and coordination of environmental health statistics.
THE FIRST YEAR
The Task Force was formally organized in November 1977. At that
time the EPA Administrator assigned staff within the Office of Research
and Development to serve as a technical secretariat to the Task Force. Sub-
sequently, at the first plenary meeting of the Task Force, a Working Group
composed of alternate Task Force members was established to increase the
Task Force's capability.*
During the first year, the national problem with regard to environ-
mentally related cancer and heart and lung diseases was outlined. The Task
Force defined pollution as those chemical pollutants present in the ambient
and workplace environment which affect humans through various media such as
air, water, and soil. It examined information on existing environmental
research programs and inventoried and categorized resources available to
Federal agencies to combat the problem. The first annual report, submitted to
Congress on August 7, 1978, stated:
There is evidence that risk and occurrence of cancer
and heart and lung diseases increase with environmental
pollution, which is broadly defined to include all
environmental factors.
* Members are listed in Appendix B; meeting dates in Appendix C.
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The extent of illness, death, and cost to society
from environmentally related cancer and heart and
lung diseases is a matter of national concern.
There is expectation that levels of illness, death,
and cost resulting from these environmentally related
diseases could be substantially reduced by preventive
measures and current preventive measures are believed
to be inadequate to obtain desired reductions of risk
and occurrence.
Increased knowledge of pollution-disease relations and
improvements in strategies and preventive measures are
needed for reduction of risk and occurrence.
The Federal Government has a central, critical role
to take in research and prevention of environmentally
related disease; changes in current Federal efforts
may be necessary if reductions of risk and occurrence
of environmentally related cancer and heart and lung
diseases are to be obtained.
In addition, in the first annual report, the Task Force identified a
limited set of areas of special concern and interest:
Standardization of Measurements and Tests
Exposure and Metabolic Mechanisms
Early Indicators of Disease
Risk Assessment
0 Education of the Public and of Health Professionals
0 Strategies to Protect Public Health.
It was decided to examine these subjects through the formation of
Project Groups, each charged with determining: (1) the contribution which
improved knowledge in each area could make to the achievement of Task Force
objectives, (2) the needs for improved knowledge and (3) the feasibility of
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undertaking interagency activities to assist in resolving problems in these
areas. Reports of the Project Groups will constitute a basis for further
actions.
The establishment of ties with other existing interagency groups
working in related fields and the exchange of information among Task Force
member agencies were also identified as areas for emphasis.
The Chairman of the U.S. House of Representatives' Subcommittee on
Health and the Environment acknowledged the first annual report on behalf of
the Subcommittee in a letter to the Chairman of the Task Force on September 8,
1978. His letter, which suggested several areas in which further effort and
consideration would be desirable, is presented in Appendix D.
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Chapter 2
STATUS SUMMARY
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Chapter 2
STATUS SUMMARY
A hierarchical approach was implicit in emphasizing the areas iden-
tified for detailed examination in the first annual report of the Task Force.
The aspects related to standardization of measurements and tests form the
basis for much of the work related to the Task Force's responsibilities.
Information and knowledge of exposure to pollutants, metabolic mechanisms
and early indicators of disease represent the next hierarchical level. The
assessment of risks and education of the public and of health professionals
forms the next level, while strategies to protect public health is at the
apex of this pyramidal structure. In addition to these areas, the develop-
ment of an information exchange system was subsequently cited as an impor-
tant activity for Task Force consideration.
Project Groups were formed in the following areas: standardiza-
tion of measurements and tests, education of the public and of health profes-
sionals, and exposure and metabolic mechanisms. The Project Groups are
composed of representatives from the Task Force agencies and other interested
Federal agencies.* The activities of these Project Groups during the past
year focused on organizing, determining the exact scope of their activities
and gathering preliminary information.
In this chapter, the status reports of these Project Groups are
given. Activities concerning information exchange and risk assessment are
* Members are listed in Appendix B.
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described. A summary of funding of the relevant research programs of the
Task Force agencies also appears in this chapter.
STANDARDIZATION OF MEASUREMENTS AND TESTS
Research in the area of environmentally related disease is conducted
under the sponsorship of numerous Federal agencies. To improve the validity,
quality and interagency applicability of this research, measurements and tests
need to be standardized. A Project Group was established to study ways of
improving the intercomparability of test results through the development of
common definitions and standard test protocols for the Task Force member agen-
cies. Biostatisticians as well as laboratory research scientists participated
in the activities of this Project Group.
As defined by the Task Force in its first annual report to Congress,
standardization of measurements and tests included chemical, physical and bio-
logical factors in laboratory, clinical and community conditions. Early dis-
cussions among the members of the Task Force and among their Working Group
representatives resulted in the suggestion that this definition be narrowed
to a more manageable scope during the initial activities of the Project Group.
Subsequently, the Project Group defined the scope of its activities to include
the standardization of measurements and tests in chemical, physical, and bio-
logical systems and in health data collection systems. This approach was
reviewed by the Task Force which recommended that the Project Group concen-
trate on the standardization of physical and chemical tests and measurements.
To address this more specific charge, the composition of the Project Group
was changed and representatives who had more direct involvement and expertise
in physical and chemical measurement procedures were appointed.
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When the members of the Project Group met to reformulate their
objectives, they decided to concentrate on policy concerns instead of on
the implementation of specific procedures. This decision was based upon the
different responsibilities and perspectives of the participating agencies,
since some of the participating agencies have regulatory functions while others
are primarily research oriented. In addition, the group decided to initially
concentrate on providing ways to compare experimental results and to formulate
Federal guidelines on the standardization of measurements and tests.
In accordance with these new objectives, the following guidelines on
the standardization of measurements and tests were developed by this Project
Group.
Federal agencies conducting research in support of efforts to
reduce environmentally related disease shall conduct their
research according to the following principles:
t The experiment, measurement, or test will be designed
and conducted according to appropriate statistical
experimental designs and with preset statistical
sensitivity.
To the extent possible, standard test methods will be
used. If such methods are unavailable, reliable methods
having performance comparable to standard or reference
methods will be used.
All chemicals, such as reagents and carrier materials,
will be identified as completely as possible in terms
of source, purity, and any other relevant character-
istics.
Documentation will be as clear, unequivocal and com-
plete as the reporting medium permits. If the docu-
mentation appears in professional publications in
which length and detail are limited, the necessary
complete documentation should be available.
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Although interagency implementation of these guidelines could be
a lengthy process, their development is an important first step toward
increasing the reliability and utility of research sponsored by the Federal
Government.
EDUCATION OF THE PUBLIC AND OF HEALTH PROFESSIONALS
The development of an informed citizenry may be the most useful,
long-term strategy for reducing both the costs and risks associated with
environmental cancer and heart and lung diseases. The lack of awareness and
understanding of environmental factors among health professionals has long
been identified as a serious deficiency in the prevention of environmental
disease. Recognizing these two factors, a Project Group on the Education
of the Public and of Health Professionals was established.
The Project Group classified the public in two broad areasworkers
and the general public. The first group consists of unionized and nonunionized
workers. The second consists of all members of the public interacting with the
environment in nonworkplace conditions, including workers away from their work,
housewives, retired persons, and most students. The health professionals area
includes physicians, osteopaths, nurses, nurse-practitioners, physician assis-
tants, dentists, health scientists and students in these fields. Within this
framework, the Project Group developed the following objectives:
Classify existing programs for the medical profession
and public into categories of information, education,
or training
Identify the material currently directed toward the
medical profession both in formative and continuing
education programs
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Identify the material currently being disseminated in
major newspapers and journals concerning the relation
of environmental pollution to cancer and heart and lung
diseases
Identify the available resources and the role of various
Federal, state, local and professional organizations and
agencies in education of the public and health profes-
sionals regarding environmentally related disease
Determine the status of communication between agencies
and organizations involved in environmental education
and the extent of duplication or gaps
Examine documents from environmental education programs
and evaluate program results to identify appropriate
strategies for educating the public and health
professionals.
Highlights of information obtained by the Project Group are presented
below.
Education of the Public
Workers
The education of workers exposed to occupational hazards is addressed
through direct channels. Numerous agencies provide support to both industry
and unions in the area of occupational and environmental hazards. Examples of
this support are presented below:
Through a series of contracts funded by NCI, and managed
by OSHA, the Cancer Alert Program was developed to inform
and alert workers to the risks from known and suspected
carcinogenic substances encountered in the workplace. As
a result of this program, the National Academy of Sciences
developed broad guidelines for a public information program
on occupational cancer. In addition, funds provided through
the Cancer Alert Program have contributed to the development
of educational materials on the recognition and control of
occupational cancer hazards for use in training programs
with employees and employers at high-risk facilities.
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OSHA, through NCI, awards grants to labor unions, trade
associations, educational institutions, and other non-
profit organizations to develop capabilities for providing
training, education, and related assistance to employees.
Within a 5-year period, it is intended that most recipient
organizations become centers of competence that can pro-
vide an extensive range of workplace safety and health
activities and services.
OSHA, Mine Safety and Health Administration and NIOSH
work closely with employee groups and unions to develop
safety and health training and awareness programs.
t NIOSH not only develops and disseminates Criteria Docu-
ments for substances considered to be a hazard in the
workplace, it also publishes a Current Intelligence
Bulletin, sent out to industry and labor, dealing with
current industrial hazards. Through its Health Hazard
Evaluation Program, NIOSH formally advises employees
and employers of health hazards in workplaces.
Research supported by NCI, NIEHS, NIOSH and other agen-
cies is aimed at investigating the exposure of workers
to such environmental hazards as asbestos, textile dusts,
and printers' ink. This information is often dissemi-
nated to the workers by the individual researchers.
EPA sponsored the development of a modular training program
for auto emissions inspection and maintenance mechanics,
with the assistance and support of auto manufacturers and
unions of auto mechanics. A modular training program is a
self-contained instructional unit designed to address the
specific requirements of a given population.
General Public
A literature search combined with communications and visits to
Federal agencies, news media representatives, educational institutions,
consumer interest groups, and other organizations revealed that there is
much information available to the public on environmental pollution and its
relationship to cancer and heart and lung diseases. Segments of this informa-
tion are disseminated through newspapers and magazines throughout the country,
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but access to information by media editors is not systematic. The majority of
editors and health writers who were interviewed believe there is a need for
an official clearinghouse where they could obtain updated or additional infor-
mation. Such a clearinghouse could also provide explanations, analyses and
summaries of environmental issues. In addition to the materials distributed by
the mass media, education material is developed and disseminated to the public
through Federal agencies and other organizations such as cancer, heart and
lung associations.
Education of Health Professionals
In assessing educational programs designed for health professionals,
the Project Group found that it is impossible to isolate professional educa-
tion on environmentally induced cancer and heart and lung diseases from the
broader category of environmental and occupational diseases. Furthermore,
much of the educational material is fragmented or incorporated into more gen-
eral topics, offered on an informal basis, or classified as elective rather
than as part of a core program. Therefore, it is difficult to catalog all
ongoing educational programs in the area of environmental cancer and heart
and lung diseases. The following examples describe some of the Federal
Government's efforts to provide environmental education to health
professionals:
NIOSH funds 12 Educational Resource Centers and awards
training grants to other educational institutions having
a total of 1472 full-time students in training for FY 1979.
Training categories include occupational medicine, occupa-
tional health nursing, occupational safety, industrial
hygiene, occupational safety and health technician work,
and others such as toxicology and epidemiology.
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EPA (Office of Education and Manpower Planning; Office
of Pesticide Programs) and DHEW (Health Services Admin-
istration) jointly sponsored the development of a modular
training program entitled "Pesticide Protection" for
specialized health professional groups. The strategy of
developing and incorporating modules into the training
cycle of health professionals has proven to be effective
in the view of those associated with the program.
DHEW (Health Resource Administration) is developing and
implementing occupational/environmental training modules
at medical schools for primary care physicians, residents,
and medical students. In addition, HRA is awarding
special initiative project grants to medical schools to
support the development of undergraduate curricula in
occupational and environmental medicine.
DOD is extensively involved in providing education and
training in environmental health to its personnel. As an
example, the Department of the Air Force provides in-depth
training in occupational health and environmental pollu-
tion to physicians, nurses, and health technicians.
NIEHS supports nine university-based Environmental Health
Sciences Centers. The staffs of these centers, with
their highly specialized and closely related research
interests, permit a multidisciplinary approach to research
and research training in environmental health sciences.
These centers have also proven to be especially effective
in attracting and training medical and nonmedical pre- and
postdoctoral students for research, academic, and medical
careers in environmental health sciences and related areas,
Workshops
Deficiencies exist in the environmental education of the public and
of health professionals as a result of inadequate information dissemination
and a lack of understanding of the problem. As a result, the Project Group
plans to sponsor workshops aimed at promoting a coordinated approach to edu-
cating both the public and health professionals.
The first workshop, scheduled for October 15 and 16, 1979, will be
held in Washington, D.C. Workshop participants, representing various health
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professional organizations, will be asked to identify the needs of health
professionals in environmental medicine and to recommend ways in which
the Federal Government and these organizations can work together.
