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 Statist
            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 arid 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 tne



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 Cnapter 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.
                                    -in-

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                      Abbreviations of Agencies and Organizations

 ACDA       Arms Control and Disarmament Agency
 ADAMHA    Alcohol, Drug Abuse, and Mental Health Administration
 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
 DOI          Department of Interior
 DOL         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 Drag Administration
 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
 IOC          Library of Congress
 MSHA        Mine Safely 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
 N1AID       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 Administration
USDA        U.S. Department of Agriculture
VA          Veterans  Administration
                                      -IV-

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                             TABLE OF CONTENTS
EXECUTIVE SUMMARY
                                                        Page

                                                         vii
Chapter 1.  INTRODUCTION
            The Task Force Responsibility
            The First Year
                                                          1

                                                          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
                                                          6
                                                          8
                                                         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
                                     -v-

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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
          •     Strategies to  Protect Public Health.
                                     -Vll-

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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
                                     -vm-

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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
                                            t

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.
                                     -IX-

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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.
                                     -x-

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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)
                                              i
           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.
                                     -1-

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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.
                                     -2-

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           t     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.
           t
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:


           t     Standardization of  Measurements  and  Tests

           t     Exposure  and Metabolic  Mechanisms

           t     Early  Indicators  of Disease

           •     Risk Assessment

           •     Education of the  Public and  of Health  Professionals

           •     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
                                     -3-

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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.
                                     -4-

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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.
                                     -5-

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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 iri  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.
                                    -6-

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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:

          •    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.
                                    -7-

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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 areas—workers
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
                                     -8-

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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.
                                    -9-

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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.

          •    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,
                                     -10-

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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.
                                    -11-

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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
                                    -12-

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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
                                     -13-

-------
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. Bernheim.  "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.

                                      -14-

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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
          i    Name of Chairman
          •    Name and telephone  number of the  Executive Secretary  or
               principal contact
                                    -15-

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                                                                                             Table  1.  Intcragency Committees of Relevance to Task Force Work
Committee Name
Chemical Selection Working Croup
Authority
Memorandum Agreement to
Establish an NCI Working Croup
Reports to
Director of NCI
Chairperson
Herman Krayblll, NCI
Information Contact
A. F. Douglas, NCI
(301 .496-5591)
Members'
NCI, NIEHS, FDA, EPA, NLM,
USDA, DOL, CPSC, NIOSH, CDC,
DOE, U.S. Army
Purpose Is to make selection and recommendation, of chemicals for consideration in the bloassay carcinogen testing program.
Committee on Health and Medicine of the Federal
Coordinating Council for Science, Engineering, and
Technology (FCCSET)
Subsection 401(b) of the National
Science and Technology Policy,
Organization and Priorities Act of
1976
Chairperson of FCCSET
Donald S. Fredrlckson, NfH
Joseph C. Perplch, ND-I
(301-496-3152)
NIH, USDA, DOC, DOD, FDA,
HCFA, DOE, EPA, EOP, DOL,
NASA, NSF, DOS, VA, DHEW
Purpose is to increase the overall effectiveness and productivity of Federal ROD efforts in health and medicine by. ( 1) addressing Interagency rocs relating to major national problems
concerned with health and medicine, (2) reviewing Federal policies related to blomcdic.l research, health care, and health promotion; (3) faclUutlns 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.
DHEW Committee to Coordinate Environmental
and Related Programs (CCERP)
Directive from DHEW Assistant
Secretary for Health, May 1979
DHEW Assistant Secretary for
Health
David P. Rail, NEKS
Raymond E. Shapiro, NIEHS
(919-S41-3S06)
NIEHS, CDC, DHEW, FDA, NCI,
NCTR, NICMS, NIOSH, CEQ, CPSC,
EPA, DOE, NSF, NLM, NtH, NEHS,
NIA, NICHD, NHLBI, NINCDS,
LOC, NOAA, USDA
Purposes are; (1) to provide a means for Interagency Information exchange on toxicology and related programs; (2) to coordinate these programs; (3) to enhance the Interagency sharing
of certain kinds of resources; and (4) to provide advice to DHEW on lexicological Issues.
CCERP Subcommittee on Environmental
Mutngenesis
Directive from DHEW Assistant
Secretary for Health, May 1979
Executive Secretary of CCERP
Fredrick J. de Serres, NIEHS
Michael Shelby, NEHS
(919-541-3492)
NIEHS, FDA, NCI, NCTR, NICHD,
NICMS, NIH, NLM, CDC, CPSC,
DOD, EPA
Purposes are- (1) to define problem areas In environmental motagenesls; (2) to foster complcmentan- and nonoverlapplng programs of research In environmental mutagenesis; (3) to propose
mecTantas 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 mutagenlcity testing.
CCERP Laboratory Chemical Carcinogen
Safety Standards (LCCSS) Subcommittee
CCERP Toxicology Information Subcommittee
(TIS)
Directive from DHEW Assistant
Secretary for Health, May 1979
Executive Secretary of CCERP
w. EmmettBarkley, NCI
Thomas Wllkenson, N1H
{301-496-3261)
NCI, EPA, NEHS, NCTR, FDA,
DHEW, NIOSH, CDC, NIH
Purpose, are- (1) to Identify specific chemical carcinogens that are used In DHEW laboratories; (2) to review Individual Carcinogen Safety Monograph, far completenessand accuracy; and
mTrra^nit comnlet.d Carcinogen Safety Monographs to the Committee to Coordinate Environmental and Related Program, 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. Klssman, NLM
Henry M. Kissman, NLM
(301-496-3147)
NLM, CDC, FDA, NCI, NCTR,
NIEHS, NICMS, NIMH, NIOSH,
CPSC, EPA, DOE, DOI
Purpose Is the collection, storage, and dissemination of appropriate Information on toxicologlc and related activities, concentrating in two area,: (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
channel, through which the participating agencies can keep each other Informed about ongoing Information activities in toxicology and related fields.
*  See page Iv for a list of abbreviations of agencies and organizations.

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                                                                                 Table I.  Interagency Committees of Relevance to Task Force Work (Continued)
Committee Name
CCERP Subcommittee to Coordinate
Polybromlnated Blpbenyls within the PHS
Authority
Directive from OHEW Assistant
Secretary for Health, May 1979
Reports to
Executive Secretary of CCER?
Chairperson
Clark Heath, CDC
Information Contact
Clark Heath, CDC
(4O1-329-3961)
Members*
CDC, N1OSH, NIZHS, FDA, NCI,
N1AMDD, NINCDS, N1CHD,
NIAtD, HSA, EPA, USDA, OSHA
Purposes arc: (I) to provide national focus for Federal efforts on the PBB problem; (2) to provide a means for cooidhiation between the lead agencies responsible for generating scientific
information needed to understand and evaluate effects reported In exposed individuals; (3) to provide an overview of the operational acpccu of each arc4 of research; «nd (4) to determine
what addition areas of research may have to be explored and to recommend necessary action to the Assistant Secretary for Heahh through the Chairman, CCERP.
CCERP Subcommittee to Coordinate Asbestos/
"Asbesdformn Research within the PHS
Directive from DHEW Assistant
Secretary for Health, Ntay 1979
Executive Secretary of CCERP
Raymond Shapiro, NtEHS
Raymond Shapiro, NEHS
(919-541-4S06)
DOI, EPA, FDA, DOL, NIH, CDC,
NIOSH, NCI, CPSC, N1AMDD,
NHIBI, OSHA, HUD
Purposes arc: (1) to identify means by which interagcncy cooperation can be furthered within the Public Health Service concerning research into the health effects of asbestos; and
(2i coordinate interagcncy investigations of such effects.
Executive Committee of the National Toxicology
Program (NTP)
Directive from DHEW Secretary
for Health, Nov. 15, 1978
Secretary of Health
Eola Klngharn, OS HA
Eula Blngham, OSHA
1202-523.9362)
NEHS, FDA, OSHA, CPSC, EPA,
NIOSH, NIH, NCI, NCTR
Purposes arc: (!) 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.
Federal Interagcncy Committee on Education's
Subcommittee on Environmental Education
Executive Order No. 11761,
Jan. 21, 1974
Secretary of OHEW
Walter Jcske, 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 lot ( 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 ai a linkage and exchange mechanism among Federal groups in environ-
mental education.
Federal Interagency Committee on the Health
and Environmental Effects of Energy Technologies
Interagcncy Collaborative Croup on Environmental
Carcinogens (tCCEC)
President's Environmental
Message of May 2), 1977
The President
Not Designated
Richard D. Brown
Mitre Corp.
(703-827-6217)
EPA, DOE, HEW/ NIOSH, HEW/
NCHS
Purpose is to review and identify specific health and environmental Issues and potential problem* 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
luch information.
National Cancer Act of 1971
Scientific Coordinator for
Environmental Cancer of NCI
Herman Krayblll, NCI
Inge Btackwood, NCI
(301-496-162S)
NCI, FDA, EPA, NIOSH, NIH,
CPSC, USDA, DOC, DOD, DOE,
DHEW, CDC, NCHS, NIEHS, NLM,
DOI, DOI, DOS, DOT, NASA,
NOAA, NSF, SI
Purpose If to establish a forum to provide for the coordination of Information exchange among Federal agencies concerned with environment at health and environmental carcinogens Issues.
See page iv for a list of abbreviations of agencies and organisations.