Prior to the workshop, each participant will receive a set of docu-
ments consisting of background material, workshop objectives and an agenda.
This material will preclude extensive introductory sessions. The planned
composition of the workshop includes representation from physician, osteopath,
nurse, nurse-practitioner, and health scientist communities. These special-
ties will be divided into working teams so as to allow a more detailed review
and documentation of their perception of the needs of health professionals
regarding diagnosis and preventive management of environmentally related
diseases. The output of each working team will be shared with the entire
group to allow for interaction.
The Project Group believes that this workshop will provide not only
a clearer understanding of health professional needs regarding environmental
education but will lead to recommendations for a coordinated approach to
improve education of health professionals in diagnosis and management of
environmentally related cancer and heart and lung diseases.
EXPOSURE AND METABOLIC MECHANISMS
Currently, information on human exposure to specific environmental
factors associated with cancer and heart and lung diseases is limited. There
is even less information on how these substances enter the body and are
metabolized. An improved understanding of these areas will also provide the
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basis for identification and possible use of early indicators of disease. A
feasibility report* reviewed information on the problems of human exposure by
examining the production, use pattern, and environmental transport of four
industrial pollutants. It described the metabolic processes for each of these
pollutants by considering retention, accumulation, and elimination of these
chemicals from the human body. The report identified areas in which inform-
ation is inadequate and where more research is needed. Specific recommenda-
tions were made for each of the four chemicals. The ability to make these
recommendations strongly suggested that the approach taken in the feasibility
study has a utility for the Task Force. The recommendations of the feasibility
report appear in Appendix E.
In reviewing the feasibility report the Task Force recognized that
the area of exposure and metabolic mechanisms is important to their responsi-
bilities, and may provide a basis in the future for the identification and
use of early indicators of diseases. It recognized that many Task Force agen-
cies are involved in research related to pollutant exposure and metabolic
mechanisms and that an interagency approach is desirable.
Therefore, in May 1979, the Task Force established a Project Group on
Exposure and Metabolic Mechanisms. The Project Group will identify research
needs in the area of exposure and metabolic mechanisms and to propose research
strategies to address these needs. The detailed description of the charge
appears in Chapter 3.
* Piver, W.T. , W. Jurgelski, T. Damstra, H. L. Falk, and J. Bemheim. "Exposure and Metabolic Mechanisms
of Four Important Industrial Pollutants: Benzene, Toluene, Carbon Disulfide and Methylene Chloride. " Pre-
pared for the Task Force on Environmental Cancer and Heart and Lung Disease. NIEHS, Research Triangle
Park, NC. December 1978.
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INFORMATION EXCHANGE
Information exchange has been an integral part of the Task Force
activities since its establishment. A unified, comprehensive, Federal strategy
for dealing with environmental health hazards necessitates the exchange of
information concerning research results and regulatory decisions. To more
fully utilize information currently available within the Federal Government,
the Task Force decided to collect, classify, and disseminate information on the
numerous coordinating committees and conferences sponsored by the Government.
The Task Force also agreed to review information bases with an initial emphasis
on those which are relevant to the three Project Groups.
Interagency Committees
Many interagency committees and groups within the Federal Government
address various aspects of environmentally related disease, ranging from causes
of environmental diseases to regulatory action. A directory of such committees
is being completed; a summary appears in Table 1.
Two criteria are used to select committees for inclusion in the
directory: the committee should be comprised of representatives from two or
more Federal agencies, and the committee's mandate should be in the area of
environmental health. For each committee, the fpllowing information is being
compiled and will be periodically updated:
Title
Roster of principal (lead) agency members
Name of Chairman
t Name and telephone number of the Executive Secretary or
principal contact
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Table 1. Interagency Committees of Relevance to Task Force Work
Committee Name
Chemical Selection Working Group
Committee on Health and Medicine of the Federal
Coordinating Council for Science, Engineering, and
Technology (FCCSET)
Authority
Memorandum Agreement to
Establish an NCI Working Croup
Reports to
Director of NCI
Chairperson
Herman Kraybill, NC[
lntam.ua. Contact
A. F. Douglas, NCI
(301-496-5591)
Purpose Is to make selection and recommendations of chemicals for consideration in the bioassay carcinogen testing program.
Subsection 401(b) of the National
Science and Technology Policy,
Organization and Priorities Act of
1976
Chairperson of FCCSET
Donald S. Fredrickson, NEH
Joseph C. Perpich, NIH
(301-496-3152)
Member*
NCI, NIEHS, FDA, EPA, NLM,
USDA, DOL, CPSC, N1OSIH, CDC,
DOE, U.S. Army
NIH, USDA, DOC, DOD, FDA,
HCFA, DOE, EPA, EOF, DOL,
NASA, NSF, DOS, VA, DHEW
Purpose is to Increase the overall effectiveness and productivity of Federal R&D efforts in health and medicine by: (1) addressing Interagency issues relating to major national problems
concerned with health and medicine; (2) reviewing Federal policies related to biomedical research, health care, and health promotion; (3) facilitating cooperation and coordination
among Federal programs and activities relating to health and medicine; and (4) providing reviews, analyses, advice and recommendations to the Chairperson of the FCCSET on Federal
policies and programs concerned with health and medicine.
D^W Committee to Coordinate Environmental
and Related Programs (CCERP)
CCERP Subcommittee on Environmental
CCERP Laboratory Chemical Carcinogen
Safety Standards (LCCSS) Subcommittee
CCERP Toxicology Information Subcommittee
(TIS)
Directive from DHEW Assistant
Secretary for Health, May 1979
Purposes are; {1} to provide a means :
of certain kinds of resources; and (4) t
Directive from DHEW Assistant
Secretary for Health, May 1979
DHEW Assistant Secretary for
Health
David P. Rail, NIEHS
Raymond E. Shapiro, NIEHS
(919-541-3506)
NIEHS, CDC, DHEW, FDA, NCI,
NCTR, NICMS, NIOSH, CEO, CPSC,
EPA, DOE, NSF, NLM, NIH, NIEHS,
NIA, NICHD, NHLBI, NINCDS,
LOG, NOAA, USDA
or Interagency information exchange on toxicology and related programs; (2) to coordinate these programs; (3) to enhance the Interagency sharing
a provide advice to DHEW on toxicological issues.
Executive Secretary of CCERP
Fredrick J. de Serres, NIEHS
Michael Shelby, NIEHS
(919-541-3492)
NffiHS, FDA, NCI, NCTR, NICHD,
NICMS, NIH, NLM, CDC, CPSC,
DOD, EPA
Purposes are: (1) to define problem areas in environmental mutagenesis; (2) to foster complementary and nonoverlapping programs of research in environmental mut agenesis; (3) to propose
mechanisms for effective action to stimulate research and development in important problem areas; (4) to provide a forum for information exchange; and (S) to advise on the utility of new
approaches and protocols for mutagen city testing.
Directive from DHEW Assistant
Secretary for Health, May 1979
Executive Secretary of CCERP
W. EmmettBarkley, NCI
Thomas Wllkenson, NIH
(301-496-3261)
NCI, EPA, NIEHS, NCTR, FDA,
DHEW, NIOSH, CDC, NIH
Purposes are: (1) to identify specific chemical carcinogens that are used in DHEW laboratories; (2} to review individual Carcinogen Safety Monographs for completeness and accuracy; and
(3) to transmit completed Carcinogen Safety Monographs to the Committee to Coordinate Environmental and Related Programs for submission to the Office of Safety, DHEW.
Directive from DHEW Director
of Office of Special Health
Projects, May 1979
Executive Secretary of CCERP
and DHEW Assistant Secretary
for Health
Henry M. Kissman, NLM
Henry M. Kljjsman, NLM
(301-496-3147)
NLM, CDC, FDA, NCI, NCTR,
NIEHS, NIGMS, NIMH, NIOSH,
CPSC, EPA, DOE, DOI
Purpose is the collection, storage, and dissemination of appropriate information on toxicologic and related activities, concentrating in two areas: (1) creation and maintenance of new
toxicology information services important to the health and environmental agencies in the government and to the scientific community; and (2) establishment of communication
channels through which the participating agencies can keep each other informed about ongoing information activities in toxicology and related fields.
Sec papc iv for a list of abbreviatlont of agencies and organizations.
(Continued)
-------
Table 1. Interagency Committees of Relevance to Task Force Work (Continued)
Committee Name
CCERP Subcommittee to Coordinate
Polybrominated Bipheuyls within the PHS
CCERP Subcommittee to Coordinate Asbestos/
"Asbestiform" Research within the PHS
Authority
Directive from DHEW Assistant
Secretary for Health, May 1979
Reports to
Executive Secretary of CCERP
Chairperson
Clark Heath, CDC
Information Contact
Clark Heath, CDC
(404-329-3961)
Members*
CDC, NIOSH, NIEHS, FDA, NCI,
NLAMDD, NINCDS, NICHD,
N1AID, HSA, EPA, USDA, OSHA
"urposes are; (1) to provide national focus for Federal efforts on the PBB problem) (2) to provide a means for coordination between the lead agencies responsible for generating scientific
^formation needed to understand and evaluate effects reported in exposed Individuals; (3) to provide an overview of the operational aspects of each area of research; and (4) to determine
what addition areas of research may have to be explored and to recommend necessary action to the Assistant Secretary for Health through the Chairman, CCERP.
Directive from DHEW Assistant
Secretary for Health, May 1979
Executive Secretary of CCERP
Raymond Shapiro, NIEHS
Raymond Shapiro, NIEHS
(919-541-4506)
DOI, EPA, FDA, DOL, NIH, CDC,
NIOSH, NCI, CPSC, NIAMDD,
NHIBI, OSHA, HUD
Purposes are: (!) to identify means by which interagency cooperation can be furthered within the Public Health Service concerning research into the health effects of asbestos; and
(2) coordinate interagency investigations of such effects.
Executive Committee of the National Toxicology
Program (NTPJ
Federal Interagency Committee on Education's
Subcommittee on Environmental Education
Directive from DHEW Secretary
for Health, Nov. IS, 1978
Secretary of Health
Eula Bingham, OSHA
Eula Bingham, OSHA
(202-323-9362)
NIEHS, FDA, OSHA, CPSC, EPA,
NIOSH, NTH, NCI, NCTR
Purposes ore; (I) to strengthen HEW's activities in the testing of chemicals of public health concern] and (2) to promote the development and validation of new and better integrated test
methods.
Executive Order No. 11761,
Jan. 21, 1974
Secretary of DHEW
Walter Joske, USDA
William Oliver!, DHEW
(202-24S-8220)
USDA, DOC, DOD, CEO, DOE,
DHEW, ADAMHA, NIH, HUD,
DOI, DOS, EPA, NASA, NSF,
SI, OASH and others
Purpose is to: (1) identify the needs and objectives of Federal programs in environmental education; (2) provide advice and recommendations on Federal educational policies and program
planning activities; (3) improve coordination, cooperation, and information exchange among agencies; and (4) act as a linkage and exchange mechanism among Federal groups In environ-
mental education.
Federal Interagency Committee on the Health
and Environmental Effects of Energy Technologies
Interagency Collaborative Group on Environmental
Carcinogens (ICGEC)
President's Environmental
Message of May 23, 1977
The President
Not Designated
Richard D. Brown
Mitre Corp.
(703-827-6217)
EPA, DOE, HEW/ NIOSH, HEW/
NTEHS
Purpose is to review and identify specific health and environmental issues and potential problems associated with the development and commercialization of conventional and advanced
energy technologies, to identify the research Information required to resolve the uncertainties of assessing relevant impacts, and to specify potential future research prospects to provide
such information.
National Cancer Act of 1971
Scientific Coordinator for
Environmental Cancer of NCI
Herman Kraybill, NCI
Inge Blackwood, NCI
(301-496-1625)
NCI, FDA, EPA, NIOSH, NIH,
CPSC, USDA, DOC, DOD, DOE,
DHEW, CDC, NCHS, NIEHS, NLM,
DOI, DOL, DOS, DOT, NASA,
NOAA, NSF, SI
Purpose Is to establish a forum to provide for the coordination of information exchange among Federal agencies concerned with environmental health and environmental carcinogens Issues,
* See page iv for a list of abbreviations of agencies and organizations.
(Continued)
-------
Table I. Interagency Committees and Relevance to Task Force Work (Continued)
ct,mm,nc, N,
fnur.i/i-ney Hr^uKilcry I.nisori Croup (IRLC)
Authority
Interagency Agreement,
October 1977
Reports to
Congress
Chairperson
Allen Helm, FDA
Information Contact
Susan Gucnette, CPSC
(202-634-4350)
Members*
FDA, CPSC, EPA, OSHA, FSQS
Purpose is to improve t,he regulation of tlireats to the public healdi throuRh interagency sharing of information avoiding duplication of effort, and developing consistent regulatory policies.
Eight working groups foster these overall objectives in die areas of: (1) compliance and enforcement; (2) education and communications; (3) epidemiology; (4) Information exchange;
(5) regulatory development; (6) research planning; (7) risk assessment; and (S) testing standards and guidelines.
lniorap.oncy T.tsk 1-urce on Environmental D.-iu ind
Mormoririf;
Inlcrngcncy Technical Committee on Heart,
BlocJ Vessel, Lung and Blood Diseases and
Blood Resources
Message of May 23, 1977
The President
John D. Bussington, CEQ
JohnD. Bussington, CEQ
(202-395-5760)
CEQ, USDA, NRC, DO1, DOE,
EPA, HUD, DHEW, NOAA
'urposes are to review present environmental monitoring and data programs, and to recommend improvements that would make these programs more effective.
Section 416 of Pub. Law 92-423,
The Public Health Service Act
Secretary of Health
Robert Levy, NHLBI
Daniel Rubin, NHLBI
( 301-496-5031)
DHEW, NIMH, USDA, VA, NSF,
SSA, HRA, DOE, HSA, NIH, DOT,
CDC, EPA, NASA, FDA
Purpose is to coordinate aspects of all Federal health programs and activities related to heart, blood vessel, lung and blood diseases and blood resources to assure the adequacy and technical
soundness of all programs; and to provide full communication and information exchange for maintaining adequate coordination of such activities.
Inr.-mEcncy Toxic Substances Data Committee (ITSDC)
ITSDC Chcmcial Substances Information Network
PHS He.ilth Statistics Coordinating Committee's
Environmental Health Statistics Subcommittee
Sect. 10(b)(l) and 2S(b) of
Pub. Law 94-469, The Toxic
Substances Control Act
Administrator of EPA and
Chairman of CEQ
Marilyn C. Bracken, EPA
Caroll L. Bastiao, CEQ
Roger M. Connor, EPA
(202-755-9336)
EPA, CEQ, OSHA, DOT, DOC,
NIEHS, OSTP, CPSC, ACDA, FDA,
ITC, DOE, NLM, NIOSH, DOI,
NCHS, NIH, NCI, DHEW, NAVY/
DOD
Purpose is to design, establish, and coordinate an efficient and effective system within the Environmental Protection Agency for the collection, dissemination to other Federal departments
and agencies, and use of data submitted to the Administrator, EPA, under the Toxic Substances Control Act.
Chairman of ITSDC
Chairman of ITSDC
Sidney Siegel, EPA
Roger M. Connor, EPA
(202-755-9336)
EPA, CEQ, OSHA, DOT, DOC,
NIEHS, OSTP, CPSC, ACDA, FDA,
ITC, DOE, NLM, NIOSH, DOI, NCHS,
NIH, NCI, DHEW, NAVY/DOD
"urpose is to develop and coordinate a network of online information systems to: (1) identify chemical information on substances' composition, structure, nomenclature; (2) access bibliographic
abstracts of published materials on chemical substances; (3) track information on government regulatory activity; (4) make available information on laboratory experiments; (5) provide data
DD production and uses of chemicals.
Public Law 95-623, The Health
Statistics and Health Care
Technology Act of 1978
PHS Committee
Paul E. Leaver-ton, NCHS
Jeffery Perlman, NCHS
(301-436-7135)
FDA, ADAMHA, HRA, HSA,
NIOSH, CDC, NIH, NCI, NCHS,
NIEHS, NHLBI, OASH
*urpose is to collect and coordinate statistical and epidemiological data from FHS agencies on the effects of the environment on health and to study the feasibility of Unking PHS agency
lata. bases.
co
i
See page Iv for a List of j
of agencies and organizations.
(Continued)
-------
Table 1. Interagency Committees of Relevance to Task Force Work (Concluded)
Committee Name
Task Force on Environmental Cancer and Heart
and Lung Disease
Toxic Substances Strategy Committee
TSCA Interagency Testing Committee
Authority
Sect. 402 of Pub. Law 95-95.
The Clean Air Act Amendments
of 1977; and Section 9 of Pub.
Law 95-623, Health Statistics
and Health Care Technology Act
of 1978
Reports to
Congress
Chairperson
Douglas M. Costle, EPA
Information Contact
George R, Simon, EPA
(202-426-2275)
Members*
EPA, NCI, NHLEI, NIOSH, NIEHS,
CDC, NCHS, FDA
Purpose is to (1) recommend a comprehensive research program to quantify the relationship between environmental pollution and human cancer and heart and lung diseases, (2) recommend
strategies to eliminate the risks of cancer or such other diseases, (3) recommend research and other measures to prevent or reduce the incidence of these environmentally related diseases,
[4) coordinate and stimulate cooperation between EPA, HEW, and other Federal agencies, and (5) report to Congress on the problems and progress of the Task Force.
The President's Environmental
Message of May 23, 1977
The President
Cus Speth, CEQ
Nathan J. Karch, CEO
(202-395-4980)
CEQ, USDA, DOC, CPSC, EPA,
DOE, DREW, FDA, NCI, NEKS,
NIOSH, DOI, NSF, OSHA, DOT,
DOS, NRC
Purpose is to develop a coherent Federal approach for (1) eliminating overlaps and filling gaps in the collection of data on toxic chemicals; and {2) coordinating Federal research and
regulatory activities affecting the collection of such data.
Sec. 4(e)Pub. Law 91-469, The
Toxic Substances Control Act
Administrator of EPA
Carter Schuth, NSF
Walter Rosen, EPA
(202-755-4891)
NSF, EPA, CEO, DOC, NCI,
NIEHS, OSHA, CPSC, DOD, DOI,
FDA
Purpose is to make recommendations to the Administrator, Environmental Protection Agency, concerning chemical substances to be given priority consideration for test rules under Section 4
of the Toxic Substances Control Act.
I
I>
to
* See page iv for a list of abbreviations of agencies and organizations.
-------
Charter, authority or justification for committee
existence
Purpose and responsibilities
Major activities, accomplishments and products
Schedule of meetings
Information on operating funds, when available.
Calendar of Events
Conferences and workshops serve as important tools for the exchange
of information. A calendar designed to provide a synopsis of meetings, sym-
posia, conferences, seminars, courses and workshops related to environmental
cancer and heart and lung diseases is being issued monthly by the Task Force.
The purpose of this calendar is to keep Federal agencies informed of when and
where these events are being held and how to obtain more detailed information
on them.
Information Bases
Data Bases on Federal Research Programs
Initial information on programmatic data bases used for program
planning and related activities was compiled during the past year. A summary
of these data bases, including the type and extent of information available,
is presented in Table 2. Data bases listed here describe scope, schedule,
staff and funding of ongoing federally sponsored programs. Efforts to assess
information on future research plans were also initiated during the past year,
but the feasibility of obtaining and disseminating such information has not
yet been fully explored.
-20-
-------
Table 2. Data E
n Federal Research Program
Agency
EPA
NCI
NHLBI
NIOSH
NIEHS
CDC
FDA
Contact/ Title
A. Pines
Chief of ORDIS
H. Canter, Chief
Research Analysis
Branch
J. Schneider
Director, International
Cancer Research Data
Bank
D. Saunders
MIS Coordinator
J. Bain bridge
Chief, Program
Planning and
Evaluation Branch
T. Clemmer
Biometry Branch
S. Von Allroen
Bureau of
Epidemiology
B. Bell, Head
Management
Systems G Policy
Name
of
Data Base
ORDIS
GENIUS
CANCERPROJ
(CANCER LINE)
Modified
IMPAC,*
CRISP*
&CMF
NIOSHTIC
IMPAC*
CRISP*
PEDS
IMPAC*
CRISP*
Information Provided by Data Base
Principal
Investigator
X
X
X
X
X
X
X
X
X
X
X
Performing
A gency
X
X
X
X
X
X
X
X
X
X
X
Project
Type
X
X
X
X
X
X
X
X
X
X
Dopt. /
Spec.
X
X
X
X
X
X
X
X
X
X
X
Total
Funds
X
+
X
X
-
X
X
-
X
X
-
Funds
Expended
byFY
X
+
X
X
X
X
X
X
X
X
X
Future
Funds
Committed
X
^
X
X
X
X
X
X
-
Personnel
Cost
X
-i-
-
X
X
X
X
X
Personnel
byCS
Level
+
+
-
X
-
X
X
-
X
X
-
Equipment
and
Supplier
X
+
-
X
X
X
X
X
-
X
X
Facilities
X
+
-
X
X
X
X
X
X
X
Milestones
X
X
-
-
X
X
-
X
X
_
X
Symposia,
etc.
+
X
-
X
~
-
-
-
Key
Word
System
Used
Inhouse C SSIE
Inhouse &
KWIC
Free Text G
hierarchical
classification
None
Inhouse
Inhouse
Inhouse
Inhouse
Frequency
of
Update
Daily for
FY79
Annual
or on
Renewal
Quarterly
Annual
or on
Renewal
Monthly
Monthly
Quarterly
Monthly
Interface
Other
Data
Bases
No
No
MEDLARS
SSIE
No
MEDLARS
TOXUNE
SSIE
No
MEDLARS
TOXUNE
Information
to
SSIE/NTIS
Yes
Yes
Yes
Yes
via
IMPAC
Yes
Yes
No
Yes
Online
Prfn touts
Limited
Yes
Yes
Yes
Yes
Limited
InFY 79
Limited
I
PO
* Systems of the Division of P
X Available.
- Not available.
-------
Environmental Health Data Bases
During this past year, the Task Force worked with NCHS in its
development of a plan for the collection and coordination of statistical and
epidemiological data on effects of the environment on health. The plan is to
be submitted to Congress by DHEW by January 1980 in accordance with Public Law
95-623. Task Force members provided assistance to NCHS in evaluating gaps and
deficiencies in current environmental health data and in developing a compre-
hensive plan for the collection and coordination of statistical and epidemio-
logical effects of environment on health. Task Force members and staff also
worked with NCHS in its presentation of a workshop in May 1979, where profes-
sionals from government and private sectors reviewed work in progress and made
recommendat i ons.
RISK ASSESSMENT
Assessment of the risk related to adverse effects of environmental
agents on human populations has a central role in the development of strategies
to protect public health. As such, it is of major importance to the Task Force
Recognizing that the Interagency Regulatory Liaison Group (IRLG) had ongoing
activity in this area, a representative from the IRLG work group on Risk
Assessment was invited to brief the Task Force.* Subsequent to this briefing,
the Task Force has been reviewing a report** by the IRLG Work Group on Risk
Assessment. The specific conclusions of the IRLG Work Group, in addition to
* Presentation by Dr. Elizabeth Anderson of EPA on activities of the IRLG Risk Assessment Working Group
at the Task Force Working Group meeting, November 3, 1978.
** Interagency Regulatory Liaison Group. Scientific Bases for Identifying Potential Carcinogens and
Estimating Their Risks. February 7, 1979.
-22-
-------
the positions taken by the various IRLG agencies in response to the issuance
of this report, have been relevant to the Task Force's concerns. It intends
to closely coordinate its activities with work being done by IRLG, the National
Toxicology Program, and others in this field.
FUNDING OF FEDERAL EFFORTS
For identifying and classifying the levels of funding, the Task Force
examined the broad scope of relevant ongoing and planned research programs and
projects of its member agencies. A scheme was developed for classifying and
quantifying Federal activities directed toward the reduction of risk of
disease under 15 categories. These are listed as follows:
Quantification of Relationships Between Environmental
Pollution and Disease
1. Determination of biological effects and dose-response
relationships
2. Understanding mechanism or mode of biological effects
3. Identification and monitoring of environmental pollutants
4. Identification and analysis of sources
5. Environmental transport and transformation analysis
6. Development of sampling, analytic and monitoring methods
7. Collection of health statistics
8. Human exposure estimation
9. Establishment of cause-and-effect association
10. Population risk assessment
-23-
-------
Reduction of Risk and Incidence
11. Estimation of costs of environmentally related illness
12. Estimation of costs of control and prevention
13. Preventive health measures
14. Education of the public and of health professionals
15. Pollutant-control measures.
A description of the type of activity included under each of these
categories appears in Appendix F. This appendix also includes detailed tables
of the expenditures of each agency* for fiscal years 1978, 1979 and 1980. A
table summarizing expenditures of Task Force agencies for 1978 by the 15-
category classification scheme is given in Table 3.
The seven agencies spent a total of approximately $270 million in
1978 on research and strategy planning relevant to Task Force objectives. A
summary of the distribution of these expenditures by agency and disease
appears in Table 4.
* Due to its observer status, the Food and Drug Administration was not included.