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                                                                                                         Table 1.  Interagency Committed and Relevance to Talk Force Work (Continued)
Committee Name
Interagency Regulatory Liaison Croup (1RLC)
tnteragency Task Force on Environmental Data and
Monitoring
Interagency Technical Committee on Heart,
Blood Vessel, Lung and Blood Diseases and
Blood Resources
Interagency Toxic Substances Data Committee (ITSDC)
ITSDC Chemcial Substances Information Network
Subcommittee
PHS Health Statistics Coordinating Committee's
Environmental Health Statistics Subcommittee
Authority
Interagency Agreement,
October 1977
Reports to
Congress
Chairperson
Allen Helm, FDA
Information Contact
Susan Cucnettc, CPSC
(202-634-4350)
Members*
FDA, CPSC, EPA, OSHA, FSQS
>urpose is to improve the regulation of threats to the public health through intcragency sharing of information avoiding duplication of effort, and developing consistent regulatory policies.
light working groups foster these overall objectives In the areas oft (J) compliance and enforcement; (2) education and communications; (3) epidemiology; (4) Information exchange;
S) regulatory development; (6) research planning; (7) risk assessment; and (8) testing standards and guidelines.
The President's Environmental
Message of May 23, 1977
The President
John D. Busstrtgton, CD?
John D. Busslngton, CEO
(202-395-5760)
CEO, USDA, NRC, DOI, DOE,
EPA, HUD, DHEW, NOAA
'uiposes arc 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
>urpose 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
loundncs J of all programs; and to provide full communication and information exchange for maintaining adequate coordination of such activities.
Sect. 10fb)(l) and 25(b) of
Pub. Law 94-469, The Toxic
Substances Control Act
Administrator of EPA and
Chairman of CEP
Marilyn C. Bracken, EPA
Carol! L. Haitian, CEO
Roger M. Connor, EPA
(202-755-9336)
EPA, CEO, OSHA, DOT, DOC,
NIEHS, OSTP, CPSC, ACDA, FDA,
ITC, DOE, NLM, NtOSH, 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 Siegcl, EPA
Roger M. Connor, EPA
(202-755-9336)
EPA, CEO, OSHA, DOT, DOC,
NEHS, OSTP, CPSC, ACDA, FDA,
ITC, DOE, NLM, N1OSH, 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
on production and uses of chemicals.
Public Law 95-623, The Health
Statistics and Health Care
Technology Act of 1978
PHS Committee
Paul E. Leaverton, NCHS
Jcffcry Perhnan, NCHS
(301-436-7135)
FDA, ADAMHA, HRA, HSA,
NIOSH, CDC, NIH, NCI, NCHS,
NIEHS, NHLBI, OASH
*urpose is to collect and coordinate statistical and epidemic logics I data from PHS agencies on die effects of the environment on health and to study the feasibility of Unking PHS agency
data bases.
00
                 * See page iv for a list of abbreviations of agencies and organizations.
                                                                                                                                                                                                                                (Continued)