-24-
-------
Table 3. 1978 Summary of Fluids by Categories for the Task Force Agencies (in thousands of dollars)
Category
1. Determination of Biological Effects
and Dose-Response Relationships
2. Understanding Mechanisms or Mode
of Biological Effects
3. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause- and-
Effect Association
10. Population Risk Assessment
1 1 . Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
15. Pollutant- Control Measures
TOTAL
Cancer
22,332
49,234
5,761
1,076
554
2,773
10,675
2,097
10,723
4,548
55
1,774
3,303
424
115,329
Heart
Disease
1,185
1,885
73
103
75
389
141
271
420
172
4,714
Lung
Disease
5,228
7,671
857
2,602
700
3,231
586
1,325
4,238
2,069
10
15
3,198
34
6,568
38,332
Nonspecific (includes
cancer, heart and lung)
3,046
2,477
7,990
14,067
7,282
15,313
3,793
2,570
1,749
6,845
12
2,641
13,739
8,913
21,087
111,523
Total
31,791
61,267
14,681
17,848
8,611
21,706
15,053
6,133
16,981
13,882
22
2,711
18,883
12,250
28,079
269,898
ro
en
-------
Table 4. 1978 Summary of Funds by Task Force Agencies (in thousands of dollars)
Disease
Cancer
Heart
Lung
Nonspecific
(Cancer, Heart,
Lung)
Total
A gency
EPA
12,678
1,348
16,946
79,059
110,031
NCI
85,837
85,837
NHLBI
443
3,852
4,295
NIOSH
6,458
227
8,832
25,018
40,535
NIEHS
10,356
2,696
8,702
4,178
25,932
CDC
268
268
NCHS
3,000
3,000
Total
115,329
4,714
38,332
111,523
269,898
-26-
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Chapter 3
TASK FORCE PLANS
-------
Chapter 3
TASK FORCE PLANS
THE APPROACH TO STRATEGY DEVELOPMENT
The development of strategies to protect public health consists
of identification and selection of measures to reduce the risks of environ-
mentally related cancer and heart and lung diseases. The development and
recommendation of these strategies is the major responsibility of the Task
Force. This was the significance of placing strategies to protect public
health at the apex of the pyramidal structure of six areas of special concern.
The selection of specific approaches for reduction of risk requires
an assessment of health risks in the light of benefits, costs and feasibility
of potential measures. In this context, research efforts directed toward a
better understanding of environmental disease relationships have their prin-
cipal utility as support for the assessment of health risk and the selection
of measures for risk reduction. These concepts are expressed schematically
in Figure 1.
The real process of selecting strategies to protect the public
health does not follow so simple and sequential a course. Available scien-
tific information does not permit full determination and quantification of
the relationships between environmental pollution and most diseases. Results
of research now underway to improve our knowledge will become available only
in future years.
The selection of strategies to protect public health is an ongoing
process and must necessarily proceed on the basis of partial knowledge. The
-27-
-------
implementation of protective measures cannot wait for full knowledge of
disease risks; these measures will be modified and reevaluated as new infor-
mation is developed.
Testing and Modification of Strategies
Research in Understanding
and Quantifying Environmental
Pollution/Disease Relationships
Categories 1-10
Identification
and Analysis
of Means for
Risk
Reduction
0
Development
of
Strategies
Categories 13-15
Consideration of
Costs, Policy and
Feasibility
Categories 11-12
Figure 1 Elements of Development of Strategies
to Reduce Risks of Environmental Disease
Task Force actions described in Chapters 1 and 2 are elements that
lead to a coherent approach to the development of comprehensive strategies.
This approach began with an initial assessment of the problems to be addressed
by the Task Force. Other early aspects of the approach included delineation of
objectives to be attained through interagency efforts, and development of Task
Force roles and capabilities.
To attain its goal, the Task Force is moving forward in three parallel
lines of activity:
Development of information exchange among Task Force
agencies
-28-
-------
t Concerted agency actions to describe existing agency
programs relevant to Task Force objectives
Development of Task Force initiatives for action in
significant problem areas.
Actions planned in these specific areas for the next year are
described in some detail beginning on page 31. In subsequent years, the Task
Force will address the following additional major steps:
Build upon the initial inventory of Federal programs, and
upon the statement of Task Force objectives, to identify
areas needing further knowledge of pollutant/disease risks
and means that can be useful in reduction of risks.
Compare these needs with the inventory of the present pro-
grams and their anticipated outcomes, in order to identify
potential gaps and overlaps in existing and planned programs.
The Task Force will describe options which would improve
prospects for environmental disease risk reduction.
Analyze these options in the light of risks, costs, benefits
and public policy, to identify the most effective choices
for new Federal initiatives. Recommendations for the
implementation of these options will be made to Congress
and to the agencies.
These actions, requiring several years for their performance, will complete the
formal approach being taken by the Task Force for the carrying out of its
mandate in Section 402 of Public Law 95-95.
The main steps of this approach are shown schematically in Figure 2.
Time flows from left to right in this diagram and several years are represented,
The actions undertaken in each box of this diagram are continuing processes;
no specific calendar dates can be assigned to them. The resulting recommenda-
tions for a comprehensive research program and for risk-reduction strategies
will be completed as rapidly as the identification and analysis of alternative
options will permit.
-29-
-------
Time
I
OJ
o
i
Identify
^ Areas
^ for
/ Early Action
/
/ Develop
/ Methods to
/ J Inventory
/ ^ Relevant
/ / 1 Agency Programs
/'
/
Define
Task Force
Objectives
and
Fields of
Action
^^^
\,^
\ Identify
\J Needs in
qt Interagency
] Information
Exchange
^-
»-
"^*
^.
Review and
Needs in
Specific Areas
Develop and
Maintain
Inventory of
Agency Programs
and Plans
Postulate
Program Needs
for
Achievement of
Objectives
Develop
Methods for
Interagency
Information
Exchange
^-
Ni
Y*
fc
Examine
of Action in
Specific Areas
r
Compare pnfonl^i Identify Examine Develop To
Available M"' _^ Proposals Feasibility Task Force _^ Congrs
Programs » Fm^,e. "^ lor » of * Recommen- ~* and
with fnP»?fortt New Actions Proposed dations Agenc
Needs ln ^eaerai by Agencies Actions
Programs
Develop and Maintain Information Exchange
Task Force Coordination with Agencies
Review and Overview by Task Force Member Agencies
Figure 2. Flow Chart of Parallel and Sequential Actions to be Undertaken by the Task Force in Attaining Its Objectives
-------
ACTIONS FOR THE NEXT YEAR
During the year which begins in August 1979, the Task Force will
move forward in its approach to strategy development with special attention to
information exchange, concerted agency efforts to inventory existing programs,
and action in significant special problem areas. The planned activities in
these areas are described in the following.
Information Exchange
Numerous other Government groups are working with separate mandates
and missions on aspects of the general problem of understanding and reducing
the risks of environmental disease. The accomplishments and objectives of
these groups are relevant to Task Force strategy planning. Information rele-
vant to Task Force objectives must be exchanged within the Task Force member
agencies and with these other groups. To further these aims during the next
year the Task Force will:
Publish a directory of interagency groups concerned with
environmentally related disease and periodically update
the directory.
Continue to issue a monthly calendar of meetings, con-
ferences, and workshops of interest to the Task Force.
Review information bases relating to the following
areas and conduct feasibility studies on:
- Plans, goals and schedules for current research
activities of the Task Force agencies
- Plans, goals and schedules for future research
activities of the Task Force agencies
- Areas of expertise of researchers and scientists
- Specialized research facilities and capabilities
of laboratories
-31-
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- Results of selected relevant research projects
- Environmental health data bases.
Review the work of the National Academy of Sciences
Institute of Medicine and the Department of Health,
Education, and Welfare resulting from their jointly
sponsored 1978 conference on Health Promotion and
Disease Prevention, now the subject of a forthcoming
report and recommendations from the Office of the
Assistant Secretary for Health.
Expand its awareness of the activities of, and exchange
information with, such other interagency groups and
programs in the environmental health field as the
Interagency Regulatory Liaison Group and the National
Toxicology Program.
Concerted Agency Efforts in Program Inventory
The Task Force will develop a descriptive inventory of ongoing
agency programs in the area of environmentally related cancer and heart and
lung diseases. The programs to be included in this inventory are those which
have been defined in terms of funding in the 15 categories.* The following
suggests one approach that has been considered by the Task Force, which it
will refine and revise as necessary.
Each agency will provide for major agency organizational units at
the program and subprogram levels, information about:
Objectives and mandated responsibilities
Activities
Resources applied
Research and resource needs.
See Appendix F for category definitions.
-32-
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The information will be obtained in response to a questionnaire to
be developed by the Task Force Working Group. Information concerning each
major unit will be assembled within the agency by its Task Force representa-
tives and other senior staff.
The assembly of this information in a common frame of reference pre-
sents a challenge. Each agency has its own independent mandates and philoso-
phy. Each approaches the Task Force mandate from its special point of view.
The programs resulting from these varied points of view must be brought
together in a common approach without losing the values, insights and inde-
pendence of thinking which each agency brings to the effort.
In order that each agency has the opportunity to present its program
in a manner appropriate to its own mandate and research orientation, each
agency organization unit will be asked to consider aspects of its mission
and program in a matrix such as that of Figure 3.
Elements of Research for
Quantification of Relation-
ships and Risk
Elements of Development of
Strategies to Reduce Risk
A
Class
of
Substances
B
Route
of
Exposure
C
Population
Group at
Risk
D
Disease
Endpoints
Figure 3. Program Information Collection Matrix
-33-
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The rows of this matrix could be some or all of the 15 categories of
research and strategy development. The columns represent four principal ways
of addressing the problems of environmental disease. Agencies differ sub-
stantially in their orientation to these problems. For example, much of EPA's
work is concerned primarily with the control and behavior of pollutants; plan-
ners and researchers in such work approach their problems in terms of Columns A
and B of this matrix, but there are also groups within EPA whose concerns
address primarily population groups in Column C. NIOSH, primarily concerned
with worker health, orients much of its work to populations at risk, Column C.
The environmental aspects of NHLBI programs are oriented strongly toward
disease etiology as seen from the viewpoint of Column D. The matrix thus
recognizes that there are important differences in agency approaches to a com-
mon problem, and provides a context in which each agency or entity can be
encouraged to describe its work in terms most appropriate to its viewpoint.
After each agency has described its program, the Task Force will
assemble the results in a common format to produce an initial inventory of
relevant ongoing, planned and needed actions as described by Task Force repre-
sentatives from the member agencies. This initial inventory will provide the
first systematic picture of agency efforts at a level of detail adequate to
permit its use in approaches to a general coordination and development of
strategies. Subsequent refinement and maintenance of this inventory will
become a continuing Task Force action in the future.
-34-
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Actions in Special Problem Areas
The Task Force plans the following actions in the coming year:
Standardization of Measurements and Tests
t Continue to identify and maintain liaison with other
Federal committees having relevant missions.
Continue to collect and review documents and other
materials on standardization; distribute key material
for interagency review and potential use.
Synthesize this information to assess current efforts
and to identify areas which require greater emphasis on
standardization.
Explore applications of quality control and assurance
in improving data intercomparability.
Identify interagency approaches to address the above
areas.
Report to the Task Force on findings and recommendations.
Education of the Public and of Health Professionals
Organize and conduct workshops to identify and assess
the needs of health professionals in environmental
education
Continue to collect and review information on relevant
education programs
Examine program contents and determine areas in consulta-
tion with health professionals where additional emphasis
may be needed
Analyze feasibility and effectiveness of various
approaches for reaching different audiences
Evaluate results of the workshops and other activities
and prepare recommendations for review by the Task
Force.
-35-
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Exposure and Metabolic Mechanisms
Describe the importance and utility of this area with
reference to the Task Force's responsibility and
concerns.
Identify other committees and groups which are actively
working in this and associated areas, and initiate and
maintain liaison with such groups.
Review the approach of the feasibility report, earlier
submitted to the Task Force, to determine if it is
appropriate and optimum for determining research needs,
especially considering
- The feasibility of using this approach on a chemical-
by-chemical basis
- The feasibility of grouping chemicals
- The ranking of chemicals or their groups in order of
priorities.
Develop and recommend preliminary research strategies and
interagency approaches to address the research needs.
Risk Assessment
Continue to review and assimilate information on risk
assessment developed by various organizations and inter-
agency groups such as the Office of Science and Technol-
ogy Policy, the National Academy of Sciences Board of
Toxicology and Environmental Health Hazards, the Inter-
agency Regulatory Liaison Group, and the National
Toxicology Program.
Evaluate the relevance of this work to the Task Force's
mandate, recognizing that much of the prior work deals
with risk assessment in the setting of specific standards
for establishing permissible levels of toxic substances,
especially carcinogenic substances.
Consider the need for new approaches in risk assessment
for the less-studied areas of environmentally related
heart and lung diseases.
-36-
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Consider alternative approaches to risk assessment for
their potential utility in the development of broad
strategies to protect public health.
Consider ways of sequentially using risk assessment and
benefit-cost analysis of environmental disease control
measures in development of strategies.
Development of Recommendations
The Task Force has not yet made any formal recommendation to the
Congress or to the agencies under its mandate of Section 402 of Public Law
95-95. The preparation of a groundwork for the development of a consensus of
approach has been the major thrusts of work to date. The Task Force is very
cognizant of the need to make recommendations within the framework of its
activities and is addressing its efforts in both general and special action
areas toward that end.
-37-
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Appendix A
PERTINENT SECTIONS OF PUBLIC LAWS 95-95 AND 95-623
-------
Appendix A
PERTINENT SECTIONS OF PUBLIC LAWS 95-95 AND 95-623
PUBLIC LAW 95-95
Clean Air Act Amendments of 1977
"INTERAGENCY COOPERATION ON PREVENTION OF ENVIRONMENTAL CANCER
AND HEART AND LUNG DISEASE
Sec 402.(a) Not later than three months after the date of
enactment of this section, there shall be established a
Task Force on Environmental Cancer and Heart and Lung Disease
(hereinafter referred to as the 'Task Force1). The Task Force
shall include representatives of the Environmental Protection
Agency, the National Cancer Institute, the National Heart, Lung,
and Blood Institute, the National Institute [for] Occupational
Safety and Health, and the National Institute [of] Environmental
Health Sciences, and shall be chaired by the Administrator
(or his delegate).
(b) The Task Force shall--
(1) recommend a comprehensive research program to
determine and quantify the relationship between envir-
onmental pollution and human cancer and heart and lung
disease;
(2) recommend comprehensive strategies to reduce or
eliminate the risks of cancer or such other diseases
associated with environmental pollution;
(3) recommend research and such other measures as may be
appropriate to prevent or reduce the incidence of envir-
omentally related cancer and heart and lung diseases;
(4) coordinate research by, and stimulate cooperation
between, the Environmental Protection Agency, the
Department of Health, Education, and Welfare, and such
other agencies as may be appropriate to prevent envir-
onmentally related cancer and heart and lung diseases;
and
(5) report to Congress, not later than one year after the
date of enactment of this section and annually thereafter,
on the problems and progress in carrying out this section."
A-l
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PUBLIC LAW 95-623
Health Services Research, Health Statistics, and Health Care Technology
Act of 1978
"STUDY OF COSTS OF DISEASES AND ADVERSE EFFECTS ON HUMANS WHICH
ARE ENVIRONMENTALLY RELATED
Sec. 7.' Section 304 (as amended by Section 3(d)) is amended by
adding at the end the following:
'(e) (1) The Secretary and the National Academy of Sciences
(acting through the Institute of Medicine and other appro-
priate units) shall, jointly and in cooperation with the
Administrator of the Environmental Protection Agency, the
Secretary of Labor, the Consumer Product Safety Commission, the
Council of Economic Advisers, the Council on Wage and Price Sta-
bility, the Council of Environmental Quality, and other entities
of the Federal Government which the Secretary determines have the
expertise in the subject of the study prescribed by this para-
graph, conduct, with funds appropriated under section 308(i) (2),
an ongoing study of the present and projected future health costs
of pollution and other environmental conditions resulting from
human activity (including human activity in any place in the
indoor or outdoor environment, including places of employment and
residence). In conducting the study, the Secretary and the
National Academy of Science (hereinafter in this subsection
referred to as the 'Academy') shall, to the extent feasible
'(A) identify the pollution (and the pollutants respon-
sible for the pollution) and other environmental conditions
which are, or may reasonably be anticipated to be, responsi-
ble for causing, contributing to, increasing susceptibility
to, or aggravating human diseases and adverse effects on
humans;
'(B) identify each such disease and adverse effect on
humans and specifically determine whether cancer, birth
defects, genetic damage, emphysema, asthma, bronchitis,
and other respiratory diseases, heart disease, stroke,
and mental illness and impairment are such a disease or
effect;
'(C) identify (on a national, regional, or other geo-
graphical basis) the source or sources of such pollutants
and conditions and estimate the portion of each pollutant
and the extent of each condition which can be traced to a
specific type of source;
A-2
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'(D) ascertain (i) the extent to which the pollutants and
conditions identified under subparagraph (A) are, or may
reasonably be anticipated to be, responsible, individu-
ally or collectively, for causing, contributing to,
increasing susceptibility to, or aggravating the diseases
and effects identified under subparagraph (B), and (ii)
the effect upon the incidence or severity of specific
diseases and effects of individual or collective, as
appropriate, incremental reductions in the pollutants and
changes in such conditions; and
'(E) quantify (i) the present and projected future
health costs of the diseases and effects identified
under subparagraph (B), and (ii) the reduction in health
costs which would result from each incremental reductions
and change referred to in subparagraph (D) (ii).
'(2) The Secretary shall enter into appropriate arrangements
with the Academy under which the Secretary shall be responsi-
ble for expenses incurred by the Academy in connection with
the study prescribed by paragraph (1).
'(3) The first report on the study prescribed by paragraph
(10) shall be made to the Committee on Human Resources of
the Senate and the Committee on Interstate and Foreign
Commerce of the House of Representatives by the Secretary and
the Academy not later than eighteen months after the date of
the enactment of this subsection. Subsequent reports on the
study shall be made by the Secretary and the Academy every
two years after the date the first report is submitted. Each
report shall (A) identify deficiencies and limitations in the
data on the matters considered in the study and recommend
actions which may be taken to eliminate such deficiencies and
limitations, (b) include such recommendations for legislation
as the Secretary determines appropriate, (C), include recommenda-
tions for facilitating studies of the effects of hazardous
substances on humans, and (D) include a description of any
administrative action proposed to be taken by the Secretary,
the Administrator of the Environmental Protection Agency, the
Secretary of Labor, and the Consumer Product Safety Commission
to reduce the costs which have been quantified under paragraph
(1) (E) (i). In conducting the study, the Secreatry and the
Academy shall seek assistance from public and private health
finanacing entities in securing the data needed for the
study.
'(4) For purposes of paragraph (1), the term 'health costs of
pollution and other environmental conditions' means the costs
of human diseases and other adverse effects on humans which
pollution and other environmental conditions are, or may
reasonably be anticipated to be, responsible for causing,
contributing to, increasing susceptibility to, or aggravating,
including the costs of preventing such diseases and effects,
A-3
-------
the costs of the treatment, cure, convalescence, and rehabila-
tation of persons afflicted by such diseases, costs reasonably
attributable to pain and suffering from such diseases and
effects, loss of income and future earnings resulting from
such diseases and effects, adverse effects on productivity
(and thus increases in production costs and consumer prices)
resulting from such diseases and effects, loss of tax revenues
resulting from such decreases in earnings and productivity,
costs to the welfare and unemployment compensation systems
and the programs of health benefits under titles XVIII and XIX
of the Social Security Act resulting from such diseases and
effects, the overall increases in costs throughout the
economy resulting from such diseases and effects, and other
related direct and indirect cost."
'INFORMATION ON EFFECTS ON HEALTH OF THE ENVIRONMENT AND
EMPLOYMENT CONDITIONS
Sec. 8. (a) Section 306 (as amended by section 5) is amended
by inserting after subsection (k) the following new subsection:
'(1) (1) The Secretary, acting through the Center, shall develop
a plan for the collection and coordination of statistical
and epidemiological data on the effects of the environment on
health. Such plan shall include a review of the data now
available on health effects, deficiencies in such data, and
methods by which existing data deficiencies can be corrected.
The Secretary shall submit such plan to the Congress not
later than January 1, 1980.
'(2) (A) The Secretary, acting through the Center, shall
establish, not later than two years after the date of the
enactment of this subsection, guidelines for the collection,
compilation, analysis, publication, and distribution of
statistics and information necessary for determining the
effects of conditions of employment and indoor and outdoor
environmental conditions on the public health. Guidelines
established under this subparagraph shall not (i) authorize
or require the disclosure of any matter described in section
552(b) (6) of title 5, United States Code, and (ii) authorize
or require the disclosure of any statistics or other information
which is exempt from disclosure pursuant to subsection (a) of
section 552 of title 5, United States Code, by reasons of
subsection (b) (4) of such section. The guidelines shall be
reviewed and, if appropriate, revised at least every three
years after the date they are initially established. Guide-
lines shall take effect on the date of the promulgation of
the regulation establishing or revising the guidelines or such
later date as may be specified in the guidelines.
A-4
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'(B) The guidelines shall be designed-
'(i) to improve coordination of environmental and health
studies, statistics, and information, and to prevent
overlap and unnecessary duplication with respect to
such studies, statistics, and information;
'ii) to assure that such studies, statistics, and
information will be available to executive departments
responsible for the administration of laws relating to
the protection of the public health and safety or the
government;
'(iii) to encourge the more effective use by executive
departments of such studies, statistics, and information;
'(iv) to improve the statistical validity and reliability
of such studies, statistics, and information; and
'(v) to assure greater responsiveness by the Department
of Health, Education, and Welfare and other executive
departments in meeting informational and analytical needs
for determining the effects of employment and indoor
and outdoor environmental conditions on public health.
'(C) In establishing and revising guidelines under subparagraph
(A), the Secretary shall take into consideration the plan
developed pursuant to paragraph (1).
'(D) The Center shall serve as a clearinghouse for statistics
and information with respect to which guidelines have been
established under subparagraph (A) and shall assist executive
departments in obtaining such statistics and information
for purposes of administering laws under their jurisdiction
relating to environmental health protection or the safety and
health of employees.
'(E) (i) Each executive department shall comply with the sub-
stantive and procedural requirements of the guidelines.
'(ii) The President shall by Executive order require each
executive department to comply with requests, made in accordance
with the guidelines, by the Secretary, the Administrator of the
Environmental Protection Agency, the Consumer Product Safety
Commission, or the Secretary of Labor for statistics and
information.
'(iii) The President may by Executive order exempt any executive
department from compliance with a requirement of the guidelines
respecting specific statistics or other information if the
President determines that the exemption is necessary in the
interest of national security.
'(F) In carrying out his duties under this paragraph, the
Secretary, acting through the Center, shall insofar as prac-
ticable, provide for coordination of his activities with those
of other Federal agencies and interagency task forces relating
to the collection, analysis, publication, or distribution of
statistics and information necessary for determining the
effects of conditions of employment and indoor and outdoor
environmental conditions on the public health.
A-5
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'(G) For purposes of this paragraph, the term 'guidelines'
means the guidelines, either as initially established or as
revised, in effect under this paragraph.
'(3) The Secretary, acting through the Center, shall con-
duct a study of the issues respecting, and the recommenda-
tions for, establishing a Federal system to assist, in a
manner designed to avoid invasion of personal privacy,
Federal, State, and other entities in locating individuals
who have been or may have been exposed to hazardous
substances to determine the effect on their health of such
exposure and to assist them in obtaining appropriate medi-
cal care and treatment. In conducting such study, the
Secretary may consult with any public and private entity
which it determines has expertise on any matter to be con-
sidered in the study. Not later than one year after
the date of the enactment of this subsection, the Secretary
shall complete the study and report to the Congress the
results of the study and any recommendations for legislation
or administrative action.
'(4) In carrying out paragraphs (1), (2), and (3), the
Secretary shall consult with and take into consideration any
recommendations of the Task Force on Environmental Cancer
and Heart and Lung Disease, the Administrator of the Environ-
mental Protection Agency, the Secretary of Labor, the Consumer
Product Safety Commission, the Council on Environmental Quality,
the National Committee on Vital and Health Statistics, and
the National Academy of Sciences (including the Institute of
Medicine and any other unit of the Academy)."
"(b) The first sentence of subsection (d) of section 308 is
amended by inserting after "unless authorized" the following:
by guidelines in effect under section 306 (1) (2) or...."
"TASK FORCE ON ENVIRONMENTAL CANCER AND HEART AND LUNG DISEASE
Sec. 9. The Director of the National Center for Health Statistics
and the head of the Center for Disease Control (or the successor to
such entity) shall each serve as members of the Task Force on
Environmental Cancer and Heart and Lung Disease established under
section 402 of Public Law 95-95."