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                                                                                         Table 1.  Intcragcocy Committees of Relevance to Task Force Work (Concluded)
Committee Name
Task Force on Environmental Cancer and Heart
and Lung Disease
Toxic Substances Strategy 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 Statistic!
and Health Cue Technology Act
of 1978
Reports to
Congress
Chairperson
Douglas M. Costlc, EPA
Information Contact
George R. Simon, EPA
(202-426-2275)
Members*
EPA, NCI, NHLBI, NIOSH, NIEHS,
CDC, NCHS, FDA
*urpose 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
Cut Speth, CEQ
Nathan]. Karch, CEQ
(202-395-4980)
CEQ, USD A, DOC, CPSC, EPA,
DOE, DHEW. FDA, NCI, NEHS,
NIOSH, DOI, NSF, OSHA, DOT,
DOS, NRC
Purpose te to develop a coherent Federal approach for(l) eliminating overlaps and filling gaps In the collect ioifof data on toxic chemical*; and (2) coordinating Federal research ind
regulatory activities affecting the collection of such data.
TSCA Interagcncy Testing Committee
Sec. 4(c)Pub. Law 91-469, The
Toxic Substances Control Act
Administrator of EPA
Carter Schuth, NSF
Walter Rosen, EPA
(202-755-4891)
NSF, EPA, CEQ, DOC, NCI,
N1EHS, OSHA, CPSC, DOD, DOI,
FDA
Purpose I* to moke recommendations to the Administrator, Environmental Protection Agency, concerning chemica substances to be given priority consideration for test rule* under Section 4
of the Toxic Substances Control Act.
See page Iv for a Hit of abbreviations of agencies and organizations.

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          •    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-

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Table 2. Data Sues on Federal Research Programs

Agency
EPA

na




NHLBI


NIOSH


NIEHS

CDC


FDA



Contact/Title
A. Fines
Chief ofORDIS
H. Cantor, Chief
Research Ana MS
J. Schneider
Director, International
Cancer Research Data
Bank
D. Saunden
MIS Coordinator


j. Balnbridge
Chief, Program
Planning and


S. Von Albnen
Bureau of

B. Bell, Head
Management


Name
of
ORDIS

GENIUS

CANCERPROJ
(CANCER LINE)