A-6
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Appendix B
MEMBERS OF THE TASK FORCE, WORKING GROUP AND PROJECT GROUPS
-------
Appendix B
MEMBERS OF THE TASK FORCE, WORKING GROUP AND PROJECT GROUPS
TASK FORCE
EPA Douglas Costle, Administrator Chairman
Stephen Gage, Assistant Administrator
for Research and Development Alternate
NCI Arthur Upton, Director
Herman Kraybill, Scientific
Coordinator for Environmental Cancer
NHLBI Robert Levy, Director
Claude Lenfant, Director, Division of Lung Diseases
Manning Feinleib, Associate Director for Epidemiology
and Biometry, Division of Heart Diseases
NIOSH Anthony Robbins, Director
Ralph Yodaiken, Senior Medical Officer, Office of
Extramural Coordination and Special Projects (OECSP)
NIEHS David Rail, Director
Raymond Shapiro, Assistant Director
for Toxicology Coordination
CDC William Foege, Director
Clark Heath, Director, Chronic
Disease Division
NCHS Dorothy Rice, Director
Paul Leaverton, Associate Director
for Research
FDA Donald Kennedy, Commissioner
Joseph Rodericks, Deputy Associate
Commissioner for Health Affairs
EPA George Simon, Senior Health Science Administrator Coordinator
Health Effects Division
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WORKING GROUP
EPA
NCI
NIEHS
NIOSH
NHLBI
CDC
NCHS
FDA
George Armstrong, Director,
Health Effects Division
George Simon, Senior Health
Health Effects Division
Chairman
Science Administrator,
Herman Kraybill, Scientific
Coordinator for Environmental Cancer
John Munn, Assistant to
Scientific Coordinator
Raymond Shapiro, Assistant
Director for Toxicology Coordination
Ralph Yodaiken, Senior Medical Officer, OECSP
Jean French, Health Scientist, OECSP
Claude Lenfant, Director,
Division of Lung Diseases
Hugh Stamper,
Division of Lung Diseases, Interstitial Lung
Diseases Branch
Sydney Parker
Division of Lung Diseases, Prevention, Education
and Manpower Branch
Manning Feinleib, Associate Director for Epidemiology
and Biometry, Division of Heart Diseases
Richey Sharrett,
Division of Heart Diseases, Epidemiology Branch
Clark Heath, Director,
Chronic Diseases Division
Philip Landrigan, Chief,
Special Studies Branch, Chronic
Diseases Division
Paul Leaverton, Associate
Director for Research
Jeffery Perlman, Office of
Statistical Research
Joseph Rodericks, Deputy Associate
Commissioner for Health Affairs
Constantine Zervos, Director,
Scientific Liaison Staff
-------
PROJECT GROUPS
Education of the Public and of Health Professionals
NIOSH Ralph Yodaiken, OECSP Chairman
Paul Pedersen, Division of Training and Manpower
Development, Robert A. Taft Laboratories
Bernadine Kuchinski, Division of Training and
Manpower Development, Robert A. Taft Laboratories
EPA Jack Keeve, Health Effects Division
Karen Morehouse, National Workforce Development Staff
Mary Averett Seelye, Office of Public Awareness
NCI Margaret Sloan, Division of Cancer Control
and Rehabilitation
NIEHS Wilford Nusser, Associate Director for Extramural Programs
NCHS Jeffery Perlman, Office of Statistical Research
POL Edward Bergin, Office of the Assistant Secretary for
Policy, Evaluation and Research
Quita Mullan, Office of the Assistant
Secretary for Policy, Evaluation and Research
Earl Heath, Director, Office of Training and Education
HEW Max Lum, Health Resources Administration
Louis Steinberg, Health Resources Administration
William Holland, Health Resoures Administration
Helen Nowlis, Director of Alcohol and Drug Abuse Education
Program, Office of Education
Standardization of Measurements and Tests
EPA Robert Medz, Monitoring Technology Division Chairman
NIAMDD Cyrus Creveling, Laboratory of Biorganic Chemistry
NCI Robert Hoover, Environmental Epidemiology Branch
Gerald Ward, Tumor Pathology Branch
Cipriano Cueto, Toxicology Branch, Carcinogenesis
Testing Program
NIOSH Judd Posner, Robert A. Taft Laboratories
Jean French, Office of Extramural Coordination and Special
Projects
B-3
-------
NIEHS Phillip Albro, Environmental Chemistry Branch
CDC David Bayse, Clinical Chemical Division
NCHS Jeffery Perlman, Office of Statistical Research
FDA Constantine Zervos, Scientific Liaison Staff
Exposure and Metabolic Mechanisms
NCI John Munn, Assistant to Scientific Chairman
Coordinator
(Project Group being formed)
B-4
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Appendix C
MEETING DATES
-------
Appendix C
MEETING DATES
Task Force
September 25, 1978
February 6, 1979
June 11, 1979
Working Group
September 15, 1978
November 3, 1978
January 17, 1979
March 14, 1979
April 23, 1979
May 23, 1979
July 11, 1979
Project Group on Education of the Public and
Health Professionals
October 25, 1978
December 1, 1978
March 15, 1979
April 12, 1979
May 29, 1979
Project Group on Standardization of Measurements and Tests
January 26, 1979
March 30, 1979
C-l
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PROPOSED MEETING DATES
Meeting
Working Group
Task Force
Working Group
Working Group
Task Force
Working Group
Working Group
Working Group
Task Force
Working Group
Day and Date Agency
Wednesday, August 29, 1979 EPA
Thursday, Oct. 18, 1979 EPA
Wednesday, Nov. 14, 1979 NCI
Wednesday, Jan 16, 1980 NIOSH
Wednesday, Feb. 13, 1980 NHLBI
Thursday, March 6, 1980 CDC
Tuesday, April 15, 1980 NIEHS
Thursday, May 15, 1980 NHLBI
Thursday, June 12, 1980 NIOSH
Tuesday, July 1, 1980 NCHS
Location
Washington, D.C.
Washington, D.C.
Bethesda, MD
Rockville, MD
Bethesda, MD
Atlanta, GA
Research Triangle
Park, NC
Bethesda, MD
Rockville, MD
Hyattsville, MD
* Time, date and place will be confirmed approximately 2 months prior to
each meeting.
C-2
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Appendix D
A RESPONSE TO THE FIRST ANNUAL REPORT
FROM CONGRESSMAN PAUL G. ROGERS
Chairman, Subcommittee on Health and the Environment
U.S House of Representatives,
The Ninety-Fifth Congress
-------
.NINGTY-FOURTH CONGRESS ROOM 241S
- - . RAYBURN HOUSE OFt-ICE BUILDING
PAUL 3. ROGERS, FLA., CHAIRMAN PHONE (202) 225-4-852
DAVID E. SATTCnriFUD III, VA. TIM Lr-:E CARTER, KV,
RICHARDSON PNiZYEn, N.C. JAMCS T. BKOYHH-U, N.O. ,
rEsH^:;vMO- ^ZoTMAD,'^;,,.., Congre^ of tlje tHmteb
HENRY A. WAXMAN, CnUI'. SAMUEL L. DEVIND, OHIO
of
ANDREWMAsyiHE. N.j. ihiOcommiitcc on 3Z>MltI) nnh tljc (Enbftomncnt
.HARLEY O. STAGGERS, W.VA. Q{ J[j0
Committee oii Smtewtntc nub Jfotdsjn Commctfe
O.C. 20515
September 8, 1978
The Honorable Douglas M. Costle
Administrator
Environmental Protection Agency
401 M Street, S. W.
Washington, D. C. 20460
Dear Doug:
I wish to congratulate you and your associates on the Task Force --
personally and on behalf of the Subcommittee -- on the First Annual
Report of the Task Force on Environmental Cancer and Heart and Lung
Disease. It is an excellent report and we are pleased"to note that it
was submitted on schedule.
Environmentally caused cancer, heart and lung disease is one of
the most important health problems facing the Nation today. I am delighted
that the Task Force, under your Chairmanship, 'has begun to address this
scientifically difficult problem. Additionally, I note the interagency
cooperation that is reflected in this report. I feel certain that the
Task Force will make a worthwhile contribution to direct the Federal
effort in reducing the incidence and severity of environmentally caused
cancer, heart and lung diseases.
The Fir'st Annual Report of the Task Force appears to be a useful
beginning toward solving the problem of environmental cancer, heart and
lung disease. The Task Force has shown prudence in considering a
relatively narrow scope of the problem initially. The resulting recom-
mendations of six areas for early interagency cooperation, as described
on pages 59-62 of the report, should result in important progress toward
problem resolution. We look forward to reports of the working groups to
be established in these areas.
I want to emphasize several specific concerns and questions raised
by the First Annual Report:
0 As the report notes on p. 2, quantitative information
on the role of environmental factors in causing cancer,
heart and lung diseases is one of the major concerns of
-------
The Honorable Douglas M. Costle
September 8, 1978
Page 2
Section 402 of P.L. 95-95. We hope that the Task Force
will be able to address the question of the relative
contributions of different etiological factors to these
diseases. This would assist in setting priorities and
directing resources.
Agency funding tables summarizing current Federal effort
in a common format appear to be very useful. Is the
distribution of funds among the various categories
optimum? How should the amount and distribution of funds
change in the future?
What are the costs of illnesses to the Nation which are
specifically related to environmentally caused diseases?
We in Congress share your belief, as expressed on p. 13,
that major health cost savings to the American public
could be achieved by preventive measures in environmental
health. But, the funding tables on pages 46-50 indicate
that none of the Task Force agencies are investigating
the critical area of the direct and indirect costs (and
potential cost savings) involved in environmentally related
cancer, heart and lung disease.
What approaches are available to reduce the incidence of
these diseases? Which ones would be most productive? What
would their costs be to individuals and to society? (No
category in the funding summaries seems to address this
question.)
Recognizing that our scientific understanding of the problem
is less than ideal and will never be complete, are there
any preventive h.ea'th measures that can be considered and
applied now or in the near future? What are these measures?
What are the needs of informational systems which can assist
the Task Force in carrying out its mission efficiently? We
welcome the initiative suggested on p. 63 for the organi-
zation of a Task Force information management system. A very
valuable purpose would be served if this, system can produce
not only technical data for agency scientists but can also
produce summaries, maps and graphic displays of problems and
progress in environmental disease questions for the use of
Congress and for the general public. The need for reliable,
accurate yet simply presented data for nontechnical decision
makers is urgent.
-------
The Honorable Douglas M. Costle
September 8, 1978
Page 3
° Early expansion of the scope of the Task Force to
include areas of nutrition, radiation and noise
pollution, as noted on p. viii of the Summary is,
in my view, critically important.
I recognize that for some or many of the above questions we may
not .have answers yet. But, I feel that efforts to find these answers
must continue and be significantly strengthened.
In closing, I want to again congratulate you and other members of
the Task Force. I believe we are off to a good start. We look at the
Task Force as a crucial element in the effort to prevent and reduce
environmentally related diseases.
Sincerely,
. ROGERS7 M.C.
Chairman, Subcommittee on
Health and the Environment
nnn ,
ru
-------
Appendix E
SUMMARY OF RECOMMENDED RESEARCH IN EXPOSURE
AND METABOLIC MECHANISMS OF FOUR TOXIC CHEMICALS*
-------
Appendix E
SUMMARY OF RECOMMENDED RESEARCH IN EXPOSURE
AND METABOLIC MECHANISMS OF FOUR TOXIC CHEMICALS*
BENZENE AND TOLUENE
Studies are needed to identify the best animal model for
benzene metabolism in the human.
The metabolism, disposition, and time course-concentra-
tions of benzene and its metabolites in bone marrow during
benzene intoxication should be further defined and char-
acterized.
Once the compounds present in bone marrow at the time of benzene
intoxication are fully identified and quantitated, their effects
on bone marrow activity should be determined in an effort to
identify the active metabolite(s).
Further and more detailed studies should be conducted on the
synergistic and inhibitory effects on benzene metabolism of
chemicals to which humans may be exposed coincident with expo-
sure to benzene.
A precise metabolic index for the level of human exposure to
toluene should be developed. The currently used rate of
hippuric acid excretion is not a quantitative measure of
exposure.
The pharmacokinetics of toluene requires further definition.
Further and more detailed studies should be conducted on the
synergistic and inhibitory effects of toluene on other chemi-
cals to which humans may be exposed coincident with exposure
to toluene.
CARBON DISULFIDE
Although it has been shown that CS~ or its metabolites can interfere
with several metabolic processes, neither the biochemical basis underlying the
From "Exposure and Metabolic Mechanisms of Four Important Industrial Pollutants," prepared by W. T. Piver,
W. Jurgelski, T. Damstra, H. L. Falk and J. Bemheim, National Institute of Environmental Health Sciences,
Research Triangle Park, NC, December 20, 1978.
E-l
-------
toxic effects of chronic exposure nor the metabolism of CS~ and its
derivatives is fully understood. Further information is needed on:
The dermal absorption of CS?.
The reactions of CS2 with hydrogen sulfide and ethylene
di bromide.
The reactions of CS? metabolites with metals and metal-
dependent enzymes.
The metabolic fate of dithiocarbamates and other CS^
metabol ites.
The nature of the bond between CS? sulfur and macromole-
cules of microsomes.
t Species comparisons of the tissue distribution, pharmaco-
kinetics, and excretory pathways of CS? and its metabolites.
t The development of specific and quantitative indicators of
early exposure to CS?. It may be possible to predict an
individual's susceptibility to CS? by determining how effi-
ciently a single dose of disulfiram (a drug apparently meta-
bolized by the same enzyme system as CS?) is metabolized
and excreted.
The reproductive, endocrine, and cardiovascular effects of
CS~ in humans and animals.
METHYLENE CHLORIDE
The mechanisms involved in the formation metabolites of inhaled methy-
lene chloride have been studied. It is of considerable interest that other
dihalomethanes may be more readily metabolized to CO and may react more effec-
tively with cofactors or enzymes, but the studies reported so far do not give
a uniform picture.
-------
It may be prudent to carry out additional research in the following
areas:
To elucidate the P, dependent metabolism of dihalo-
methanes and the inhibitions of that system by the end
product, CO.
To study the P. independent inducible enzyme system
that can convert dihalomethanes to CO.
To clarify the toxicity of plasma-CO for cytochrome systems
and myoglobin compared to the toxicity of high saturation
with COHb.
To get a clearer picture of the effects of dihalomethane resp.
COHb on the CNS in causing toxicity.
To find out whether fluorine substitution in dihalomethanes
produces changes in metabolism, storage, and toxicity.
E-3
-------
Appendix F
CATEGORIZATION AND FUNDING OF FEDERAL PROGRAMS
-------
Appendix F
CATEGORIZATION AND FUNDING OF FEDERAL PROGRAMS
INTRODUCTION
The work of Task Force agencies directed toward quantification and
reduction of the risks of environmental cancer, heart and lung disease has
been classified in 15 categories. This appendix contains descriptions of
these categories. It also contains tables summarizing agency funds expended
in each category in FY 1978, and planned expenditures in FY 1979 and FY 1980,
for programs relevant to cancer and heart and lung diseases.
CATEGORIZATION SCHEME
Chapter 2 describes a scheme for categorizing Federal expenditures.
That categorization scheme is shown in Figure F-l as a flow chart embracing all
Federal activities required to accomplish Task Force objectives. Although no
attempt has been made to show a comprehensive flow, some of the important links
among the various categories are displayed.
DESCRIPTIONS OF CATEGORIES
1. Determination of biological Effects and Dose-Response
Relationships includes research which identifies the nature and range of
biological effects associated with pollutants and research concerned with
the quantitative characterization of the relationship between varying dosages
of pollutants and the biological effects of such dosages. Studies in this
category are typically laboratory in nature.
F-l
-------
Research in Areas of Current Task Force Concern
Population-Oriented Pollutant-Oriented
Methodology-Oriented
Dr.'U-rmination ol Biological
Utec.1:, and Dose-Response
KoLnt'cnships oJ Pollutants
;mrj Colaclors
Understanding Mechanism
or Mode o( Biological
Effects
3 identification and
Monitoring of
Environmental Pollutants as
Potential Disease Agents
9 Epidemiological Studies
ol Exposure-Health
Effect Associations
4 Identification and Analysis
of Pollutant Sources
5 Analysis of Environmental
Transport and Transfor-
mation of Pollutants in
Various Media and
Pathways (e g . Air. Water,
Ingestion. Dermal)
Development ol Sampling.
Analytic and Monitoring
Methods
Other Federal Activities
(Beyond Scope o( Current
Task Force Activity!
Development of Pollutant
Control Technology
Studies of Impacts of
Pollutant Control
Measures on National
Economy
11 Estimation of Costs of
Environmentally Related
Disease
Strategy Planning for Reduction of Risk and Incidence
Figure F-1 Flow of Research, Strategy and Control Federal Efforts with Respect to Environmental Cancer and Heart and Lung Disease
-------
2. Understanding Mechanism or Mode of Biological Effects includes
research which evaluates the mode and extent of entry of environmental pollu-
tants into the human body, their body pathways, toxin endpoints, and residence
time. Studies of mechanisms of cellular or subcellular interactions with
pollutants are also included.
3. Identification and Monitoring of Environmental Pollutants
includes characterization, chemical analyses and monitoring of pollutants
for research studies. Operational monitoring for regulatory purposes or for
the fulfillment of legislative mandates is not considered to be within the
purview of Task Force concerns at this time and is excluded from this defi-
nition. Research on measurement of the presence and concentrations of pol-
lutants in various media and various environmental settings is the principal
aspect of work performed in this category.
4. Identification and Analysis of Sources refers to investiga-
tions of sources of environmental pollutants which may impact on human health.
These studies are either pollutant-specific or source-specific. The former
includes research addressed to identifying and characterizing various sources
from which a specific pollutant is emitted. The latter addresses the type,
amount, and manner of release of various contaminants from a single source or
type of source.
5. Environmental Transport and Transformation Analysis studies
predict environmental concentrations of a pollutant based on understanding of
its transport processes and the physical or chemical changes that occur during
such transport. Primary tools in such studies are analytical or physical
F-3
-------
models of environmental transport and transformation. Included in this cate-
gory are studies which attribute concentrations of pollutants in the ambient
environment to sources.
6. Development of Sampling, Analytic, and Monitoring Methods
is aimed at developing better environmental sampling techniques, labora-
tory analysis methods and monitoring equipment.
7. Collection of Health Statistics consists of all programs
which involve the gathering of health information in order to create data
bases of general utility. Morbidity, mortality and health status data
collected for the purpose of providing baseline information are included in
this category. The objective of these programs is often the reporting of
statistics, in contrast to using them in assessment of cause-and-effect
association and other research projects. (A separate category for cause-
and-effect association is included below.)
8. Human Exposure Estimation involves studies which estimate
the magnitude of the level of exposure of individuals to pollution through
various pathways over defined periods of time. Precise estimation of human
exposures requires modeling or monitoring of ambient, residential, and
occupational environments.
9. Establishment of Cause-and-Effect Association encompasses
epidemiological studies of disease incidence. This category of study seeks
to associate variation in environmental exposure with the prevalence of
disease while controlling for other factors which may influence the prevalence
of disease.
F-4
-------
10. Population Risk Assessment studies integrate the results of
various studies included in the categories defined above for estimation of
risk to the population due to a particular pollutant or type of source. These
studies can assist in the establishment of priorities for research and for
regulation of environmental pollutants.
11. Estimations of the Costs of Environmentally Related Illness
include studies which evaluate the direct and indirect economic impact of
environmental pollution on human health. This category includes evalua-
tions of human morbidity costs attributable to environmental pollution, and
estimation of future health care costs which would be avoided if pollution
could be reduced by specified amounts.
12. Costs of Control and Prevention studies estimate and evalu-
ate the economic costs of implementing pollutant control programs. This
category includes studies involved with the estimation of costs of control
and prevention as well as cost-benefit analyses related to the implementa-
tion of specific pollution control programs.
13. Preventive Health includes a range of programs aimed at the
avoidance or minimization of harmful effects of pollutant agent exposure.
Programs which are specifically directed toward education and pollution con-
trol (discussed below) are excluded. An example of a preventive health pro-
gram is the screening of workers with potential cardiovascular problems from
work environments particularly hazardous to such persons.
14. Education of the Public and of Health Professionals consists of
programs directed toward improving the capability of the medical professional
F-5
-------
in recognizing and treating environmental disease, efforts to educate the
general public about environmental hazards as a means of prevention of environ-
mentally caused illness, and programs to educate the public in environmental
disease awareness. Grant programs to health professional training institutions
which have these objectives appear in this category.
15. Pollutant Control Measures include efforts which establish or
evaluate measures of control and the development of pollutant control meth-
odologies. This category includes research programs directed at improving
control devices to reduce pollutants released into the environment as well
as programs directed toward reducing exposure to pollutants by alteration of
source or receptor patterns.
AGENCY FUNDING OF PROGRAMS IN ENVIRONMENTAL CANCER AND HEART AND
LUNG DISEASE
The remainder of this appendix includes a summary of research
funding and a brief narrative for each agency for FY 1978, 1979, and 1980.
The funding information is classified by the 15 categories and by disease
classes (Tables F-l through F-7). Headings of Cancer, Heart Disease and
Lung Disease refer to programs relating wholly or principally to one of
those diseases. Expenditures listed under the heading of Nonspecific are
for programs which are substantially relevant to more than one of the major
disease classes.
F-6
-------
SUMMARY OF RESEARCH FUNDING
-------
Table F-l. Summary of Funds for EPA (in thousands of dollars)
Category
1. Determination of Biological Effects
and Dose-Response Relationships
2. Understanding Mechanisms or Mode
of Biological Effects
3, Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11 . Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
15. Pollutant- Control Measures
TOTAL
Cancer
1978 1979 1980
2,296
2,424
1,378
577
300
1,261
163
191
1,251
2t837
12,678
7,900
6,219
4,121
1,321
413
2,155
1,000
2,774
2,865
1,335
130
30,233
12,913
3,659
4,406
810
866
3,530
1,000
3,010
3,461
2,600
150
940
37,345
Heart
1978 1979 1980
89
143
73
100
75
389
138
25
316
1,348
315
100
73
40
301
250
1,079
580
1,450
60
2,090
Lung
1978 1979 1980
667
756
371
2,535
645
2,330
76
1,296
665
1,348
10
15
210
2
6,020
16,946
1,616
891
600
744
111
16,146
20,108
900
2,848
885
200
70
25,240
30,143
Nonspecific (includes
cancer, heart, and lung)
1978 1979 1980
1,497
1,169
7,549
13,250
7,097
13,808
271
2,163
639
6,266
12
2,641
1,175
621
20,901
79,059
16,716
6,854
26,858
7,134
18,675
13,517
77
2,141
5,373
4,725
2,776
800
69
25,013
130,728
22,770
9,335
14,934
6,648
20, 579
15,522
750
3,255
13,236
10,192
2,731
1,000
90
21,566
142,608
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EPA
The Environmental Protection Agency (EPA) was established in the
Executive Branch as an independent agency pursuant to Reorganization Plan
No. 3 in 1970. It was created to protect and enhance the quality of the
environment through the development of a comprehensive, coordinated attack
on environmental pollution in the areas of air, water, solid waste, radia-
tion, noise and toxic substances. Much of the environmental legislation
that Congress has recently enacted has broadened EPA's mission. As a result,
the Agency is now a preventive public health agency as well as an environ-
mental one, and is thus greatly concerned with the problem of environmental
cancer and heart and lung diseases. The Agency is specifically charged
with protecting human health and the environment through the promulgation
and enforcement of standards and regulations. To accomplish these goals,
the Agency is organized into the following major offices: the Office of
Air, Noise, and Radiation, the Office of Toxic Substances, the Office of
Water and Waste Management, and the Office of Research and Development.
Research at EPA is managed through the Office of Research and Develop-
ment (ORD) which is responsible for providing a sound scientific base for
the promulgation, enforcement and review of environmental standards and
regulations. The major objectives of ORD are to characterize pollution
threats; define the health and ecological dangers from pollutant sources;
and develop, test and evaluate appropriate means to control pollution.
Overall, since 1978, the emphasis in the ORD budget has been shifting away
from the identification, analysis, and monitoring of pollutants in the
environment to health effects research, and long-range, anticipatory research.
The focal point of EPA's increased emphasis on the health effects of
pollutants is the 1980 "public health initiative" which totals $37 million.
This money, which is divided among the air, drinking water, toxics and
radiation media focuses on the following research and development activities
that are of concern to the Task Force:
1. The development of short-term and screening tests to permit
the rapid, inexpensive detection of toxic pollutants;
2. The development of exposure assessment techniques to help
predict the concentrations of toxic pollutants as they reach
man through various routes of exposure and are absorbed, trans-
formed or accumulated in the body; and
3. The conduct of epidemiological studies to validate and improve
the predictive capabilities of animal tests and exposure models.
To supplement ORD's public health initiative, the Agency will continue to
support a program of anticipatory research. This small basic research program
will almost double in size from FY 1979 to FY 1980. It is designed to develop
better exposure assessment methods and models, and support data on the trans-
port and transformation of pollutants. It is also designed to permit explora-
tion of long-term research needs in areas such as the relationship between the
incidence of cancer and exposure to ambient environmental pollution.
Table F-l summarizes EPA's research and development efforts in the areas
of environmental cancer and heart and lung diseases. It should be noted that
the figures in this table do not represent EPA's total budget, and that the
figures for FY 1979 and FY 1980 are only proposed expenditures.
F-9
-------
Table F-2. Summary of Funds for NCI (In thousands of dollars)
Category
I . Determination of Biological Effects
and Dose-Response Relationship*
?. Understanding Mechanisms or Mode
of niolnglral Effects
3. Identifies lion and Monitoring of
Environmental Pollutants
4. Identification and Analyst! of
Source!
5. Environmental Traniport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Metliodl
7. Collection of Health Statistic!
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11. Estimation of Costt of Environ-
mentally Related Illness
12. Estimation of Cost* of Control
and Prevention
13. Preventive Health Measures
14. Education of die Public and of
Health Professionals
15. Pollutant-Control Measures
TOTAL
Cancer
1978 1979 1980
13,037
42,496
3,817
480
51
127
9,792
1,786
8,353
1,171
55
1,345
3,287
40
85,837
19,432
38,231
3,378
686
56
111
11,632
1,761
9,059
1,359
107
2,936
3,681
45
92,474
28,294
33,871
2,387
675
62
125
12,339
1,000
8,965
1,097
105
7,850
3,765
45
100,580
Heart
1978 1979 1980
Lung
1978 1979 1980
Nonspecific (Includes
cancer, heart, and lung)
1978 1979 198O
-------
NCI
The majority of the National Cancer Institute (NCI) monies for environ-
mental cancer programs were from the Division of Cancer Cause and Prevention.
Support for such activities also resides in the Divisions of Cancer Biology
and Diagnosis, Cancer Treatment, Cancer Control and Rehabilitation, and
Cancer Research Resources and Centers. Monies allocated for activities such
as smoking and health, diet and nutrition, and co-carcinogenesis (viral chemi
cal) were excluded by limits of definition as set forth by the Task Force.