Modified
IMPAC,*
CRISP*
OCMF
NIOSHT1C


IMPAC*
CRISP*
FEDS


IMPAC*
CRISP*

Information Provided by Data Base
Principal
Investigator
X

X

X


X
X

X


X
X
X


X
X

Performing
Agency
X

X

X


X


X


X
X
X


X


Project
Type
X

X

X


X


X


X
X
X


X


Dent./
Spec.
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


Future
Funds
Committed
X

+

X


X


X


X
-
X


X


Personnel
Con
X

+

-


X


X


X
•
X


X


Pcnwnnel
byCS
Level
+

+

-


X


X


X

X


X



Equipment
and
Supplier
X

4-

-


X
x


X


X

-


X



Facilities
X

-»•

-


X
x


X


x

-


X



Milestones
X

X

•


X


X


-

X


X



Symposia,
etc.
+

X

•


-


X




-


-




Word
Syit«m
Uied
Inhouf e C SSIE

Inhouic C

Free Text C
laeili

None


Inhouce


Inhouce

Inhousc


Inhousc




Frequency
of
Update
Dally for

Annual
Renewal
Quarterly


Annual
or on


Monthly


Monthly

^Kiuterly


Monthly



Interface
with
Other
Datt
Bases
No

No

MEDLARS
SSIE


No


MEDLARS
TOXUNE


SSIE

No


MEDLARS
TOXUNE




tafonniticB
w
SSIE/NTIS
Yei

Yes




Yci
via
IMPAC


Yei


Yei

No


Ye*




Online
PriDtOutl
Limited

Ye«




Y«i





Limited

In FY 79


Limited


* Syitcmt of the Division of Ret
X  Available.
+ Supplied by tape from a finan
- Not available.
urce Grants, N!H.

ial* branch.

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           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
recommendations.

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-

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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-

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                       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-

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                             Table 3.  1978 Summary of Funds 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
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
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
IS
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
rv>
01

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Table 4.  1978 Summary of Funds by Task Force Agencies (in thousands of dollars)
Disease
Cancer
Heart
Lung
Nonspecific
(Cancer, Heart,
Lung)

Total
Agency
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

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                                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-

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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
1
»
Research in Understanding
and Quantifying Environmental
Pollution/Disease Relationships
Categories 1-10

0
/ Identification \
i and Analysis \
1 of Means for I
I Risk /
\ Reduction /
o
Consideration of
Costs. Policy and
Feasibility
Categories 11-12
0
«


Development
of
Strategies
Categories 13-15



                        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-

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          •     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:

          t     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.
          t     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-

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                                                                                          Time
Identify
Areas
for
Early Action

—HP
Review and
Needs in
Specific Areas
«»-

Examine
Feasibility
of Action in
Specific Areas


                Define
              Task Force
              Objectives
                  and
                Fields of
                Action
co
o
 I
                                                           Postulate
                                                        Program Needs
                                                              for
                                                        Achievement of
                                                          Obiectives
Compare
Available
Programs
  with
 Needs
Identify
Potential
New
Emphases
in Federal
Programs







Identify
Proposals
for
New Actions
by Agencies

 Examine
Feasibility
   of
Proposed
 Actions
  Develop
Task Force
Recommen-
  dations
   To
Congress
  and
Agencies
Identify
Needs in
Interagency
Information
Exchange
o»
	 S9
Develop
Methods for
Interagency
Information
Exchange
Or


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

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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.
           t    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
          t    Activities
          t    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

i



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 ajevel 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

          •    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.

          t    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

          t    Evaluate results of the workshops  and  other activities
               and prepare recommendations for review  by the Task
               Force.
                                    -35-

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Exposure and MetabolicMechanisms

•    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 Force').  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

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                                   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
                                     B-l

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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
                                     B-2

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 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

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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

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                        Appendix C

                      MEETING DATES
                        Task Force

                    September 25, 1978
                     February 6, 1979
                      June 11, 1979
                      forking 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

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       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 v.'ill  make a worthwhile contribution to direct the  Federal
          effort in reducing  the incidence and severity of environmentally caused
          cancer, heart and  lung diseases.

               The First 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

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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 heaHh 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.

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The Honorable Douglas M.  Costle
September 8, 1978
Page 3
     0     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 wc3 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,
                                           r?   '
                                      V    >  : •  v  .-
                                      PAUL''G. ROGERS', M.C.
                                      Chairman,  Subcommittee on
                                      Health and the Environment
 PGRicew

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                    Appendix E

  SUMMARY OF RECOMMENDED RESEARCH  IN EXPOSURE
AND METABOLIC MECHANISMS OF FOUR TOXIC CHEMICALS*

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                                  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

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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 CS~ with hydrogen  sulfide  and  ethylene
               dibromide.

          •    The reactions of CS~ metabolites with  metals  and  metal -
               dependent enzymes.

          t    The metabolic fate  of dithiocarbamates and  other  CS?
               metabolites.

          •    The nature  of the bond  between CS~  sulfur and macromole-
               cules of microsomes.

          •    Species comparisons of  the tissue distribution, pharmaco-
               kinetics, and excretory pathways of CS^ and its metabolites.

          •    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.
                                    E-2

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          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

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                 Appendix F



CATEGORIZATION AND FUNDING OF FEDERAL PROGRAMS

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                                 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

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                                                        Research in Areas of Current Task Force Concern

                                                 Population-Orie nted                        Pollutant-Oriented
                                                                                                              Olher Federal Activities
                                                                                                             (Beyond Scope of Current
                                                                                                               Task Force Activity)
                                                                    Methodology-Oriented
1. Determination ol Biological
  EHects and Dose-Response
  Relationships of Pollutants
  and Cofactors
3.  Identification and
   Monitoring of
   Environmental Pollutants as
   Potential Disease Agents
                                                                                                             Development of Pollutant
                                                                                                                Control Technology
                                                                                      4. Identification and Analysis
                                                                                         of Pollutant Sources
                                                                                         Studies of Impacts of
                                                                                           Pollutant Control
                                                                                         Measures on National
                                                                                              Economy
                                                                 6. Development of Sampling
                                                                    Analytic and Monitoring
                                                                    Methods
2. Understanding Mechanism
   or Mode of Biological
   Effects
                                                                                       5. Analysis of Environmental
                                                                                         Transport and Transfor-
                                                                                         mation of Pollutants in
                                                                                         Various Media and
                                                                                         Pathways (e.g.. Air. Water,
                                                                                         Ingestion.  Dermal)
                                             9. Epidemiological Studies
                                               of Exposure-Health
                                               Effect Associations
                                                                                                                                                                                Legal and Political
                                                                                                                                                                                  Considerations
11. Estimation of Costs of
   Environmentally Related
                                   12.  Estimation of Costs of
                                       Control and Prevention
                             10.  Population Risk
                                 Assessment
                                                                                    Strategy Planning for Reduction of Risk and Incidence
                                                                                            Measures to Reduce Risk and Incidence
                                14 Education of Public
                                   and Health Profes-
                                   sionals
                                                            15 Pollutant Control
                                                               Measures
                                         13. Preventive Health
                                            Measures
                           Figure F-1.  Flow of Research, Strategy and Control — Federal Efforts with Respect to Environmental Cancer and Heart and Lung Disease

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           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

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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

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            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

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 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

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SUMMARY OF RESEARCH FUNDING

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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
2,296
2,424
1,378
577
300
1,261
163
191
1,251
2^837





12,678
7,900
6,219
4,121
1,321
413
2,155
1,000
2,774
2,865
1,335



130

30,233
1980
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
bis
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

-------
                                    EPA


      The Environmental  Protection  Agency  (EPA) was  established  in  the
 Executive Branch  as an  independent agency pursuant  to  Reorganization Plan
 No.  J 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
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 Statistic*
8. Human Exposure Estimation
9. Establishment of Cause- a nd-
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
1978
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
Cancer
1979 1980
19,432
38,231
3,378
686
56
111
11,632
1,761
9,059
1,359

J07
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 inng)
1978 1979 1980

















































-------
                                    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. 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
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
1978
















Cancer
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


ISO
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 1980

















































-------
                                  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)
C ategory
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
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
Luiig
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

-------
                                  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 NIOSH1s 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-S.  Summary of Funds for NIEHS (in thousands of dollars)
Category
1. Determination of Biological Effect*
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 Statistic*
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
1978
5,370
3,936
63
3
203
23

120
460
-178





10,356
Cancer
1979 1980
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

-------
                                  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

-------
Table F-6.  Summary of Funds for NCHS (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- a ml -
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
1978
















Cancer
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

-------
                                  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

-------
Table F-7.  Summary of Funds for CDC (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
1978
















Cancer
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

-------
                                    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 epidemiclogic-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

-------