In the Summary of Funds table for the first annual report to Congress,
15 categories were used to determine the general nature and distribution of
support for environmental cancer activities of NCI. The table further showed
that only about half of the categories represented major activities for
expenditure of funds. Of these areas, the largest amounts were committed to
studies on the mechanisms or mode of biological effects. Work on the deter-
mination of biological effects, surveillance (collection of health statistics
in this report) and cause-and-effect associations were next in order of
importance. Table F-2 in this report shows that these same categories
remained as principal areas for expenditures of funds.
The dollar figures reflected in this report are somewhat reduced for
years 1978 and 1979 from those reported last year. While last year's
figures were derived from Program Managers, the present table was developed
by coordinating the budget for these activities through NCI budget channels.
The figure reported for 1978 represents actual obligations. Results from
only two of the three NCI Council Meetings are reported for 1979. Figures
for 1979 and 1980 are estimates based upon the 1980 President's budget.
F-ll
-------
Table F-3. Summary of Funds for NHLBI (in thousands of dollars)
Category
1. Determination of Biological Effects
and Dose-Response Relationships
2. Undemanding Mechanisms or Mode
of biological Effects
3. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11. Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of die Public and of
Health Professionals
15. Pollutant-Control Measures
TOTAL
Cancer
1978 1979 1980
Heart
1978 1979 1980
292
56
95
443
346
65
65
476
371
55
55
481
Lung
1978 1979 1980
426
2,068
96
118
613
349
150
32
3,852
436
1,932
96
119
620
234
148
29
3,614
434
1,431
121
129
642
272
129
30
3, 188
Nonspecific (includes
cancer, heart, and lung)
1978 1979 198O
-------
NHLBI
The Division of Lung Dieases of the National Heart, Lung and Blood
Institute (NHLBI) is responsible for planning, administering, coordinating
and evaluating all extramural activities concerned with diseases of the lung
and respiratory disorders. The Division's program encompasses basic research,
targeted research, clinical trials and demonstration, National Pulmonary
Centers, technological development, and application of research findings.
Research on the. effects of the environment upon the respiratory system is
continuing, through the regular research grant mechanism, with a total com-
mitment of $3,852,000 in 1978. The projection for 1979 is similar, $3,614,000
already committed as of June 1979, which does not include the funds which will
be committed as a result of investigator-initiated grants during the rest of
FY 1979. Similarly, the Division has already committed $3,188,000 for research
on environmental effects on the respiratory system in 1980. It is anticipated
that this amount will be increased with the approval and funding of investigator-
initiated grants awarded before the end of 1980.
The Division of Heart and Vascular Diseases at NHLBI has funded research
related to Task Force activity that has emphasized understanding the mechanism
or mode of the biological effects induced by environmental agents that impact on
heart disease. Project funding for cardiovascular research has included develop-
ment of models for estimation of disease risk, as well as basic research on the
etiology and development of heart disease relevant to environmental factors. The
FY 1978 and 1979 funding represents projects paid or committed, and the FY 1980
figures represent estimates.
F-13
-------
Table F-4. Summary of Funds for NIOSH (in thousands of dollars)
Category
1. Determination of Biological Effects
and Uoie-Response Relationships
2. Understanding Mechanisms or Mode
of Biological Effects
3. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
1 1 . Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
15. Pollutant-Control Measures
TOTAL
Cancer
1978 1979 1980
1,629
378
503
16
1,362
720
659
362
429
16
384
6,458
2,286
531
705
23
1,381
731
669
368
436
16
390
7,536
2,880
660
1,450
47
1,738
1,619
844
1,043
556
16
487
11,340
Heart
1978 1979 1980
43
3
9
172
227
60
3
10
175
248
79
4
31
221
335
Lujig
1978 1979 1980
1,025
1,645
256
491
510
12
1,390
162
2,838
503
8,832
1,437
2,307
359
498
518
12
1,411
164
2,880
511
10,097
1,729
2,810
735
626
1, 142
41
1,778
467
3,626
646
13,600
Nonspecific (includes
cancer, heart, and lung)
1978 1979 1980
528
148
274
1,259
442
354
900
117
12,551
8,259
186
25,018
741
208
384
1,278
449
359
910
118
12,739
10,783
188
28, 157
934
268
795
1,609
993
457
923
1,045
16,043
10,783
238
34,088
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NIOSH
The National Institute for Occupational Safety and Health (NIOSH) is
responsible for conducting research aimed at minimizing health and safety
risks to employees from exposures to hazardous chemical and physical agents
in the workplace. Research priorities are established through Congressional
mandates, the needs of the standards development program, National Toxi-
cology Program priorities, Occupational Safety and Health Administration/Mine
Safety and Health Administration short-term research requests, and priorities
defined by NIOSH researchers.
Since FY 1977 NIOSH has accelerated its research to identify new work-
place hazards and to define more adequately the scope of hazards that were
already suspected or clearly recognized. For FY 1980 NIOSH has requested
additional funding of approximately $12,000,000 over the FY 1979 level for
four programs which will allow for a substantial increase in cancer and lung
disease research. These project areas are: metal and nonmetallic mining,
health hazard evaluations, occupational health and safety data collection,
and synergistic and additive effects of tobacco smoke coupled with work-
related exposure to toxic chemicals.
Cancer
Since its initiation in FY 1975 NIOSH's Occupational Carcinogenesis
Program has increased significantly. In FY 1975 $1,800,000 was expended
on NIOSH's cancer-related activities while in FY 1980 it is expected that
over $10,700,000 will be expended. In 1977 projects were implemented in
three major areas of concentration which have continued to be expanded:
recognition (surveillance and assessment), evaluation (epidemiological and
laboratory studies) and control (engineering, medical and technology transfer),
Lung Disease
Funding for research concerning occupationally induced lung diseases
is expected to increase approximately 75 percent from FY 1977 through FY 1980.
The largest percent increase in funding is in the area of risk assessment
where retrospective mortality and industrial hygiene studies are targeted to
specific industries (e.g., coal mining) and agents (e.g., silica). Laboratory
and clinical studies are aimed at determining the etiology and subsequent
control mechanisms of various occupational lung diseases. Also, emphasis
has been placed on defining biological effects, devising sensitive and
specific diagnostic tests and sampling procedures, and developing and
strengthening dose-response relationships.
Heart Disease
The amount of funds available for research concerning heart disease is
expected to increase to $335,000 in FY 1980. In addition to mortality and mor-
bidity studies, NIOSH also plans to fund research projects through its grant
program concerning the cause and prevention of occupationally induced cardio-
vascular disease.
F-15
-------
Table F-5. Summary of Funds for NIEHS (in thousands of dollars)
Category
1. Determination of Biological Effecti
and Dose-Response Relationship*
2. Understanding Mechanisms or Mode
of Biological Effects
3. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
S. Environmental Transport and
Transformation Analysis
0. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11. Estimation of Costs of Environ-
mentally Related Illness
12. Ettimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
IS. Pollutant- Control Measures
TOTAL
Cancer
1978 1979 1980
5,370
3,936
63
3
203
23
120
460
-178
10,356
5,868
4,280
68
4
220
25
130
498
193
11, 286
5,590
4,108
63
4
203
23
120
465
180
10,756
Heart
1978 1979 1980
1,053
1,450
3
3
187
2,696
1,078
1,484
4
4
194
2,764
1,059
1,456
4
4
191
2,714
Lung
1978 1979 1980
3,110
3,202
134
67
55
292
17
1, 570
210
45
8,702
3,420
3,522
147
73
61
321
18
1,727
231
49
9,569
3,210
3,333
134
67
55
292
17
1,576
214
45
8,943
Nonspecific (includes
cancer, heart, and lung)
1978 1979 1980
996
1, 160
107
759
185
144
79
53
210
439
13
33
4,178
1,361
1,416
116
828
202
157
86
58
229
479
15
35
4,982
1, 136
1,458
107
760
185
144
79
54
210
439
13
33
4,618
I
CTl
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NIEHS
The work of NIEHS, relevant to prevention of environmentally related
cancer and heart and lung diseases, addresses research over a wide spectrum
of topics ranging from identification of environmental pollutants to studies
of health hazards and epidemiology. There is also an emphasis upon develop-
ment of environmental health science resources through extramural grants
and an Institute and grant training program.
The funding levels for FY 1978 for the three disease categories
reported in the Task Force's first annual report were quite accurate.
However, the current estimate for FY 1979, in most cases, reflect about
a 10 percent increase over FY 1979 estimates that were made last year.
These increases were made possible by modest increases over FY 1978 in
the intramural program budget. After correcting for inflation, the actual
level of research effort in the activities described in the narrative
would be about the same as for FY 1978. Likewise, it can be noted that
there is no increase in level of funding for FY 1980 over FY 1979 reflect-
ing current and short-term budgetary constraints. (The 1980 funding
information is based on the 1980 President's budget.)
In case of the disease category "nonspecific," there are significant
increases from last year's submission which can be attributed to a large
research contract associated with the National Toxicology Program. This
program will be examining a broad spectrum of pathological outcomes
(including cancer and cardiopulmonary disease) which may result from both
perinatal and life-time exposure of animals to a variety of environmental
chemicals.
F-17
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Table F-6. Summary of Funds for NCHS (in thousands of dollars)
Category
1 . Determination of Biological Effects
and Doie-Kesponse Relationships
2. Understanding Mechanisms or Mode
of Biological Effects
J. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
b. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11. Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
15. Pollutant-Control Measure*
TOTAL
Cancer
1978 1979 1980
Heart
1978 1979 1980
Lung
1978 1979 1980
Nonspecific (includes
cancer, heart, and lung)
1978 1979 1980
3,000
3,000
3,400
3,400
4,400
4,400
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NCHS
The National Center for Health Statistics (NCHS), through its many
data systems, routinely produces data on disease incidence, including
cancer and heart and lung diseases. These data systems frequently pro-
vide the basis for research carried out by other Federal agencies and
are aimed at determining and quantifying the relationships between cancer
and heart and lung diseases and environmental pollutants.
Environmentally related activities within NCHS include three major
projects. Under Public Law 95-623, NCHS was mandated by Congress to
determine the feasibility of establishing a central clearinghouse for
environmental and health data systems and research within the Federal
Government. This mandate also includes the identification of duplication
of research between agencies as well as any existing gaps. A workshop was
recently held in response to the mandate, and it resulted in recommendations
by the members which would strengthen the area of environmental health
research if implemented.
NCHS is currently in the process of producing the first United States
Atlas of Mortality. Separate maps for white males, white females, nonwhite
males, and nonwhite females will be produced. Age will be accounted for
by age-adjustment using 1940 as the standard population making these data
comparable with other NCHS data. Each major cause of death will be mapped,
indicating the geographic distribution of mortality. This project has
environmental implications since several of the diseases have strong
associations with environmental factors.
The third project under progress involves calculating age-adjusted
morbidity rates from the Health Interview Survey (HIS) for the 31 largest
Standard Metropolitan Statistical Areas. The years 1973-1977 will be used,
as well as the years 1963-1967. This enables comparisons to be made
between cities and between time periods for individual cities. Both
chronic and acute disease information will be used. However, at present
only chronic disease age-adjusted rates for 1973-1977 have been calculated.
Once all the calculations are made, the information will be incorporated
into the Council on Environmental Quality's UPGRADE system. The data can
then be linked to EPA water (STORET) and air (SAROAD) data already within
the system.
F-19
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Table F-7. Summary of Funds for CDC (in thousands of dollars)
Category
J. Determination of Biological Effects
and lJoie-Res|ionie Relationships
2. Understanding Mechanisms or Mode
of biological Effects
3. Identification and Monitoring of
Environmental Pollutants
4. Identification and Analysis of
Sources
5. Environmental Transport and
Transformation Analysis
6. Sampling, Analytic and
Monitoring Methods
7. Collection of Health Statistics
8. Human Exposure Estimation
9. Establishment of Cause-and-
Effect Association
10. Population Risk Assessment
11. Estimation of Costs of Environ-
mentally Related Illness
12. Estimation of Costs of Control
and Prevention
13. Preventive Health Measures
14. Education of the Public and of
Health Professionals
IS. Pollutant- Control Measures
TOTAL
Cancer
1978 1979 1980
11
146
30
187
Heart
1978 1979 1980
Lung
1978 1979 1980
Nonspecific (Includes
cancer, heart, and lung)
1978 1979 1980
25
60
58
102
23
268
42
115
195
209
200
56
6
823
45
126
215
220
94
700
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CDC
The Center for Disease Control (CDC) is involved in studies related to
the understanding and prevention of environmentally related diseases. Col-
laborative studies with other Federal agencies and state health departments
in the area of environmental disease reduction are also undertaken by CDC.
A substantial amount of funding for the Chronic Disease Division is
related to category 9, the establishment of cause-and-effect associations.
This category includes the cancer surveillance and epidemiologic-oriented
investigations conducted by the Division. The funding information for
FY 1978 and FY 1980 has not been included, but a slightly upward level of
expenditure is anticipated in FY 1980 for this Division.
The Bureau of Laboratories is engaged in identification, monitoring and
analysis of sources of environmental pollutants, and in risk assessment
studies. The funding information for this Bureau is reported in Table F-7
under the column "nonspecific."
F-21
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